Mary Ellen Schneider

The number of new geriatricians in the United States is declining, even as the over-65 population grows rapidly, according to a report from the Center for Health Workforce Studies at the University at Albany, part of the State University of New York system.

The report, which was funded by the Health Resources and Services Administration, finds that although the projected number of physicians entering practice each year is expected to be adequate to meet the “aggregate demand,” it may not be well matched to the needs of older Americans. And the report points to the need for more geriatricians, registered nurses, clinical psychologists, nursing home administrators, and other health care workers to meet the needs of the increasing older population.

The report also found that the demand for services by older adults is likely to be affected by health insurance reimbursement policies, emerging technology, new models of care, and changes in the profession-specific scope of practice.

“The years between 2011 and 2050 will be the critical period for the U.S. health care system, as the baby boomers retire from the labor force,” the report said. “It is not too early for the health care system to begin to prepare for those years, if it is to effectively meet the challenge of population aging.”

The report details the broad impact of the aging population on the health care workforce and the impact on 18 specific health professions. The full report is available online at http://chws.albany.edu

The number of new geriatricians in the United States is declining, even as the over-65 population grows rapidly, according to a report from the Center for Health Workforce Studies at the University at Albany, part of the State University of New York system.

The report, which was funded by the Health Resources and Services Administration, finds that although the projected number of physicians entering practice each year is expected to be adequate to meet the “aggregate demand,” it may not be well matched to the needs of older Americans. And the report points to the need for more geriatricians, registered nurses, clinical psychologists, nursing home administrators, and other health care workers to meet the needs of the increasing older population.

The report also found that the demand for services by older adults is likely to be affected by health insurance reimbursement policies, emerging technology, new models of care, and changes in the profession-specific scope of practice.

“The years between 2011 and 2050 will be the critical period for the U.S. health care system, as the baby boomers retire from the labor force,” the report said. “It is not too early for the health care system to begin to prepare for those years, if it is to effectively meet the challenge of population aging.”

The report details the broad impact of the aging population on the health care workforce and the impact on 18 specific health professions. The full report is available online at http://chws.albany.edu

The number of new geriatricians in the United States is declining, even as the over-65 population grows rapidly, according to a report from the Center for Health Workforce Studies at the University at Albany, part of the State University of New York system.

The report, which was funded by the Health Resources and Services Administration, finds that although the projected number of physicians entering practice each year is expected to be adequate to meet the “aggregate demand,” it may not be well matched to the needs of older Americans. And the report points to the need for more geriatricians, registered nurses, clinical psychologists, nursing home administrators, and other health care workers to meet the needs of the increasing older population.

The report also found that the demand for services by older adults is likely to be affected by health insurance reimbursement policies, emerging technology, new models of care, and changes in the profession-specific scope of practice.

“The years between 2011 and 2050 will be the critical period for the U.S. health care system, as the baby boomers retire from the labor force,” the report said. “It is not too early for the health care system to begin to prepare for those years, if it is to effectively meet the challenge of population aging.”

The report details the broad impact of the aging population on the health care workforce and the impact on 18 specific health professions. The full report is available online at http://chws.albany.edu

WASHINGTON — Government officials and health information technology leaders plan to spend this year laying the groundwork for a system that would allow for the electronic transfer of ambulatory, emergency department, and laboratory data to public health agencies in less than a day.

Over time, officials would like to implement a real-time nationwide public health monitoring system. “The system we have is simply not adequate,” Mike Leavitt, secretary of the Health and Human Services department (HHS), said at a meeting of the American Health Information Community, which is an advisory committee to HHS.

The United States faces not only the possibility of a bioterrorist attack but also the threat of pandemic, he said.

Mr. Leavitt said he would like to get a “spotty net” of surveillance off the ground quickly by collecting a few key indicators from as many electronic data sources as possible. Getting just 2–4 basic data points from all available sources would be a “quantum leap forward,” he said.

Information from small and medium-sized primary care practices will be key to any electronic biosurveillance system, said Dr. David Kibbe, who represented the American Academy of Family Physicians at the meeting.

“There is widespread agreement that information technology can substantially improve surveillance both for ongoing public health and for health emergencies,” said Dr. Thomas R. Frieden, commissioner of the New York City Department of Health and Mental Hygiene, who presented information on current electronic surveillance programs at the meeting.

Currently, there is a wide range of biosurveillance activities underway at the federal, state, and local levels, and in the private sector, Dr. Frieden said. For example, the Centers for Disease Control and Prevention operates the Public Health Information Network, which provides an architecture for public health information technology. Most recently, the agency established the BioSense program to support the connection of clinical care to public health and supporting “situational awareness” at the national level.

A number of state and local health departments have begun electronic reporting either from clinical laboratories or clinical information systems.

In New York City, the health department uses electronic reporting data on a daily basis. The system, which has been operating for more than 5 years, collects information from ambulance dispatches, emergency department visits, pharmacy purchases, outpatient visits, and other sources. The system also collects free text, which allows officials to evaluate information they might not have thought about otherwise. Currently, 50 hospitals—representing about 90% of emergency department visits in the city—report daily.

The electronic reporting system has proved helpful in the early detection of pockets of influenza. The electronic syndromic system consistently picks up influenza activity 2–3 weeks before any other system.

New York City is not alone. North Carolina has a statewide, hospital-based clinical data monitoring system. It allows for monitoring of real-time inpatient, outpatient, and emergency department data.

But some major needs must be addressed to reach the goal of a nationwide system, Dr. John Loonsk, of the federal Office of the National Coordinator for Health Information Technology, said at the meeting.

For example, data need to be standardized so they can be compared across reporting organizations, privacy and confidentiality need to be ensured, and improvements need to be made in the current patchwork of state and local health information technology capability, he said.

One area that potentially could be implemented rapidly is the electronic reporting of lab results, Dr. Loonsk said. This has value both to public health and for the routine use of clinicians, he said.

Information from small and medium-sized primary care practices will be key to any system. DR. KIBBE

WASHINGTON — Government officials and health information technology leaders plan to spend this year laying the groundwork for a system that would allow for the electronic transfer of ambulatory, emergency department, and laboratory data to public health agencies in less than a day.

Over time, officials would like to implement a real-time nationwide public health monitoring system. “The system we have is simply not adequate,” Mike Leavitt, secretary of the Health and Human Services department (HHS), said at a meeting of the American Health Information Community, which is an advisory committee to HHS.

The United States faces not only the possibility of a bioterrorist attack but also the threat of pandemic, he said.

Mr. Leavitt said he would like to get a “spotty net” of surveillance off the ground quickly by collecting a few key indicators from as many electronic data sources as possible. Getting just 2–4 basic data points from all available sources would be a “quantum leap forward,” he said.

Information from small and medium-sized primary care practices will be key to any electronic biosurveillance system, said Dr. David Kibbe, who represented the American Academy of Family Physicians at the meeting.

“There is widespread agreement that information technology can substantially improve surveillance both for ongoing public health and for health emergencies,” said Dr. Thomas R. Frieden, commissioner of the New York City Department of Health and Mental Hygiene, who presented information on current electronic surveillance programs at the meeting.

Currently, there is a wide range of biosurveillance activities underway at the federal, state, and local levels, and in the private sector, Dr. Frieden said. For example, the Centers for Disease Control and Prevention operates the Public Health Information Network, which provides an architecture for public health information technology. Most recently, the agency established the BioSense program to support the connection of clinical care to public health and supporting “situational awareness” at the national level.

A number of state and local health departments have begun electronic reporting either from clinical laboratories or clinical information systems.

In New York City, the health department uses electronic reporting data on a daily basis. The system, which has been operating for more than 5 years, collects information from ambulance dispatches, emergency department visits, pharmacy purchases, outpatient visits, and other sources. The system also collects free text, which allows officials to evaluate information they might not have thought about otherwise. Currently, 50 hospitals—representing about 90% of emergency department visits in the city—report daily.

The electronic reporting system has proved helpful in the early detection of pockets of influenza. The electronic syndromic system consistently picks up influenza activity 2–3 weeks before any other system.

New York City is not alone. North Carolina has a statewide, hospital-based clinical data monitoring system. It allows for monitoring of real-time inpatient, outpatient, and emergency department data.

But some major needs must be addressed to reach the goal of a nationwide system, Dr. John Loonsk, of the federal Office of the National Coordinator for Health Information Technology, said at the meeting.

For example, data need to be standardized so they can be compared across reporting organizations, privacy and confidentiality need to be ensured, and improvements need to be made in the current patchwork of state and local health information technology capability, he said.

One area that potentially could be implemented rapidly is the electronic reporting of lab results, Dr. Loonsk said. This has value both to public health and for the routine use of clinicians, he said.

Information from small and medium-sized primary care practices will be key to any system. DR. KIBBE

WASHINGTON — Government officials and health information technology leaders plan to spend this year laying the groundwork for a system that would allow for the electronic transfer of ambulatory, emergency department, and laboratory data to public health agencies in less than a day.

Over time, officials would like to implement a real-time nationwide public health monitoring system. “The system we have is simply not adequate,” Mike Leavitt, secretary of the Health and Human Services department (HHS), said at a meeting of the American Health Information Community, which is an advisory committee to HHS.

The United States faces not only the possibility of a bioterrorist attack but also the threat of pandemic, he said.

Mr. Leavitt said he would like to get a “spotty net” of surveillance off the ground quickly by collecting a few key indicators from as many electronic data sources as possible. Getting just 2–4 basic data points from all available sources would be a “quantum leap forward,” he said.

Information from small and medium-sized primary care practices will be key to any electronic biosurveillance system, said Dr. David Kibbe, who represented the American Academy of Family Physicians at the meeting.

“There is widespread agreement that information technology can substantially improve surveillance both for ongoing public health and for health emergencies,” said Dr. Thomas R. Frieden, commissioner of the New York City Department of Health and Mental Hygiene, who presented information on current electronic surveillance programs at the meeting.

Currently, there is a wide range of biosurveillance activities underway at the federal, state, and local levels, and in the private sector, Dr. Frieden said. For example, the Centers for Disease Control and Prevention operates the Public Health Information Network, which provides an architecture for public health information technology. Most recently, the agency established the BioSense program to support the connection of clinical care to public health and supporting “situational awareness” at the national level.

A number of state and local health departments have begun electronic reporting either from clinical laboratories or clinical information systems.

In New York City, the health department uses electronic reporting data on a daily basis. The system, which has been operating for more than 5 years, collects information from ambulance dispatches, emergency department visits, pharmacy purchases, outpatient visits, and other sources. The system also collects free text, which allows officials to evaluate information they might not have thought about otherwise. Currently, 50 hospitals—representing about 90% of emergency department visits in the city—report daily.

The electronic reporting system has proved helpful in the early detection of pockets of influenza. The electronic syndromic system consistently picks up influenza activity 2–3 weeks before any other system.

New York City is not alone. North Carolina has a statewide, hospital-based clinical data monitoring system. It allows for monitoring of real-time inpatient, outpatient, and emergency department data.

But some major needs must be addressed to reach the goal of a nationwide system, Dr. John Loonsk, of the federal Office of the National Coordinator for Health Information Technology, said at the meeting.

