US Surgeon General Research Articles

Missing Teeth: Reviewing the Sociology of Oral Health and Healthcare

AbstractBoth the US Surgeon General and the World Health Organization have called for further social scientific research on the social determinants of oral health. Oral disease can have detrimental effects on quality of life, having been linked with physical, mental, and social impairments. This article reviews the recent literature pertaining to the sociology of oral health and healthcare. The purpose of this review is to summarize and revive a necessary field. In order to maintain a focus on the United States and expand into other social science disciplines, relevant anthropological works were also included. The review discusses five key areas in both the sociology and anthropology of oral health. Of the 25 included articles, research maintained a focus on the dental profession, the construction of oral health, the mouth and the social self, social factors in dental care, and cultural assumptions of oral health. While the reviewed studies have aided in closing the gap, much of the research has been conducted outside of the United States, has used oral health as a case study for larger arguments, and has not considered the role of social inequality. Future research is necessary to more fully frame oral health and healthcare in society.

Perceptions of family history and genetic testing and feasibility of pedigree development among African Americans with hypertension.

Pedigree development, family history, and genetic testing are thought to be useful in improving outcomes of chronic illnesses such as hypertension (HTN). However, the clinical utility of pedigree development is still unknown. Further, little is known about the perceptions of African Americans (AAs) of family history and genetic testing. This study examined the feasibility of developing pedigrees for AAs with HTN and explored perceptions of family history and genetic research among AAs with HTN. The US Surgeon General's My Family Health Portrait was administered, and 30-60 min in-person individual interviews were conducted. Descriptive statistics were used to analyze pedigree data. Interview transcripts were analyzed with content analysis and constant comparison. Twenty-nine AAs with HTN were recruited from one free clinic (15 women, 14 men; mean age 49 years, standard deviation (SD) 9.6). Twenty-six (90%) reported their family history in sufficient detail to develop a pedigree. Perceptions of family history included knowledge of HTN in the family, culturally influenced family teaching about HTN, and response to family history of HTN. Most participants agreed to future genetic testing and DNA collection because they wanted to help others; some said they needed more information and others expressed a concern for privacy. The majority of AAs in this sample possessed extensive knowledge of HTN within their family and were able to develop a three-generation pedigree with assistance. The majority were willing to participate in future genetic research.

Is There a Link Between Oral Health and Diabetes?

Since the US Surgeon General's report on oral health in the year 2000, there has been an increased interest in determining whether a link exists between oral health and overall health. Several systemic diseases appear to be correlated with periodontal disease, an inflammatory disease that affects the soft and hard structures that support the teeth, but the mechanisms are generally unknown. This presentation will evaluate the “association” and “reversibility” between diabetes and oral health, on the basis of an evaluation of the highest level of evidence (meta-analyses and systematic reviews) available up to March 2014. The high-level evidence indicates that patients with diabetes had significantly more severe markers for periodontal disease activity (e.g. poorer oral hygiene levels, more severe gingival disease and more severe periodontitis). The treatment of periodontitis and regular preventive measures including scaling is efficacious in improving glycemic control in patients with diabetes, lending further support to the concept that the association is reversible. An understanding of these correlations is important to allow dental and diabetes healthcare providers to inform their patients of increased risks and to counsel such patients to seek additional medical and dental assessment or intervention, as indicated.

Exclusive breastfeeding for six months: the WHO six months recommendation in the Asia Pacific Region.

In 2001 the World Health Assembly adopted the infant feeding strategy which included the recommendation for exclusive breastfeeding until 6 months of age with continued breastfeeding while complementary foods are introduced. This recommendation has been endorsed by many national authorities, professional organisations and most countries in the Asia Pacific Region. Reviews by WHO, the US Surgeon General, Agency for Healthcare Research and Quality, US Department of Health and Human Services and others have documented the many benefits of breastfeeding. The introduction of solid foods before six months of age is associated with increased rates of infection, reduced breastmilk production, disruption to the microbiome and possibly obesity. If solids are introduced at around six months (by 26 weeks) there is no evidence of increases in allergic diseases.

Seasonal variation in night blindness incidence among Union soldiers in the US Civil War.

During the US Civil War, medical officers typically attributed night blindness among soldiers to malingering. A dietary basis was not generally suspected or appreciated. Incident cases of night blindness, scurvy, and diarrheal diseases, as well as mean troop strength among Union troops, were abstracted by month and race from tabulations of the US Surgeon General for the period from July 1861 through June 1866. Monthly incidence rates and annual incidence rates are presented as time series by race. Night blindness incidence was seasonal. Seasonal patterns of night blindness incidence were similar for white and black soldiers, although the peak incidence rates were approximately 2-3 times higher in black soldiers. The seasonal effect for white Union soldiers increased progressively to 1864. The seasonal pattern for night blindness roughly parallels that for scurvy and for diarrheal diseases. The peak season for night blindness incidence was summer, and the next highest season was spring. The mode of monthly incidence rates for diarrheal diseases slightly anticipated that for night blindness and scurvy. In addition, there was greater relative variation in monthly incidence for night blindness and scurvy than for diarrheal diseases. Nutritional night blindness occurred in a seasonal pattern among soldiers forced to subsist on nutritionally inadequate diets. The seasonal pattern is consistent with seasonal variations in the availability of foodstuffs with high vitamin A or provitamin A content, superimposed on marginal vitamin A reserves, and possibly exacerbated by co-occurring seasonal patterns of diarrheal disease.