For example, data need to be standardized so they can be compared across reporting organizations, privacy and confidentiality need to be ensured, and improvements need to be made in the current patchwork of state and local health information technology capability, he said.

One area that potentially could be implemented rapidly is the electronic reporting of lab results, Dr. Loonsk said. This has value both to public health and for the routine use of clinicians, he said.

Information from small and medium-sized primary care practices will be key to any system. DR. KIBBE

Over the next year or so, leaders in the health information technology community will work on ways to make medication history and some general demographic information available to consumers in a portable health record.

Experts at a Webcast meeting of the American Health Information Community agreed that this is the “low-hanging fruit” that could eventually pave the way for widespread access to portable, consumer-controlled personal health records. The American Health Information Community is an advisory committee to the Department of Health and Human Services.

The development of portable electronic demographic information, or registration information, would be a way to do away with the medical clipboard, HHS Secretary Mike Leavitt said.

“The timeliness of access to medical information is critical to patients,” said Nancy Davenport-Ennis, CEO of the National Patient Advocate Foundation and a member of the American Health Information Community. Today, most patients feel they own their medical record but when they go to get lab results from their physician, it can often take days or weeks, she said.

But one of the major hurdles in creating secure and portable patient health records is authentications, said Dr. Reed Tuckson of UnitedHealth Group, who presented information to the group.

Other obstacles include the inability to locate patient information across multiple settings, segmentation of the consumer market, privacy concerns, low levels of consumer trust, few electronic health records to connect to, and the lack of an established business model.

But there have been some successes, said David Lansky, Ph.D., of the Markle Foundation, who presented information to the group. For example, the Department of Veterans Affairs set up a patient portal, and the Department of Defense has a similar program. And some health plans offer prepopulated personal health records.

“We're not starting with a blank slate,” Dr. Lansky said.

Over the next year or so, leaders in the health information technology community will work on ways to make medication history and some general demographic information available to consumers in a portable health record.

Experts at a Webcast meeting of the American Health Information Community agreed that this is the “low-hanging fruit” that could eventually pave the way for widespread access to portable, consumer-controlled personal health records. The American Health Information Community is an advisory committee to the Department of Health and Human Services.

The development of portable electronic demographic information, or registration information, would be a way to do away with the medical clipboard, HHS Secretary Mike Leavitt said.

“The timeliness of access to medical information is critical to patients,” said Nancy Davenport-Ennis, CEO of the National Patient Advocate Foundation and a member of the American Health Information Community. Today, most patients feel they own their medical record but when they go to get lab results from their physician, it can often take days or weeks, she said.

But one of the major hurdles in creating secure and portable patient health records is authentications, said Dr. Reed Tuckson of UnitedHealth Group, who presented information to the group.

Other obstacles include the inability to locate patient information across multiple settings, segmentation of the consumer market, privacy concerns, low levels of consumer trust, few electronic health records to connect to, and the lack of an established business model.

But there have been some successes, said David Lansky, Ph.D., of the Markle Foundation, who presented information to the group. For example, the Department of Veterans Affairs set up a patient portal, and the Department of Defense has a similar program. And some health plans offer prepopulated personal health records.

“We're not starting with a blank slate,” Dr. Lansky said.

Over the next year or so, leaders in the health information technology community will work on ways to make medication history and some general demographic information available to consumers in a portable health record.

Experts at a Webcast meeting of the American Health Information Community agreed that this is the “low-hanging fruit” that could eventually pave the way for widespread access to portable, consumer-controlled personal health records. The American Health Information Community is an advisory committee to the Department of Health and Human Services.

The development of portable electronic demographic information, or registration information, would be a way to do away with the medical clipboard, HHS Secretary Mike Leavitt said.

“The timeliness of access to medical information is critical to patients,” said Nancy Davenport-Ennis, CEO of the National Patient Advocate Foundation and a member of the American Health Information Community. Today, most patients feel they own their medical record but when they go to get lab results from their physician, it can often take days or weeks, she said.

But one of the major hurdles in creating secure and portable patient health records is authentications, said Dr. Reed Tuckson of UnitedHealth Group, who presented information to the group.

Other obstacles include the inability to locate patient information across multiple settings, segmentation of the consumer market, privacy concerns, low levels of consumer trust, few electronic health records to connect to, and the lack of an established business model.

But there have been some successes, said David Lansky, Ph.D., of the Markle Foundation, who presented information to the group. For example, the Department of Veterans Affairs set up a patient portal, and the Department of Defense has a similar program. And some health plans offer prepopulated personal health records.

“We're not starting with a blank slate,” Dr. Lansky said.

ORLANDO — Adolescent smokers are a difficult population to reach, but researchers are trying some novel approaches to combat smoking in that group including reduction, instead of cessation, and financial incentives.

“To date the field has been frustrated by relatively low success rates,” Robin Mermelstein, Ph.D., of the University of Illinois at Chicago, said at the annual meeting of the Society for Research on Nicotine and Tobacco.

With adolescents, researchers need to consider innovative approaches and target programs where the teens are—in schools, she said.

Some researchers are aiming to do just that. For example, Ping Sun, Ph.D., of the University of Southern California, Los Angeles, and his colleagues are examining the combination of a cessation and prevention curriculum in a single school-based program. In a recent study, Dr. Sun modified the existing Project EX program for application in the classroom.

The program targets at-risk, high school students in California and includes eight learning sessions over a 6-week period. The classroom sessions cover the effects of tobacco on lifestyle, the health impact of tobacco use, and how to avoid smoking relapses.

The intervention also includes unique aspects such as a mock talk show, yoga, and meditation.

More than 1,000 students were randomly assigned to either the cessation and prevention program or standard care, which is whatever curriculum would normally be taught in the students' health class.

Preliminary results show that the effects of the intervention on knowledge, weekly smoking, and daily smoking were all favorable, Dr. Sun said. A post-test survey also showed that most students liked the program and especially enjoyed the meditation component, he said.

These preliminary findings illustrate that it is possible to combine prevention and cessation in a single classroom program and that the approach works equally well for smokers and nonsmokers, Dr. Sun said.

Since smoking cessation is difficult to achieve with adolescent smokers, researchers are also considering ways to reduce smoking in individuals who don't want to quit.

Karen Hanson, Ph.D., and her colleagues at the University of Minnesota recruited teens from 14 high schools in the Minneapolis/St. Paul area who smoked five cigarettes a day and had no intention to quit.

As part of the pilot study, students received either the nicotine patch, nicotine gum, or a placebo. In addition, all the students received cognitive-behavioral therapy sessions that lasted 10–15 minutes and focused on strategies including limiting smoking in certain situations and increasing intervals between cigarettes.

More than 100 adolescents with a mean age of 17 years completed the study. At baseline, participants smoked a mean of 12 cigarettes per day. By the study's completion, 58% of participants cut their smoking intake by at least half. The nicotine-patch group reduced smoking significantly, compared with the other treatment groups, she said.

The 7-day abstinence rates were 4% at the end of treatment, 9% at 3 months, and 7% at 6 months; there were no significant differences between treatment groups, she said.

“Reducing smoking is feasible but it's not an end goal because unless treatment is sustained, reduction was not maintained,” Dr. Hanson said.

Another strategy that works well with adolescents is to offer them cash incentives to quit, according to Suchitra Krishnan-Sarin, Ph.D., of Yale University, New Haven, Conn.

Dr. Krishnan-Sarin tested the idea that contingency management-based intervention—in this case money—could act as a nondrug reinforcer to bolster smoking cessation.

In the preliminary phase, Dr. Krishnan-Sarin and her colleagues recruited students from two high schools to participate in either weekly cognitive-behavioral therapy plus contingency management, or weekly cognitive-behavioral therapy alone.

Smoking abstinence was reinforced on an escalating scale. Participants could earn more than $300 in 1 month plus vouchers for attendance. The control group received about $120 in total for providing breath carbon monoxide (CO) samples plus vouchers for attendance. Both groups provided breath CO samples as evidence of abstinence.

A higher percentage of those students who received contingency management plus cognitive-behavioral therapy completed treatment. In the first week, there were significant differences between the groups. The contingency management plus cognitive-behavioral therapy group had achieved a 77% abstinence rate, compared with 7% for the therapy-only group.

At 1 month, 53% of the intervention group was abstinent, compared with 0% for the control group.

The results show that contingency-management techniques can increase retention and abstinence, Dr. Krishnan-Sarin said, and can be implemented in a school-based setting.

In the second phase of the study, the researchers plan to waive parental consent since in many cases parents don't know that their teens are smoking. They are also considering a briefer version of the cognitive-behavioral therapy component, Dr. Krishnan-Sarin said.

ORLANDO — Adolescent smokers are a difficult population to reach, but researchers are trying some novel approaches to combat smoking in that group including reduction, instead of cessation, and financial incentives.

“To date the field has been frustrated by relatively low success rates,” Robin Mermelstein, Ph.D., of the University of Illinois at Chicago, said at the annual meeting of the Society for Research on Nicotine and Tobacco.

With adolescents, researchers need to consider innovative approaches and target programs where the teens are—in schools, she said.

Some researchers are aiming to do just that. For example, Ping Sun, Ph.D., of the University of Southern California, Los Angeles, and his colleagues are examining the combination of a cessation and prevention curriculum in a single school-based program. In a recent study, Dr. Sun modified the existing Project EX program for application in the classroom.

The program targets at-risk, high school students in California and includes eight learning sessions over a 6-week period. The classroom sessions cover the effects of tobacco on lifestyle, the health impact of tobacco use, and how to avoid smoking relapses.

The intervention also includes unique aspects such as a mock talk show, yoga, and meditation.

More than 1,000 students were randomly assigned to either the cessation and prevention program or standard care, which is whatever curriculum would normally be taught in the students' health class.

Preliminary results show that the effects of the intervention on knowledge, weekly smoking, and daily smoking were all favorable, Dr. Sun said. A post-test survey also showed that most students liked the program and especially enjoyed the meditation component, he said.

These preliminary findings illustrate that it is possible to combine prevention and cessation in a single classroom program and that the approach works equally well for smokers and nonsmokers, Dr. Sun said.

Since smoking cessation is difficult to achieve with adolescent smokers, researchers are also considering ways to reduce smoking in individuals who don't want to quit.

Karen Hanson, Ph.D., and her colleagues at the University of Minnesota recruited teens from 14 high schools in the Minneapolis/St. Paul area who smoked five cigarettes a day and had no intention to quit.

As part of the pilot study, students received either the nicotine patch, nicotine gum, or a placebo. In addition, all the students received cognitive-behavioral therapy sessions that lasted 10–15 minutes and focused on strategies including limiting smoking in certain situations and increasing intervals between cigarettes.

More than 100 adolescents with a mean age of 17 years completed the study. At baseline, participants smoked a mean of 12 cigarettes per day. By the study's completion, 58% of participants cut their smoking intake by at least half. The nicotine-patch group reduced smoking significantly, compared with the other treatment groups, she said.

The 7-day abstinence rates were 4% at the end of treatment, 9% at 3 months, and 7% at 6 months; there were no significant differences between treatment groups, she said.

“Reducing smoking is feasible but it's not an end goal because unless treatment is sustained, reduction was not maintained,” Dr. Hanson said.

Another strategy that works well with adolescents is to offer them cash incentives to quit, according to Suchitra Krishnan-Sarin, Ph.D., of Yale University, New Haven, Conn.

Dr. Krishnan-Sarin tested the idea that contingency management-based intervention—in this case money—could act as a nondrug reinforcer to bolster smoking cessation.

In the preliminary phase, Dr. Krishnan-Sarin and her colleagues recruited students from two high schools to participate in either weekly cognitive-behavioral therapy plus contingency management, or weekly cognitive-behavioral therapy alone.

Smoking abstinence was reinforced on an escalating scale. Participants could earn more than $300 in 1 month plus vouchers for attendance. The control group received about $120 in total for providing breath carbon monoxide (CO) samples plus vouchers for attendance. Both groups provided breath CO samples as evidence of abstinence.

A higher percentage of those students who received contingency management plus cognitive-behavioral therapy completed treatment. In the first week, there were significant differences between the groups. The contingency management plus cognitive-behavioral therapy group had achieved a 77% abstinence rate, compared with 7% for the therapy-only group.

At 1 month, 53% of the intervention group was abstinent, compared with 0% for the control group.

The results show that contingency-management techniques can increase retention and abstinence, Dr. Krishnan-Sarin said, and can be implemented in a school-based setting.

In the second phase of the study, the researchers plan to waive parental consent since in many cases parents don't know that their teens are smoking. They are also considering a briefer version of the cognitive-behavioral therapy component, Dr. Krishnan-Sarin said.

ORLANDO — Adolescent smokers are a difficult population to reach, but researchers are trying some novel approaches to combat smoking in that group including reduction, instead of cessation, and financial incentives.

“To date the field has been frustrated by relatively low success rates,” Robin Mermelstein, Ph.D., of the University of Illinois at Chicago, said at the annual meeting of the Society for Research on Nicotine and Tobacco.

With adolescents, researchers need to consider innovative approaches and target programs where the teens are—in schools, she said.

Some researchers are aiming to do just that. For example, Ping Sun, Ph.D., of the University of Southern California, Los Angeles, and his colleagues are examining the combination of a cessation and prevention curriculum in a single school-based program. In a recent study, Dr. Sun modified the existing Project EX program for application in the classroom.

The program targets at-risk, high school students in California and includes eight learning sessions over a 6-week period. The classroom sessions cover the effects of tobacco on lifestyle, the health impact of tobacco use, and how to avoid smoking relapses.

The intervention also includes unique aspects such as a mock talk show, yoga, and meditation.

More than 1,000 students were randomly assigned to either the cessation and prevention program or standard care, which is whatever curriculum would normally be taught in the students' health class.

Preliminary results show that the effects of the intervention on knowledge, weekly smoking, and daily smoking were all favorable, Dr. Sun said. A post-test survey also showed that most students liked the program and especially enjoyed the meditation component, he said.

These preliminary findings illustrate that it is possible to combine prevention and cessation in a single classroom program and that the approach works equally well for smokers and nonsmokers, Dr. Sun said.

Since smoking cessation is difficult to achieve with adolescent smokers, researchers are also considering ways to reduce smoking in individuals who don't want to quit.

Karen Hanson, Ph.D., and her colleagues at the University of Minnesota recruited teens from 14 high schools in the Minneapolis/St. Paul area who smoked five cigarettes a day and had no intention to quit.

As part of the pilot study, students received either the nicotine patch, nicotine gum, or a placebo. In addition, all the students received cognitive-behavioral therapy sessions that lasted 10–15 minutes and focused on strategies including limiting smoking in certain situations and increasing intervals between cigarettes.

More than 100 adolescents with a mean age of 17 years completed the study. At baseline, participants smoked a mean of 12 cigarettes per day. By the study's completion, 58% of participants cut their smoking intake by at least half. The nicotine-patch group reduced smoking significantly, compared with the other treatment groups, she said.

The 7-day abstinence rates were 4% at the end of treatment, 9% at 3 months, and 7% at 6 months; there were no significant differences between treatment groups, she said.

“Reducing smoking is feasible but it's not an end goal because unless treatment is sustained, reduction was not maintained,” Dr. Hanson said.

Another strategy that works well with adolescents is to offer them cash incentives to quit, according to Suchitra Krishnan-Sarin, Ph.D., of Yale University, New Haven, Conn.

Dr. Krishnan-Sarin tested the idea that contingency management-based intervention—in this case money—could act as a nondrug reinforcer to bolster smoking cessation.

In the preliminary phase, Dr. Krishnan-Sarin and her colleagues recruited students from two high schools to participate in either weekly cognitive-behavioral therapy plus contingency management, or weekly cognitive-behavioral therapy alone.

Smoking abstinence was reinforced on an escalating scale. Participants could earn more than $300 in 1 month plus vouchers for attendance. The control group received about $120 in total for providing breath carbon monoxide (CO) samples plus vouchers for attendance. Both groups provided breath CO samples as evidence of abstinence.

A higher percentage of those students who received contingency management plus cognitive-behavioral therapy completed treatment. In the first week, there were significant differences between the groups. The contingency management plus cognitive-behavioral therapy group had achieved a 77% abstinence rate, compared with 7% for the therapy-only group.

At 1 month, 53% of the intervention group was abstinent, compared with 0% for the control group.

The results show that contingency-management techniques can increase retention and abstinence, Dr. Krishnan-Sarin said, and can be implemented in a school-based setting.

In the second phase of the study, the researchers plan to waive parental consent since in many cases parents don't know that their teens are smoking. They are also considering a briefer version of the cognitive-behavioral therapy component, Dr. Krishnan-Sarin said.

The sweeping abortion ban signed into law last month in South Dakota has sent shock waves through reproductive medicine and could lead to a Supreme Court showdown on the legality of abortion.

The law makes it a felony to perform an abortion except in cases where the mother's life is in danger and prohibits the administering, prescribing, procuring, or selling of any substance that terminates a pregnancy. But the law does allow the sale of contraceptives that can be administered before a pregnancy “could be determined through conventional medical testing.”

The “Women's Health and Human Life Protection Act,” which is set to take effect in July, will likely face an immediate court challenge from the Planned Parenthood Federation of America. Planned Parenthood's Sioux Falls clinic is the only abortion clinic in the state, and officials there have vowed to exhaust all legal options to prevent the ban from taking effect.

Physicians on both sides of the debate said that they see the new law as a watershed event.

“This is very dangerous,” said Dr. Warren Hern, director of the Boulder (Colorado) Abortion Clinic. “You cannot practice medicine in this kind of an environment.”

Antiabortion advocates have made abortion an ideological issue, he said, instead of a public health issue. Dr. Hern said he suspects that even if the law doesn't go into effect, many women in South Dakota will think the procedure is illegal.

Even without a ban, access is limited because fewer and fewer physicians want to perform abortions, Dr. Hern said. Performing abortions is the way to the bottom in medicine, he said, and physicians who specialize in performing abortion have become targets for assassination.

“They don't have to make abortion illegal,” Dr. Hern said.

Banning abortion will not eliminate the procedure, said Dr. Suzanne T. Poppema, a vice chair of Physicians for Reproductive Choice and Health, but it will jeopardize women's health.

If the South Dakota ban goes into effect, many women will be forced to travel to other states for abortions, she said. Those who can't afford to travel out of state may try to buy abortifacients online, if they have Internet access. In that case, physicians can expect to see bleeding complications in emergency departments, Dr. Poppema said.

Aside from the potential health effects on women in the state, Dr. Poppema said she resents the idea of politicians telling physicians how to practice medicine. “I think that politicians insinuating themselves into the doctor-patient relationship is not a good thing,” she said.

But Dr. Gene Rudd, associate executive director of the Christian Medical & Dental Associations, said the government is already involved in the practice of medicine and placing restrictions on abortion is an appropriate role.

Dr. Rudd said there will always be women who opt to have abortions, but he expects the number of abortions would fall dramatically if the procedure were outlawed or severely restricted.

Whether or not the new law survives efforts to block its implemention, it is already having ramifications in other states. “There will be a pendulum swing toward restrictions on abortion,” he said.

The law was also praised by the American Association of Pro Life Obstetricians and Gynecologists. Dr. Joe DeCook, vice president of the group, said a ban on abortion is in the interest of women, who face both negative emotional and physical consequences from abortion.

Ten other states—Alabama, Georgia, Indiana, Kentucky, Mississippi, Missouri, Ohio, Oklahoma, Tennessee, and West Virginia—are considering bans on abortion that are similar to the one enacted in South Dakota or laws that would ban abortion automatically if Roe v. Wade were overturned by the Supreme Court, according to Planned Parenthood.

The sweeping abortion ban signed into law last month in South Dakota has sent shock waves through reproductive medicine and could lead to a Supreme Court showdown on the legality of abortion.

The law makes it a felony to perform an abortion except in cases where the mother's life is in danger and prohibits the administering, prescribing, procuring, or selling of any substance that terminates a pregnancy. But the law does allow the sale of contraceptives that can be administered before a pregnancy “could be determined through conventional medical testing.”

The “Women's Health and Human Life Protection Act,” which is set to take effect in July, will likely face an immediate court challenge from the Planned Parenthood Federation of America. Planned Parenthood's Sioux Falls clinic is the only abortion clinic in the state, and officials there have vowed to exhaust all legal options to prevent the ban from taking effect.

Physicians on both sides of the debate said that they see the new law as a watershed event.

“This is very dangerous,” said Dr. Warren Hern, director of the Boulder (Colorado) Abortion Clinic. “You cannot practice medicine in this kind of an environment.”

Antiabortion advocates have made abortion an ideological issue, he said, instead of a public health issue. Dr. Hern said he suspects that even if the law doesn't go into effect, many women in South Dakota will think the procedure is illegal.

Even without a ban, access is limited because fewer and fewer physicians want to perform abortions, Dr. Hern said. Performing abortions is the way to the bottom in medicine, he said, and physicians who specialize in performing abortion have become targets for assassination.

“They don't have to make abortion illegal,” Dr. Hern said.

Banning abortion will not eliminate the procedure, said Dr. Suzanne T. Poppema, a vice chair of Physicians for Reproductive Choice and Health, but it will jeopardize women's health.

If the South Dakota ban goes into effect, many women will be forced to travel to other states for abortions, she said. Those who can't afford to travel out of state may try to buy abortifacients online, if they have Internet access. In that case, physicians can expect to see bleeding complications in emergency departments, Dr. Poppema said.

Aside from the potential health effects on women in the state, Dr. Poppema said she resents the idea of politicians telling physicians how to practice medicine. “I think that politicians insinuating themselves into the doctor-patient relationship is not a good thing,” she said.

But Dr. Gene Rudd, associate executive director of the Christian Medical & Dental Associations, said the government is already involved in the practice of medicine and placing restrictions on abortion is an appropriate role.

Dr. Rudd said there will always be women who opt to have abortions, but he expects the number of abortions would fall dramatically if the procedure were outlawed or severely restricted.