Telephone Peer Counseling of Breastfeeding Among WIC Participants: A Randomized Controlled Trial

The US Surgeon General has recommended that peer counseling to support breastfeeding become a core service of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). As of 2008, 50% of WIC clients received services from local WIC agencies that offered peer counseling. Little is known about the effectiveness of these peer counseling programs. Randomized controlled trials of peer counseling interventions among low-income women in the United States showed increases in breastfeeding initiation and duration, but it is doubtful that the level of support provided could be scaled up to service WIC participants nationally. We tested whether a telephone peer counseling program among WIC participants could increase breastfeeding initiation, duration, and exclusivity. We randomly assigned 1948 WIC clients recruited during pregnancy who intended to breastfeed or were considering breastfeeding to 3 study arms: no peer counseling, 4 telephone contacts, or 8 telephone contacts. We combined 2 treatment arms because there was no difference in the distribution of peer contacts. Nonexclusive breastfeeding duration was greater at 3 months postpartum for all women in the treatment group (adjusted relative risk: 1.22; 95% confidence interval [CI]: 1.10-1.34) but greater at 6 months for Spanish-speaking clients only (adjusted relative risk: 1.29; 95% CI: 1.10-1.51). The likelihood of exclusive breastfeeding cessation was less among Spanish-speaking clients (adjusted odds ratio: 0.78; 95% CI: 0.68-0.89). A telephone peer counseling program achieved gains in nonexclusive breastfeeding but modest improvements in exclusive breastfeeding were limited to Spanish- speaking women.

Tobacco Control Policy and Electronic Cigarettes

Tobacco Control Policy and Electronic Cigarettes

Www.smokehaz.eu – a review of the evidence on smoking and lung health

This year marks the 50th anniversary of the landmark report on smoking and health, released by US Surgeon General Dr. Luther Terry [1]. It was the first US government advisory committee report linking smoking and ill health. The report was a wake-up call for America and the world. The Advisory Committee, headed up by Terry, concluded in 1964 that: “Cigarette smoking contributes substantially to mortality from certain specific diseases and to the overall death rate.” “Cigarette smoking is causally related to lung cancer in men; the magnitude of the effect of cigarette smoking far outweighs all other factors. The data for women, though less extensive, point in the same direction.” “Cigarette smoking is the most important of the causes of chronic bronchitis in the United States, and increases the risk of dying from chronic bronchitis and emphysema.” “Male cigarette smokers have a higher death rate from coronary artery disease than non-smoking males…” This rigorous scientific report laid the foundation for tobacco control efforts in the USA and around the world. This year sees the welcome continuation of the Terry tradition of rigorous science with …

E‐cigarettes and the future of tobacco control

E‐cigarettes and the future of tobacco control

Protecting our children from environmental tobacco smoke: one of our great healthcare challenges

This editorial refers to ‘Exposure to parental smoking in childhood or adolescence is associated with increased carotid intima-media thickness in young adults: evidence from the Cardiovascular Risk in Young Finns Study and the Childhood Determinants of Adult Health study’[†][1], by S. Gall et al. , on page 2484. This year marks the 50th anniversary of the US Surgeon General's first report on Smoking and Health. This landmark report in 1964 concluded that cigarette smoking is harmful and causes lung and laryngeal cancer. In 1986, the Surgeon General released a further report on the Health Consequences of Involuntary Smoking , providing conclusive evidence that environmental tobacco smoke (ETS) exposure, or passive smoking, causes lung cancer. Half a century later and despite major public health initiatives on tobacco control, tobacco use remains a leading cause of preventable death worldwide. It is estimated that about one-third of adults are regularly exposed to ETS globally.1 Within the European Union (EU), ∼14% of non-smokers are exposed to ETS at home, and 30% of working adults are potentially exposed to passive smoking at the workplace.2 Astonishingly, as many as 700 million children worldwide are also exposed to ETS, mostly at home.3 Furthermore, those who are most likely to smoke are between the ages of 20 and 45, a period that coincides with parenthood.4 … [1]: #fn-2

TCORS set to support the FDA's regulatory role: Program designed to generate tobacco‐related research to inform policy

TCORS set to support the FDA's regulatory role: Program designed to generate tobacco‐related research to inform policy