Whether or not the new law survives efforts to block its implemention, it is already having ramifications in other states. “There will be a pendulum swing toward restrictions on abortion,” he said.

The law was also praised by the American Association of Pro Life Obstetricians and Gynecologists. Dr. Joe DeCook, vice president of the group, said a ban on abortion is in the interest of women, who face both negative emotional and physical consequences from abortion.

Ten other states—Alabama, Georgia, Indiana, Kentucky, Mississippi, Missouri, Ohio, Oklahoma, Tennessee, and West Virginia—are considering bans on abortion that are similar to the one enacted in South Dakota or laws that would ban abortion automatically if Roe v. Wade were overturned by the Supreme Court, according to Planned Parenthood.

The sweeping abortion ban signed into law last month in South Dakota has sent shock waves through reproductive medicine and could lead to a Supreme Court showdown on the legality of abortion.

The law makes it a felony to perform an abortion except in cases where the mother's life is in danger and prohibits the administering, prescribing, procuring, or selling of any substance that terminates a pregnancy. But the law does allow the sale of contraceptives that can be administered before a pregnancy “could be determined through conventional medical testing.”

The “Women's Health and Human Life Protection Act,” which is set to take effect in July, will likely face an immediate court challenge from the Planned Parenthood Federation of America. Planned Parenthood's Sioux Falls clinic is the only abortion clinic in the state, and officials there have vowed to exhaust all legal options to prevent the ban from taking effect.

Physicians on both sides of the debate said that they see the new law as a watershed event.

“This is very dangerous,” said Dr. Warren Hern, director of the Boulder (Colorado) Abortion Clinic. “You cannot practice medicine in this kind of an environment.”

Antiabortion advocates have made abortion an ideological issue, he said, instead of a public health issue. Dr. Hern said he suspects that even if the law doesn't go into effect, many women in South Dakota will think the procedure is illegal.

Even without a ban, access is limited because fewer and fewer physicians want to perform abortions, Dr. Hern said. Performing abortions is the way to the bottom in medicine, he said, and physicians who specialize in performing abortion have become targets for assassination.

“They don't have to make abortion illegal,” Dr. Hern said.

Banning abortion will not eliminate the procedure, said Dr. Suzanne T. Poppema, a vice chair of Physicians for Reproductive Choice and Health, but it will jeopardize women's health.

If the South Dakota ban goes into effect, many women will be forced to travel to other states for abortions, she said. Those who can't afford to travel out of state may try to buy abortifacients online, if they have Internet access. In that case, physicians can expect to see bleeding complications in emergency departments, Dr. Poppema said.

Aside from the potential health effects on women in the state, Dr. Poppema said she resents the idea of politicians telling physicians how to practice medicine. “I think that politicians insinuating themselves into the doctor-patient relationship is not a good thing,” she said.

But Dr. Gene Rudd, associate executive director of the Christian Medical & Dental Associations, said the government is already involved in the practice of medicine and placing restrictions on abortion is an appropriate role.

Dr. Rudd said there will always be women who opt to have abortions, but he expects the number of abortions would fall dramatically if the procedure were outlawed or severely restricted.

Whether or not the new law survives efforts to block its implemention, it is already having ramifications in other states. “There will be a pendulum swing toward restrictions on abortion,” he said.

The law was also praised by the American Association of Pro Life Obstetricians and Gynecologists. Dr. Joe DeCook, vice president of the group, said a ban on abortion is in the interest of women, who face both negative emotional and physical consequences from abortion.

Ten other states—Alabama, Georgia, Indiana, Kentucky, Mississippi, Missouri, Ohio, Oklahoma, Tennessee, and West Virginia—are considering bans on abortion that are similar to the one enacted in South Dakota or laws that would ban abortion automatically if Roe v. Wade were overturned by the Supreme Court, according to Planned Parenthood.

Misconceptions on Menstruation

Many women have little knowledge about how their menstrual cycle works, according to the results of a recent national poll commissioned by the Association of Reproductive Health Professionals. For example, about two-thirds of women surveyed said it is “natural” for a woman to get her period even when she is taking oral contraceptives. Women were not aware that the monthly bleeding that occurs with oral contraceptives is withdrawal bleeding, not menstrual bleeding. “This survey clearly demonstrates that women need more information to be able to understand their menstrual cycles, especially what effect hormonal contraceptives have on their periods,” Dr. Beth Jordan, ARHP Medical Director, said in a statement. The survey findings are online at

www.arhp.org/2005MenstruationSurvey

States Vary on Contraceptive Access

According to a new analysis from the Guttmacher Institute, California, Alaska, South Carolina, Alabama, and New York are setting a national example of how to reduce unintended pregnancies in the United States, while Nebraska, North Dakota, Indiana, Ohio, and Utah are falling short in opening up access to contraceptives. The nonprofit institute, which focuses on reproductive health research, conducted a state-by-state analysis of access to contraception. The states were evaluated based on how well they met the need for subsidized contraceptive services and supplies, whether local laws were likely to help or hinder access to contraception, and the amount of public funding for family planning. A complete ranking of the states is available online at

www.guttmacher.org/statecenter/ccfs.html/

Environmental Fertility Risks

More research and improved testing are needed to gauge the impact of environmental toxins on reproductive health and fertility, said Resolve: The National Infertility Association, which is calling on researchers to look into exposure from cigarette smoke, alcohol, heavy metals, plastics, mercury, lead, and agricultural pesticides. A Centers for Disease Control and Prevention report said that the number of couples reporting difficulty becoming pregnant or carrying a pregnancy to term has grown from 6.1 million in 1995 to 7.3 million in 2002. “While we recognize that most cases of infertility cannot be prevented, we believe that through more research, better testing, and increased awareness of knowledge about environmental contaminants and their impact on reproductive health, we can take action to prevent some cases of infertility and improve pregnancy outcomes,” Resolve President and CEO Joseph C. Isaacs said in a statement.

Wisconsin Doctors Want Cap Back

Wisconsin doctors hailed the state assembly's passage of a bill from Rep. Curt Gielow (R) that would reinstate a cap on noneconomic damages at $750,000. The 10-year-old cap was overturned by the Wisconsin Supreme Court in 2005, “throwing Wisconsin's once envied medical liability system into turmoil,” according to a statement from the Wisconsin Hospital Association (WHA) and the Wisconsin Medical Society. Since the dissolution of the cap, physicians have cancelled their recruiting visits to the state, and premiums for the Injured Patients and Families Compensation Fund (IPFCF) have increased by 25%, the associations claim. “Four awards have already exceeded the previous cap, the number of lawsuits in excess of $1 million are up by over 22%, and a stunning $8.4 million verdict was handed down in Dane County,” the statement said. “This bill helps doctors concentrate on what concerns them the most: caring for patients,” said Dr. Susan Turney, chief executive officer and executive vice president of the Wisconsin Medical Society. “It doesn't change the fact that injured patients are fully compensated for their economic losses yet helps to maintain access to health care in Wisconsin.” The state's high court had ruled that the cap was unconstitutional beyond a reasonable doubt.

Antiabortion Protesters Win Ruling

In the latest abortion-related court ruling, the Supreme Court decided that a federal extortion law—the Hobbs Act—cannot be used against antiabortion protesters. In the cases Scheidler v. National Organization for Women, and Operation Rescue v. National Organization for Women, the court overturned the ruling of a federal appeals court and found that the Hobbs Act should be interpreted to apply only to violence committed through robbery or extortion. In its decision, the Supreme Court stated that the 1994 Freedom of Access to Clinic Entrances Act was passed specifically to address abortion clinic violence. But Nancy Keenan, president of NARAL Pro-Choice America, said in a statement that the 1994 law had so far been ineffective at stopping the illegal actions of protesters.

Misconceptions on Menstruation

Many women have little knowledge about how their menstrual cycle works, according to the results of a recent national poll commissioned by the Association of Reproductive Health Professionals. For example, about two-thirds of women surveyed said it is “natural” for a woman to get her period even when she is taking oral contraceptives. Women were not aware that the monthly bleeding that occurs with oral contraceptives is withdrawal bleeding, not menstrual bleeding. “This survey clearly demonstrates that women need more information to be able to understand their menstrual cycles, especially what effect hormonal contraceptives have on their periods,” Dr. Beth Jordan, ARHP Medical Director, said in a statement. The survey findings are online at

www.arhp.org/2005MenstruationSurvey

States Vary on Contraceptive Access

According to a new analysis from the Guttmacher Institute, California, Alaska, South Carolina, Alabama, and New York are setting a national example of how to reduce unintended pregnancies in the United States, while Nebraska, North Dakota, Indiana, Ohio, and Utah are falling short in opening up access to contraceptives. The nonprofit institute, which focuses on reproductive health research, conducted a state-by-state analysis of access to contraception. The states were evaluated based on how well they met the need for subsidized contraceptive services and supplies, whether local laws were likely to help or hinder access to contraception, and the amount of public funding for family planning. A complete ranking of the states is available online at

www.guttmacher.org/statecenter/ccfs.html/

Environmental Fertility Risks

More research and improved testing are needed to gauge the impact of environmental toxins on reproductive health and fertility, said Resolve: The National Infertility Association, which is calling on researchers to look into exposure from cigarette smoke, alcohol, heavy metals, plastics, mercury, lead, and agricultural pesticides. A Centers for Disease Control and Prevention report said that the number of couples reporting difficulty becoming pregnant or carrying a pregnancy to term has grown from 6.1 million in 1995 to 7.3 million in 2002. “While we recognize that most cases of infertility cannot be prevented, we believe that through more research, better testing, and increased awareness of knowledge about environmental contaminants and their impact on reproductive health, we can take action to prevent some cases of infertility and improve pregnancy outcomes,” Resolve President and CEO Joseph C. Isaacs said in a statement.

Wisconsin Doctors Want Cap Back

Wisconsin doctors hailed the state assembly's passage of a bill from Rep. Curt Gielow (R) that would reinstate a cap on noneconomic damages at $750,000. The 10-year-old cap was overturned by the Wisconsin Supreme Court in 2005, “throwing Wisconsin's once envied medical liability system into turmoil,” according to a statement from the Wisconsin Hospital Association (WHA) and the Wisconsin Medical Society. Since the dissolution of the cap, physicians have cancelled their recruiting visits to the state, and premiums for the Injured Patients and Families Compensation Fund (IPFCF) have increased by 25%, the associations claim. “Four awards have already exceeded the previous cap, the number of lawsuits in excess of $1 million are up by over 22%, and a stunning $8.4 million verdict was handed down in Dane County,” the statement said. “This bill helps doctors concentrate on what concerns them the most: caring for patients,” said Dr. Susan Turney, chief executive officer and executive vice president of the Wisconsin Medical Society. “It doesn't change the fact that injured patients are fully compensated for their economic losses yet helps to maintain access to health care in Wisconsin.” The state's high court had ruled that the cap was unconstitutional beyond a reasonable doubt.

Antiabortion Protesters Win Ruling

In the latest abortion-related court ruling, the Supreme Court decided that a federal extortion law—the Hobbs Act—cannot be used against antiabortion protesters. In the cases Scheidler v. National Organization for Women, and Operation Rescue v. National Organization for Women, the court overturned the ruling of a federal appeals court and found that the Hobbs Act should be interpreted to apply only to violence committed through robbery or extortion. In its decision, the Supreme Court stated that the 1994 Freedom of Access to Clinic Entrances Act was passed specifically to address abortion clinic violence. But Nancy Keenan, president of NARAL Pro-Choice America, said in a statement that the 1994 law had so far been ineffective at stopping the illegal actions of protesters.

Misconceptions on Menstruation

Many women have little knowledge about how their menstrual cycle works, according to the results of a recent national poll commissioned by the Association of Reproductive Health Professionals. For example, about two-thirds of women surveyed said it is “natural” for a woman to get her period even when she is taking oral contraceptives. Women were not aware that the monthly bleeding that occurs with oral contraceptives is withdrawal bleeding, not menstrual bleeding. “This survey clearly demonstrates that women need more information to be able to understand their menstrual cycles, especially what effect hormonal contraceptives have on their periods,” Dr. Beth Jordan, ARHP Medical Director, said in a statement. The survey findings are online at

www.arhp.org/2005MenstruationSurvey

States Vary on Contraceptive Access

According to a new analysis from the Guttmacher Institute, California, Alaska, South Carolina, Alabama, and New York are setting a national example of how to reduce unintended pregnancies in the United States, while Nebraska, North Dakota, Indiana, Ohio, and Utah are falling short in opening up access to contraceptives. The nonprofit institute, which focuses on reproductive health research, conducted a state-by-state analysis of access to contraception. The states were evaluated based on how well they met the need for subsidized contraceptive services and supplies, whether local laws were likely to help or hinder access to contraception, and the amount of public funding for family planning. A complete ranking of the states is available online at

www.guttmacher.org/statecenter/ccfs.html/

Environmental Fertility Risks

More research and improved testing are needed to gauge the impact of environmental toxins on reproductive health and fertility, said Resolve: The National Infertility Association, which is calling on researchers to look into exposure from cigarette smoke, alcohol, heavy metals, plastics, mercury, lead, and agricultural pesticides. A Centers for Disease Control and Prevention report said that the number of couples reporting difficulty becoming pregnant or carrying a pregnancy to term has grown from 6.1 million in 1995 to 7.3 million in 2002. “While we recognize that most cases of infertility cannot be prevented, we believe that through more research, better testing, and increased awareness of knowledge about environmental contaminants and their impact on reproductive health, we can take action to prevent some cases of infertility and improve pregnancy outcomes,” Resolve President and CEO Joseph C. Isaacs said in a statement.

Wisconsin Doctors Want Cap Back

Wisconsin doctors hailed the state assembly's passage of a bill from Rep. Curt Gielow (R) that would reinstate a cap on noneconomic damages at $750,000. The 10-year-old cap was overturned by the Wisconsin Supreme Court in 2005, “throwing Wisconsin's once envied medical liability system into turmoil,” according to a statement from the Wisconsin Hospital Association (WHA) and the Wisconsin Medical Society. Since the dissolution of the cap, physicians have cancelled their recruiting visits to the state, and premiums for the Injured Patients and Families Compensation Fund (IPFCF) have increased by 25%, the associations claim. “Four awards have already exceeded the previous cap, the number of lawsuits in excess of $1 million are up by over 22%, and a stunning $8.4 million verdict was handed down in Dane County,” the statement said. “This bill helps doctors concentrate on what concerns them the most: caring for patients,” said Dr. Susan Turney, chief executive officer and executive vice president of the Wisconsin Medical Society. “It doesn't change the fact that injured patients are fully compensated for their economic losses yet helps to maintain access to health care in Wisconsin.” The state's high court had ruled that the cap was unconstitutional beyond a reasonable doubt.

Antiabortion Protesters Win Ruling

In the latest abortion-related court ruling, the Supreme Court decided that a federal extortion law—the Hobbs Act—cannot be used against antiabortion protesters. In the cases Scheidler v. National Organization for Women, and Operation Rescue v. National Organization for Women, the court overturned the ruling of a federal appeals court and found that the Hobbs Act should be interpreted to apply only to violence committed through robbery or extortion. In its decision, the Supreme Court stated that the 1994 Freedom of Access to Clinic Entrances Act was passed specifically to address abortion clinic violence. But Nancy Keenan, president of NARAL Pro-Choice America, said in a statement that the 1994 law had so far been ineffective at stopping the illegal actions of protesters.

Specialty Hospital Review

Two influential members of Congress have asked the Office of the Inspector General for the Department of Health and Human Services and the Government Accountability Office to examine patient safety and quality, and the financial arrangements at physician-owned specialty hospitals. Sen. Chuck Grassley (R- Iowa), chairman of the Senate Finance Committee and Sen. Max Baucus (D-Mont.), the committee's ranking member, have been investigating the impact of physician-owned specialty hospitals for the past few years. “There are two issues that leap out for review: patient safety, and the use of taxpayer dollars through Medicare and Medicaid,” Sen. Baucus said in a statement. “If patients' health is at risk in these facilities, we need to uncover that now. If Medicare and Medicaid dollars are paying for less than the best care in these facilities, that demands immediate attention.”

Assessing PsA Treatments

A proposed congressional resolution would direct the Secretary of Health and Human Services to convene a special panel to study the availability of treatments and other medical care to individuals with psoriasis and psoriatic arthritis. Rep. Jim Gerlach (R- Pa.) introduced the resolution (H. Con. Res. 340) in February and at press time nine members of Congress had signed on to support the measure. Under the proposed resolution, the special panel would also consider the ability of psoriasis and psoriatic arthritis patients to access prescription therapies and report its findings to Congress by February 2007. “While new, more effective and safer treatments finally are becoming available, too many people do not yet have access to the treatments that may make a significant difference in the quality of their lives,” the resolution says. The resolution was referred to the House Committee on Energy and Commerce's subcommittee on health.

Musculoskeletal Research Funding

Congress should reject President Bush's fiscal year 2007 budget request and instead allocated more than $500 million to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), according to the American Academy of Orthopaedic Surgeons. Members of the group recently traveled to Capitol Hill to lobby legislators for increased federal funding for musculoskeletal research. Under the President's FY 2007 budget request, NIAMS, part of the National Institutes of Health, would face a $3 million funding cut. In 2003, musculoskeletal conditions accounted for 157 million visits to physician offices, 29 million visits to emergency departments, 15 million visits to hospital outpatient departments, and 8 million hospitalizations, according to the organization.

Fighting Off Bad Bugs

Congress should be taking more aggressive steps to give incentives to pharmaceutical and biotechnology industries to fight antibiotic resistance, physicians and other policy makers said during a press conference sponsored by the Infectious Diseases Society of America. The group released its “hit list” of the six most dangerous, drug-resistant microbes. “These are life-threatening drug-resistant infections, and we're seeing them every day,” said Dr. Martin J. Blaser, IDSA president. “What is worse is that our ammunition is running out and there are no reinforcements in sight.” Market exclusivity—a method that's worked favorably in the past for pediatric drugs, would be an option, he said. So would calling for tax credits for the manufacture or distribution of these products. Another option is to establish an independent commission to identify which drugs are more sufficient in combatting resistant microbes. “The superbugs are not waiting, and neither should we,” Dr. Blaser said.

P4P Comes of Age

More than 100 pay-for-performance programs were operating around the country as of last September, according to a new report from the Alliance for Health Reform. Members of Congress and the Bush administration also are exploring ways to test pay for performance within the Medicare program, including Medicare's voluntary physician reporting program which began earlier this year. So far, the private sector has taken the lead on pay for performance, according to the report. A prime example is the Bridges to Excellence program, sponsored by several large employers and operating in Cincinnati, Louisville, Ky., Massachusetts, and Albany/Schenectady, N.Y. The program is expanding into the District of Columbia/Maryland/Virginia area, Minnesota, and Georgia. The group offers payment incentives to high-performing physicians in the area of diabetes and cardiac care, and in the use of health information technology. But despite the success of this model and some others, critics say there are a number of unanswered questions. For example, proponents need to identify the size of the bonus or penalty needed to make a difference in quality, and to figure out what adjustments need to be made to payment systems across different medical specialties, according to the report.

Specialty Hospital Review

Two influential members of Congress have asked the Office of the Inspector General for the Department of Health and Human Services and the Government Accountability Office to examine patient safety and quality, and the financial arrangements at physician-owned specialty hospitals. Sen. Chuck Grassley (R- Iowa), chairman of the Senate Finance Committee and Sen. Max Baucus (D-Mont.), the committee's ranking member, have been investigating the impact of physician-owned specialty hospitals for the past few years. “There are two issues that leap out for review: patient safety, and the use of taxpayer dollars through Medicare and Medicaid,” Sen. Baucus said in a statement. “If patients' health is at risk in these facilities, we need to uncover that now. If Medicare and Medicaid dollars are paying for less than the best care in these facilities, that demands immediate attention.”

Assessing PsA Treatments

A proposed congressional resolution would direct the Secretary of Health and Human Services to convene a special panel to study the availability of treatments and other medical care to individuals with psoriasis and psoriatic arthritis. Rep. Jim Gerlach (R- Pa.) introduced the resolution (H. Con. Res. 340) in February and at press time nine members of Congress had signed on to support the measure. Under the proposed resolution, the special panel would also consider the ability of psoriasis and psoriatic arthritis patients to access prescription therapies and report its findings to Congress by February 2007. “While new, more effective and safer treatments finally are becoming available, too many people do not yet have access to the treatments that may make a significant difference in the quality of their lives,” the resolution says. The resolution was referred to the House Committee on Energy and Commerce's subcommittee on health.

Musculoskeletal Research Funding

Congress should reject President Bush's fiscal year 2007 budget request and instead allocated more than $500 million to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), according to the American Academy of Orthopaedic Surgeons. Members of the group recently traveled to Capitol Hill to lobby legislators for increased federal funding for musculoskeletal research. Under the President's FY 2007 budget request, NIAMS, part of the National Institutes of Health, would face a $3 million funding cut. In 2003, musculoskeletal conditions accounted for 157 million visits to physician offices, 29 million visits to emergency departments, 15 million visits to hospital outpatient departments, and 8 million hospitalizations, according to the organization.

Fighting Off Bad Bugs

Congress should be taking more aggressive steps to give incentives to pharmaceutical and biotechnology industries to fight antibiotic resistance, physicians and other policy makers said during a press conference sponsored by the Infectious Diseases Society of America. The group released its “hit list” of the six most dangerous, drug-resistant microbes. “These are life-threatening drug-resistant infections, and we're seeing them every day,” said Dr. Martin J. Blaser, IDSA president. “What is worse is that our ammunition is running out and there are no reinforcements in sight.” Market exclusivity—a method that's worked favorably in the past for pediatric drugs, would be an option, he said. So would calling for tax credits for the manufacture or distribution of these products. Another option is to establish an independent commission to identify which drugs are more sufficient in combatting resistant microbes. “The superbugs are not waiting, and neither should we,” Dr. Blaser said.

P4P Comes of Age

More than 100 pay-for-performance programs were operating around the country as of last September, according to a new report from the Alliance for Health Reform. Members of Congress and the Bush administration also are exploring ways to test pay for performance within the Medicare program, including Medicare's voluntary physician reporting program which began earlier this year. So far, the private sector has taken the lead on pay for performance, according to the report. A prime example is the Bridges to Excellence program, sponsored by several large employers and operating in Cincinnati, Louisville, Ky., Massachusetts, and Albany/Schenectady, N.Y. The program is expanding into the District of Columbia/Maryland/Virginia area, Minnesota, and Georgia. The group offers payment incentives to high-performing physicians in the area of diabetes and cardiac care, and in the use of health information technology. But despite the success of this model and some others, critics say there are a number of unanswered questions. For example, proponents need to identify the size of the bonus or penalty needed to make a difference in quality, and to figure out what adjustments need to be made to payment systems across different medical specialties, according to the report.

Specialty Hospital Review

Two influential members of Congress have asked the Office of the Inspector General for the Department of Health and Human Services and the Government Accountability Office to examine patient safety and quality, and the financial arrangements at physician-owned specialty hospitals. Sen. Chuck Grassley (R- Iowa), chairman of the Senate Finance Committee and Sen. Max Baucus (D-Mont.), the committee's ranking member, have been investigating the impact of physician-owned specialty hospitals for the past few years. “There are two issues that leap out for review: patient safety, and the use of taxpayer dollars through Medicare and Medicaid,” Sen. Baucus said in a statement. “If patients' health is at risk in these facilities, we need to uncover that now. If Medicare and Medicaid dollars are paying for less than the best care in these facilities, that demands immediate attention.”

Assessing PsA Treatments

A proposed congressional resolution would direct the Secretary of Health and Human Services to convene a special panel to study the availability of treatments and other medical care to individuals with psoriasis and psoriatic arthritis. Rep. Jim Gerlach (R- Pa.) introduced the resolution (H. Con. Res. 340) in February and at press time nine members of Congress had signed on to support the measure. Under the proposed resolution, the special panel would also consider the ability of psoriasis and psoriatic arthritis patients to access prescription therapies and report its findings to Congress by February 2007. “While new, more effective and safer treatments finally are becoming available, too many people do not yet have access to the treatments that may make a significant difference in the quality of their lives,” the resolution says. The resolution was referred to the House Committee on Energy and Commerce's subcommittee on health.

Musculoskeletal Research Funding

Congress should reject President Bush's fiscal year 2007 budget request and instead allocated more than $500 million to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), according to the American Academy of Orthopaedic Surgeons. Members of the group recently traveled to Capitol Hill to lobby legislators for increased federal funding for musculoskeletal research. Under the President's FY 2007 budget request, NIAMS, part of the National Institutes of Health, would face a $3 million funding cut. In 2003, musculoskeletal conditions accounted for 157 million visits to physician offices, 29 million visits to emergency departments, 15 million visits to hospital outpatient departments, and 8 million hospitalizations, according to the organization.

Fighting Off Bad Bugs

Congress should be taking more aggressive steps to give incentives to pharmaceutical and biotechnology industries to fight antibiotic resistance, physicians and other policy makers said during a press conference sponsored by the Infectious Diseases Society of America. The group released its “hit list” of the six most dangerous, drug-resistant microbes. “These are life-threatening drug-resistant infections, and we're seeing them every day,” said Dr. Martin J. Blaser, IDSA president. “What is worse is that our ammunition is running out and there are no reinforcements in sight.” Market exclusivity—a method that's worked favorably in the past for pediatric drugs, would be an option, he said. So would calling for tax credits for the manufacture or distribution of these products. Another option is to establish an independent commission to identify which drugs are more sufficient in combatting resistant microbes. “The superbugs are not waiting, and neither should we,” Dr. Blaser said.

P4P Comes of Age

More than 100 pay-for-performance programs were operating around the country as of last September, according to a new report from the Alliance for Health Reform. Members of Congress and the Bush administration also are exploring ways to test pay for performance within the Medicare program, including Medicare's voluntary physician reporting program which began earlier this year. So far, the private sector has taken the lead on pay for performance, according to the report. A prime example is the Bridges to Excellence program, sponsored by several large employers and operating in Cincinnati, Louisville, Ky., Massachusetts, and Albany/Schenectady, N.Y. The program is expanding into the District of Columbia/Maryland/Virginia area, Minnesota, and Georgia. The group offers payment incentives to high-performing physicians in the area of diabetes and cardiac care, and in the use of health information technology. But despite the success of this model and some others, critics say there are a number of unanswered questions. For example, proponents need to identify the size of the bonus or penalty needed to make a difference in quality, and to figure out what adjustments need to be made to payment systems across different medical specialties, according to the report.

Researchers now have a pathway for conducting early clinical testing of drugs in a small number of human subjects under new guidance from the Food and Drug Administration.

Officials at the FDA finalized guidance on exploratory investigational new drug (IND) studies which allows researchers to move forward with small human studies before beginning traditional phase I safety testing in humans. The guidance, published in January, makes recommendations on safety testing, manufacturing, and clinical approaches in these early studies.

The FDA also published draft guidance and a direct final rule that outlines new standards for the manufacture of drugs solely for use in phase I studies. The rule is aimed at making it easier for scientists to produce small quantities of drugs for small-scale, early-phase human testing.

“This is about saving lives and about building medicine's future,” said Dr. Andrew von Eschenbach, acting FDA Commissioner of Food and Drugs.

Currently, less than 10% of IND applications for new molecular entities progress beyond the investigational stage, according to the FDA. These changes will remove some of the hurdles from very early drug development, Dr. von Eschenbach said during a media teleconference sponsored by the FDA.

But critics of the approach say it relaxes needed human subjects protections at a time when the safety of clinical trials is already being questioned.

In guidance on the exploratory IND, FDA officials outline their thinking that drug sponsors have not taken full advantage of the flexibility in the existing regulations and often provide more supporting information than is required for an exploratory IND.

Exploratory IND studies involve administering either a subpharmacologic dose of a product or doses that are expected to produce a pharmacologic but not a toxic effect, so the risk to human subjects is considered lower than in a traditional phase I study, the FDA said in its guidance documents.

Since exploratory IND studies pose fewer risks, the FDA said, they can be initiated in humans with less, or different, preclinical support than what is required for traditional IND studies.

Previously, one of the major obstacles in the development of new drugs was that the requirements for beginning early experimental studies were the same as those for large pharmaceutical companies who are making drugs for thousands of patients, Dr. Steven Rosenberg, chief of surgery at the National Cancer Institute, said during the teleconference.

“We've been at the mercy of large biotech and pharmaceutical companies who have the resources to fulfill the very stringent regulations that exist for taking these new products to very large numbers of patients,” he said.

The changes made by the FDA will make it possible for scientists to take new ideas to small numbers of patients with desperate diseases and test those agents in ways that weren't possible before, he said.

But Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said he remains concerned that the usual protection for human subjects has been “watered down.” Under the new process outlined by the FDA, a safety problem that might have been detected through more extensive animal studies now may be missed, he said.

Dr. Wolfe said the types of studies described in the exploratory IND are already being done but with the previous protections in place for human subjects.

Sen. Charles Grassley (R-Iowa), chairman of the Senate Committee on Finance, which has been conducting oversight of the FDA's consumer protections, also expressed safety concerns.

“Of course people want to get safer, better drugs faster, but there have to be sufficient checks and balances in the drug approval process,” Sen. Grassley said in a statement.

The usual protection for human subjects has been 'watered down.' DR. WOLFE

Researchers now have a pathway for conducting early clinical testing of drugs in a small number of human subjects under new guidance from the Food and Drug Administration.

Officials at the FDA finalized guidance on exploratory investigational new drug (IND) studies which allows researchers to move forward with small human studies before beginning traditional phase I safety testing in humans. The guidance, published in January, makes recommendations on safety testing, manufacturing, and clinical approaches in these early studies.

The FDA also published draft guidance and a direct final rule that outlines new standards for the manufacture of drugs solely for use in phase I studies. The rule is aimed at making it easier for scientists to produce small quantities of drugs for small-scale, early-phase human testing.

“This is about saving lives and about building medicine's future,” said Dr. Andrew von Eschenbach, acting FDA Commissioner of Food and Drugs.

Currently, less than 10% of IND applications for new molecular entities progress beyond the investigational stage, according to the FDA. These changes will remove some of the hurdles from very early drug development, Dr. von Eschenbach said during a media teleconference sponsored by the FDA.

But critics of the approach say it relaxes needed human subjects protections at a time when the safety of clinical trials is already being questioned.

In guidance on the exploratory IND, FDA officials outline their thinking that drug sponsors have not taken full advantage of the flexibility in the existing regulations and often provide more supporting information than is required for an exploratory IND.

Exploratory IND studies involve administering either a subpharmacologic dose of a product or doses that are expected to produce a pharmacologic but not a toxic effect, so the risk to human subjects is considered lower than in a traditional phase I study, the FDA said in its guidance documents.

Since exploratory IND studies pose fewer risks, the FDA said, they can be initiated in humans with less, or different, preclinical support than what is required for traditional IND studies.

Previously, one of the major obstacles in the development of new drugs was that the requirements for beginning early experimental studies were the same as those for large pharmaceutical companies who are making drugs for thousands of patients, Dr. Steven Rosenberg, chief of surgery at the National Cancer Institute, said during the teleconference.

“We've been at the mercy of large biotech and pharmaceutical companies who have the resources to fulfill the very stringent regulations that exist for taking these new products to very large numbers of patients,” he said.

The changes made by the FDA will make it possible for scientists to take new ideas to small numbers of patients with desperate diseases and test those agents in ways that weren't possible before, he said.

But Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said he remains concerned that the usual protection for human subjects has been “watered down.” Under the new process outlined by the FDA, a safety problem that might have been detected through more extensive animal studies now may be missed, he said.

Dr. Wolfe said the types of studies described in the exploratory IND are already being done but with the previous protections in place for human subjects.

Sen. Charles Grassley (R-Iowa), chairman of the Senate Committee on Finance, which has been conducting oversight of the FDA's consumer protections, also expressed safety concerns.

“Of course people want to get safer, better drugs faster, but there have to be sufficient checks and balances in the drug approval process,” Sen. Grassley said in a statement.

The usual protection for human subjects has been 'watered down.' DR. WOLFE

Researchers now have a pathway for conducting early clinical testing of drugs in a small number of human subjects under new guidance from the Food and Drug Administration.

Officials at the FDA finalized guidance on exploratory investigational new drug (IND) studies which allows researchers to move forward with small human studies before beginning traditional phase I safety testing in humans. The guidance, published in January, makes recommendations on safety testing, manufacturing, and clinical approaches in these early studies.

The FDA also published draft guidance and a direct final rule that outlines new standards for the manufacture of drugs solely for use in phase I studies. The rule is aimed at making it easier for scientists to produce small quantities of drugs for small-scale, early-phase human testing.

“This is about saving lives and about building medicine's future,” said Dr. Andrew von Eschenbach, acting FDA Commissioner of Food and Drugs.

Currently, less than 10% of IND applications for new molecular entities progress beyond the investigational stage, according to the FDA. These changes will remove some of the hurdles from very early drug development, Dr. von Eschenbach said during a media teleconference sponsored by the FDA.

But critics of the approach say it relaxes needed human subjects protections at a time when the safety of clinical trials is already being questioned.

In guidance on the exploratory IND, FDA officials outline their thinking that drug sponsors have not taken full advantage of the flexibility in the existing regulations and often provide more supporting information than is required for an exploratory IND.

Exploratory IND studies involve administering either a subpharmacologic dose of a product or doses that are expected to produce a pharmacologic but not a toxic effect, so the risk to human subjects is considered lower than in a traditional phase I study, the FDA said in its guidance documents.

Since exploratory IND studies pose fewer risks, the FDA said, they can be initiated in humans with less, or different, preclinical support than what is required for traditional IND studies.

Previously, one of the major obstacles in the development of new drugs was that the requirements for beginning early experimental studies were the same as those for large pharmaceutical companies who are making drugs for thousands of patients, Dr. Steven Rosenberg, chief of surgery at the National Cancer Institute, said during the teleconference.

“We've been at the mercy of large biotech and pharmaceutical companies who have the resources to fulfill the very stringent regulations that exist for taking these new products to very large numbers of patients,” he said.

The changes made by the FDA will make it possible for scientists to take new ideas to small numbers of patients with desperate diseases and test those agents in ways that weren't possible before, he said.

But Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said he remains concerned that the usual protection for human subjects has been “watered down.” Under the new process outlined by the FDA, a safety problem that might have been detected through more extensive animal studies now may be missed, he said.

Dr. Wolfe said the types of studies described in the exploratory IND are already being done but with the previous protections in place for human subjects.

Sen. Charles Grassley (R-Iowa), chairman of the Senate Committee on Finance, which has been conducting oversight of the FDA's consumer protections, also expressed safety concerns.

“Of course people want to get safer, better drugs faster, but there have to be sufficient checks and balances in the drug approval process,” Sen. Grassley said in a statement.

The usual protection for human subjects has been 'watered down.' DR. WOLFE

Americans age 65 and older are living longer with fewer disabling health problems, according to a report from the U.S. Census Bureau.

The decline in disability is partly due to increased education levels among seniors, better treatments for cardiovascular diseases, and improvements in the management of chronic conditions, Richard M. Suzman, Ph.D., associate director of behavioral and social research for the National Institute on Aging said at a press briefing sponsored by the National Institutes of Health.

“Education is a particularly powerful factor in both life expectancy and health,” Dr. Suzman said.

The report, “65+ in the United States: 2005,” draws on existing data to examine the growth of the senior population, longevity and health, economic characteristics, geographic distribution, and social characteristics. The National Institute on Aging, a part of the National Institutes of Health, commissioned the report.

Census officials predict that the number of people age 65 and older will double within the next 25 years, leaving policy makers with more decisions to make on how to pay for and provide care to the senior population.

By 2030, nearly one of every five Americans—about 72 million people—will be 65 or older, said C. Louis Kincannon, director of the U.S. Census Bureau, and already the fastest-growing segment of the U.S. population is seniors age 85 and older.

But if current trends are any indication, those seniors could experience less disability from disease. A number of surveys compiled for the census report show an overall decline in disability among seniors over the past two decades. For example, one study estimates the level of disability at about 20% in 1999, compared with 26% in 1982.

Studies that assess instrumental activities of daily living, such as cooking, light housework, and using the telephone, show declining trends in disability. However, studies evaluating activities of daily living such as bathing, eating, and dressing show mixed results, according to the report.

Evidence from four surveys shows that about 20% of seniors have chronic disability, 7% to 8% have severe cognitive impairments, and about 30% experience difficulty with mobility.

“There still is a huge burden of disability once you look at the oldest old group,” Dr. Jane F. Potter, president-elect of the American Geriatrics Society said in an interview.

Prevention, including encouraging older patients to exercise regularly, is key in combating disability from chronic conditions, said Dr. Potter, who is also the section chief of geriatrics and gerontology at the University of Nebraska in Omaha.

About 80% of seniors have at least one chronic health condition and half have at least two chronic conditions.

Arthritis and heart disease are among the top chronic conditions affecting seniors. In 1998–2000, 19.3% of people age 75 years and older and 11.8% of those age 65 to 74 had activity limitations caused by arthritis and other musculoskeletal conditions. Heart and circulatory diseases affected 11.1% of seniors age 65 to 74 and 17.1% of seniors age 75 and older, according to data collected between 1998 and 2000.

Improvements in socioeconomic and living conditions in the first part of the 20th century and more recently advancements in public health and biomedical research have led to improvements in U.S. life expectancy. Life expectancy in the United States has reached 76.9 years, compared with 47.3 in 1900 and 68.2 in 1950.

But there are still racial differences in life expectancy, and the United States is lagging behind other populous countries, especially Japan and some Western European countries.

Continued progress on life expectancy will require advances in the prevention and treatment of heart disease, improved knowledge of the genetic links to cancer, and the need to adopt healthy lifestyles, according to the report.

The census report also analyzed how seniors were receiving medical care and other support. Individuals age 65 and older were less likely to have a regular source of medical care than younger people. And seniors were more likely to seek care at the emergency departments. The highest rates of emergency department use were among people age 75 and older, according to the report.

Among long-term care arrangements, home and community-based care are the most common. About 70%–80% of noninstitutionalized seniors receive their care from friends and family, frequently with help from a paid provider. But more than 65% of seniors who are noninstitutionalized depend on unpaid help only. Those who received paid care generally get fewer hours of care per week, according to the report.

More than 90% of institutionalized older individuals live in nursing homes, according to the report, and most of those residents are age 85 and older.

Another trend in long-term care is the use of assisted living facilities. A 1999 survey found that more than 800,000 people age 65 and older were living in assisted care facilities, and more than half reported no chronic disability.

“We're in totally unchartered territory,” Dr. Jonathan M. Evans, chief of geriatrics and palliative medicine at the University of Virginia, Charlottesville, said in an interview. One of the biggest concerns is that there will not be enough paid caregivers in 20 years or so to meet the needs of the older population, based on current projections. “We will have to fundamentally rethink the way care is provided,” Dr. Evans said.

But it could be an opportunity, he said, to get family members and volunteers involved in providing care within nursing homes and to make nursing homes a part of the community.

The report is available online at www.census.gov/prod/2006pubs/p23-209.pdf

Americans age 65 and older are living longer with fewer disabling health problems, according to a report from the U.S. Census Bureau.

The decline in disability is partly due to increased education levels among seniors, better treatments for cardiovascular diseases, and improvements in the management of chronic conditions, Richard M. Suzman, Ph.D., associate director of behavioral and social research for the National Institute on Aging said at a press briefing sponsored by the National Institutes of Health.

“Education is a particularly powerful factor in both life expectancy and health,” Dr. Suzman said.

The report, “65+ in the United States: 2005,” draws on existing data to examine the growth of the senior population, longevity and health, economic characteristics, geographic distribution, and social characteristics. The National Institute on Aging, a part of the National Institutes of Health, commissioned the report.

Census officials predict that the number of people age 65 and older will double within the next 25 years, leaving policy makers with more decisions to make on how to pay for and provide care to the senior population.

By 2030, nearly one of every five Americans—about 72 million people—will be 65 or older, said C. Louis Kincannon, director of the U.S. Census Bureau, and already the fastest-growing segment of the U.S. population is seniors age 85 and older.

But if current trends are any indication, those seniors could experience less disability from disease. A number of surveys compiled for the census report show an overall decline in disability among seniors over the past two decades. For example, one study estimates the level of disability at about 20% in 1999, compared with 26% in 1982.

Studies that assess instrumental activities of daily living, such as cooking, light housework, and using the telephone, show declining trends in disability. However, studies evaluating activities of daily living such as bathing, eating, and dressing show mixed results, according to the report.

Evidence from four surveys shows that about 20% of seniors have chronic disability, 7% to 8% have severe cognitive impairments, and about 30% experience difficulty with mobility.

“There still is a huge burden of disability once you look at the oldest old group,” Dr. Jane F. Potter, president-elect of the American Geriatrics Society said in an interview.

Prevention, including encouraging older patients to exercise regularly, is key in combating disability from chronic conditions, said Dr. Potter, who is also the section chief of geriatrics and gerontology at the University of Nebraska in Omaha.

About 80% of seniors have at least one chronic health condition and half have at least two chronic conditions.

Arthritis and heart disease are among the top chronic conditions affecting seniors. In 1998–2000, 19.3% of people age 75 years and older and 11.8% of those age 65 to 74 had activity limitations caused by arthritis and other musculoskeletal conditions. Heart and circulatory diseases affected 11.1% of seniors age 65 to 74 and 17.1% of seniors age 75 and older, according to data collected between 1998 and 2000.

Improvements in socioeconomic and living conditions in the first part of the 20th century and more recently advancements in public health and biomedical research have led to improvements in U.S. life expectancy. Life expectancy in the United States has reached 76.9 years, compared with 47.3 in 1900 and 68.2 in 1950.

But there are still racial differences in life expectancy, and the United States is lagging behind other populous countries, especially Japan and some Western European countries.

Continued progress on life expectancy will require advances in the prevention and treatment of heart disease, improved knowledge of the genetic links to cancer, and the need to adopt healthy lifestyles, according to the report.

The census report also analyzed how seniors were receiving medical care and other support. Individuals age 65 and older were less likely to have a regular source of medical care than younger people. And seniors were more likely to seek care at the emergency departments. The highest rates of emergency department use were among people age 75 and older, according to the report.

Among long-term care arrangements, home and community-based care are the most common. About 70%–80% of noninstitutionalized seniors receive their care from friends and family, frequently with help from a paid provider. But more than 65% of seniors who are noninstitutionalized depend on unpaid help only. Those who received paid care generally get fewer hours of care per week, according to the report.

More than 90% of institutionalized older individuals live in nursing homes, according to the report, and most of those residents are age 85 and older.

Another trend in long-term care is the use of assisted living facilities. A 1999 survey found that more than 800,000 people age 65 and older were living in assisted care facilities, and more than half reported no chronic disability.

“We're in totally unchartered territory,” Dr. Jonathan M. Evans, chief of geriatrics and palliative medicine at the University of Virginia, Charlottesville, said in an interview. One of the biggest concerns is that there will not be enough paid caregivers in 20 years or so to meet the needs of the older population, based on current projections. “We will have to fundamentally rethink the way care is provided,” Dr. Evans said.

But it could be an opportunity, he said, to get family members and volunteers involved in providing care within nursing homes and to make nursing homes a part of the community.

The report is available online at www.census.gov/prod/2006pubs/p23-209.pdf

Americans age 65 and older are living longer with fewer disabling health problems, according to a report from the U.S. Census Bureau.

The decline in disability is partly due to increased education levels among seniors, better treatments for cardiovascular diseases, and improvements in the management of chronic conditions, Richard M. Suzman, Ph.D., associate director of behavioral and social research for the National Institute on Aging said at a press briefing sponsored by the National Institutes of Health.

“Education is a particularly powerful factor in both life expectancy and health,” Dr. Suzman said.

The report, “65+ in the United States: 2005,” draws on existing data to examine the growth of the senior population, longevity and health, economic characteristics, geographic distribution, and social characteristics. The National Institute on Aging, a part of the National Institutes of Health, commissioned the report.

Census officials predict that the number of people age 65 and older will double within the next 25 years, leaving policy makers with more decisions to make on how to pay for and provide care to the senior population.

By 2030, nearly one of every five Americans—about 72 million people—will be 65 or older, said C. Louis Kincannon, director of the U.S. Census Bureau, and already the fastest-growing segment of the U.S. population is seniors age 85 and older.

But if current trends are any indication, those seniors could experience less disability from disease. A number of surveys compiled for the census report show an overall decline in disability among seniors over the past two decades. For example, one study estimates the level of disability at about 20% in 1999, compared with 26% in 1982.

Studies that assess instrumental activities of daily living, such as cooking, light housework, and using the telephone, show declining trends in disability. However, studies evaluating activities of daily living such as bathing, eating, and dressing show mixed results, according to the report.

Evidence from four surveys shows that about 20% of seniors have chronic disability, 7% to 8% have severe cognitive impairments, and about 30% experience difficulty with mobility.

“There still is a huge burden of disability once you look at the oldest old group,” Dr. Jane F. Potter, president-elect of the American Geriatrics Society said in an interview.

Prevention, including encouraging older patients to exercise regularly, is key in combating disability from chronic conditions, said Dr. Potter, who is also the section chief of geriatrics and gerontology at the University of Nebraska in Omaha.

About 80% of seniors have at least one chronic health condition and half have at least two chronic conditions.

Arthritis and heart disease are among the top chronic conditions affecting seniors. In 1998–2000, 19.3% of people age 75 years and older and 11.8% of those age 65 to 74 had activity limitations caused by arthritis and other musculoskeletal conditions. Heart and circulatory diseases affected 11.1% of seniors age 65 to 74 and 17.1% of seniors age 75 and older, according to data collected between 1998 and 2000.

Improvements in socioeconomic and living conditions in the first part of the 20th century and more recently advancements in public health and biomedical research have led to improvements in U.S. life expectancy. Life expectancy in the United States has reached 76.9 years, compared with 47.3 in 1900 and 68.2 in 1950.

But there are still racial differences in life expectancy, and the United States is lagging behind other populous countries, especially Japan and some Western European countries.

Continued progress on life expectancy will require advances in the prevention and treatment of heart disease, improved knowledge of the genetic links to cancer, and the need to adopt healthy lifestyles, according to the report.

The census report also analyzed how seniors were receiving medical care and other support. Individuals age 65 and older were less likely to have a regular source of medical care than younger people. And seniors were more likely to seek care at the emergency departments. The highest rates of emergency department use were among people age 75 and older, according to the report.

Among long-term care arrangements, home and community-based care are the most common. About 70%–80% of noninstitutionalized seniors receive their care from friends and family, frequently with help from a paid provider. But more than 65% of seniors who are noninstitutionalized depend on unpaid help only. Those who received paid care generally get fewer hours of care per week, according to the report.

More than 90% of institutionalized older individuals live in nursing homes, according to the report, and most of those residents are age 85 and older.

Another trend in long-term care is the use of assisted living facilities. A 1999 survey found that more than 800,000 people age 65 and older were living in assisted care facilities, and more than half reported no chronic disability.

“We're in totally unchartered territory,” Dr. Jonathan M. Evans, chief of geriatrics and palliative medicine at the University of Virginia, Charlottesville, said in an interview. One of the biggest concerns is that there will not be enough paid caregivers in 20 years or so to meet the needs of the older population, based on current projections. “We will have to fundamentally rethink the way care is provided,” Dr. Evans said.

But it could be an opportunity, he said, to get family members and volunteers involved in providing care within nursing homes and to make nursing homes a part of the community.

The report is available online at www.census.gov/prod/2006pubs/p23-209.pdf

ORLANDO – Cigarette sales may be at a 55-year low, but such favorable news is probably not due to efforts among physicians to counsel patients to stop smoking.

In fact, physicians broach the topic with smokers during only 1 in 5 office visits, according to a nationwide survey of primary care and specialist physicians.

From their perspective, providers noted that time constraints during the typical office visit and the belief that smokers aren't likely to change their behavior contributed to their inaction.

Physicians who responded to a 2001–2003 national survey reported counseling smokers in 20% of visits, compared with 21% of smokers' visits in a 1994–1996 survey, Dr. Anne N. Thorndike of Massachusetts General Hospital, Boston, reported at the annual meeting of the Society for Research on Nicotine and Tobacco.

And there was only slight improvement in the identification of smokers, she said. In the later survey, physicians reported identifying smoking status during 68% of all visits, compared with 66% of visits in the earlier survey.

The data come from the National Ambulatory Medical Care Survey, an annual assessment of office-based physicians in the United States who see adult patients. The researchers compared 2001–2003 survey data on 58,991 visits with 1994–1996 survey data on 84,104 visits.

The analysis showed that physicians did increase their prescriptions for cessation medications. In 1994–1996, physicians reported prescribing cessation medications during 0.8% of smokers' visits. That figure rose to 1.7% in 2001–2003. The majority of the increase was due to the availability of bupropion, Dr. Thorndike noted.

Primary care physicians were almost twice as likely to offer counseling as were specialists, but as unlikely to identify smokers, she said. Pregnancy increased the likelihood of identification of smoking status but did not increase the likelihood that smokers would be counseled about quitting.

A separate survey of physicians and other health care providers in a Washington state HMO network found that while almost all physicians surveyed said they identify smoking status and discuss it with their patients, fewer report taking any further action.

Anne Perez-Cromwell and her colleagues at Free & Clear Inc. in Seattle mailed a survey to 250 physicians and other providers and received 105 responses. Nearly half of the providers surveyed were family medicine physicians, 15% were internists, and the other providers included family medicine and internal medicine nurse practitioners and physician assistants.

Nearly all providers (97%) said that they made a point of discussing smoking with all patients who smoke, regardless of their health status or interest in quitting.

But only 69% said they referred patients to either the HMO's tobacco cessation program administered by Free & Clear, or the state's quit line. About 15% of respondents said they were aware of treatment resources but did not refer patients, and 16% said they were not aware of the programs.

ORLANDO – Cigarette sales may be at a 55-year low, but such favorable news is probably not due to efforts among physicians to counsel patients to stop smoking.

In fact, physicians broach the topic with smokers during only 1 in 5 office visits, according to a nationwide survey of primary care and specialist physicians.

From their perspective, providers noted that time constraints during the typical office visit and the belief that smokers aren't likely to change their behavior contributed to their inaction.

Physicians who responded to a 2001–2003 national survey reported counseling smokers in 20% of visits, compared with 21% of smokers' visits in a 1994–1996 survey, Dr. Anne N. Thorndike of Massachusetts General Hospital, Boston, reported at the annual meeting of the Society for Research on Nicotine and Tobacco.

And there was only slight improvement in the identification of smokers, she said. In the later survey, physicians reported identifying smoking status during 68% of all visits, compared with 66% of visits in the earlier survey.

The data come from the National Ambulatory Medical Care Survey, an annual assessment of office-based physicians in the United States who see adult patients. The researchers compared 2001–2003 survey data on 58,991 visits with 1994–1996 survey data on 84,104 visits.

The analysis showed that physicians did increase their prescriptions for cessation medications. In 1994–1996, physicians reported prescribing cessation medications during 0.8% of smokers' visits. That figure rose to 1.7% in 2001–2003. The majority of the increase was due to the availability of bupropion, Dr. Thorndike noted.

Primary care physicians were almost twice as likely to offer counseling as were specialists, but as unlikely to identify smokers, she said. Pregnancy increased the likelihood of identification of smoking status but did not increase the likelihood that smokers would be counseled about quitting.

A separate survey of physicians and other health care providers in a Washington state HMO network found that while almost all physicians surveyed said they identify smoking status and discuss it with their patients, fewer report taking any further action.

Anne Perez-Cromwell and her colleagues at Free & Clear Inc. in Seattle mailed a survey to 250 physicians and other providers and received 105 responses. Nearly half of the providers surveyed were family medicine physicians, 15% were internists, and the other providers included family medicine and internal medicine nurse practitioners and physician assistants.

Nearly all providers (97%) said that they made a point of discussing smoking with all patients who smoke, regardless of their health status or interest in quitting.

But only 69% said they referred patients to either the HMO's tobacco cessation program administered by Free & Clear, or the state's quit line. About 15% of respondents said they were aware of treatment resources but did not refer patients, and 16% said they were not aware of the programs.

ORLANDO – Cigarette sales may be at a 55-year low, but such favorable news is probably not due to efforts among physicians to counsel patients to stop smoking.

In fact, physicians broach the topic with smokers during only 1 in 5 office visits, according to a nationwide survey of primary care and specialist physicians.

From their perspective, providers noted that time constraints during the typical office visit and the belief that smokers aren't likely to change their behavior contributed to their inaction.

Physicians who responded to a 2001–2003 national survey reported counseling smokers in 20% of visits, compared with 21% of smokers' visits in a 1994–1996 survey, Dr. Anne N. Thorndike of Massachusetts General Hospital, Boston, reported at the annual meeting of the Society for Research on Nicotine and Tobacco.

And there was only slight improvement in the identification of smokers, she said. In the later survey, physicians reported identifying smoking status during 68% of all visits, compared with 66% of visits in the earlier survey.

The data come from the National Ambulatory Medical Care Survey, an annual assessment of office-based physicians in the United States who see adult patients. The researchers compared 2001–2003 survey data on 58,991 visits with 1994–1996 survey data on 84,104 visits.

The analysis showed that physicians did increase their prescriptions for cessation medications. In 1994–1996, physicians reported prescribing cessation medications during 0.8% of smokers' visits. That figure rose to 1.7% in 2001–2003. The majority of the increase was due to the availability of bupropion, Dr. Thorndike noted.

Primary care physicians were almost twice as likely to offer counseling as were specialists, but as unlikely to identify smokers, she said. Pregnancy increased the likelihood of identification of smoking status but did not increase the likelihood that smokers would be counseled about quitting.

A separate survey of physicians and other health care providers in a Washington state HMO network found that while almost all physicians surveyed said they identify smoking status and discuss it with their patients, fewer report taking any further action.

Anne Perez-Cromwell and her colleagues at Free & Clear Inc. in Seattle mailed a survey to 250 physicians and other providers and received 105 responses. Nearly half of the providers surveyed were family medicine physicians, 15% were internists, and the other providers included family medicine and internal medicine nurse practitioners and physician assistants.

Nearly all providers (97%) said that they made a point of discussing smoking with all patients who smoke, regardless of their health status or interest in quitting.

But only 69% said they referred patients to either the HMO's tobacco cessation program administered by Free & Clear, or the state's quit line. About 15% of respondents said they were aware of treatment resources but did not refer patients, and 16% said they were not aware of the programs.