O025 Exposure to secondhand smoke and risk of peripheral arterial disease in Southern Chinese non-smokers: The Guangzhou Biobank Cohort Study-Cardiovascular Disease Subcohort

Objectives: We studied the association between secondhand smoke (SHS) exposure and peripheral arterial disease (PAD) in Chinese non-smokers. Methods: We conducted a cross-sectional study using baseline data from the Guangzhou Biobank Cohort Study: Cardiovascular Disease Sub-cohort Study (GBCS-CVD). Guangzhou residents aged ≥ 50 years were recruited between 2003 and 2008. Baseline data included measurement of ankle brachial pressure index (ABPI) and self-reported smoking status and SHS exposure. Univariate and multivariate logistic regression analyses were used to analyze the association between SHS and PAD (defined as ABPI < 0.9). Results: Of the 1507 non-smokers, 24 (1.6%) had PAD. Of these, 12 were men and 12 were women. Exposure to SHS at home of ≥25 h per week was reported by 16.7% of PAD cases compared with 3.8% of those without PAD (χ2 test, p = 0.003). After adjustment for potential confounders, exposure to ≥25 h per week at home was still associated with PAD (adjusted OR 7.86, 95% CI 2.00–30.95, p = 0.003), with suggestion of a dose-response relationship. Conclusions: Our results extend the US Surgeon General’s 2006 report that SHS exposure is an independent risk factor for PAD. National smoke-free legislation is needed to protect all people from exposure.

Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy.

We conducted a systematic review and meta-analysis to characterize the relationship between smoking and miscarriage. We searched the PubMed database (1956-August 31, 2011) using keywords and conducted manual reference searches of included articles and reports of the US Surgeon General. The full text of 1,706 articles was reviewed, and 98 articles that examined the association between active or passive smoking and miscarriage were included in the meta-analysis. Data were abstracted by 2 reviewers. Any active smoking was associated with increased risk of miscarriage (summary relative risk ratio = 1.23, 95% confidence interval (CI): 1.16, 1.30; n = 50 studies), and this risk was greater when the smoking exposure was specifically defined as during the pregnancy in which miscarriage risk was measured (summary relative risk ratio = 1.32, 95% CI: 1.21, 1.44; n = 25 studies). The risk of miscarriage increased with the amount smoked (1% increase in relative risk per cigarette smoked per day). Secondhand smoke exposure during pregnancy increased the risk of miscarriage by 11% (95% CI: 0.95, 1.31; n = 17 studies). Biases in study publication, design, and analysis did not significantly affect the results. This finding strengthens the evidence that women should not smoke while pregnant, and all women of reproductive age should be warned that smoking increases the risk of miscarriage.

A To-Do List for the Next US Surgeon General

A To-Do List for the Next US Surgeon General

The 50th Anniversary of the US Surgeon General's Report on Tobacco: What We've Accomplished and Where We Go From Here

January 11, 2014, marks the 50th anniversary of a significant milestone in our nation's public health. It was on this date in 1964 that US Surgeon General, Dr. Luther Terry, courageously released the first Surgeon General's Report on Smoking and Health.[1][1] This landmark report transformed the way

The 2014 Surgeon General's Report: Commemorating the 50th Anniversary of the 1964 Report of the Advisory Committee to the US Surgeon General and Updating the Evidence on the Health Consequences of Cigarette Smoking

The question of whether cigarette smoking was associated with lung cancer was central to the expansion of epidemiology into the study of chronic diseases in the 1950s. The culmination of this era was the 1964 report of the Advisory Committee to the Surgeon General, a landmark document that included an objective synthesis of the evidence of the health consequences of smoking according to causal criteria. The report concluded that cigarette smoking was a cause of lung cancer in men and sufficient in scope that "remedial action" was warranted at the societal level. The 2014 Surgeon General's report commemorates the 50th anniversary of the 1964 report. The evidence on the health consequences of smoking has been updated many times in Surgeon General's reports since 1964. These have summarized our increasingly greater understanding of the broad spectrum of the deleterious health effects of exposure to tobacco smoke across most major organ systems. In turn, this evidence has been translated into tobacco control strategies implemented to protect the public's health. The Surgeon General report process is an enduring example of evidence-based public health in practice. Substantial progress has been made, but cigarette smoking remains one of the most pressing global health issues of our time.

The Evolution of Physical Activity on Prescription (FaR) in Sweden

In 1996, the first Report of the US Surgeon General on Physical Activity and Health provided an extensive knowledge overview about the positive effects of physical activity (PA) on several health outcomes and PA recommendations. This contributed to an enhanced interest for PA in Sweden. The Swedish Professional Associations for Physical Activity (YFA) were appointed to form a Scientific Expert Group in the project “Sweden on the Move” and YFA created the idea of Physical Activity on Prescription (FaR) and the production of a handbook (FYSS) for healthcare professionals. In Swedish primary care, licensed healthcare professionals, i.e. physicians, physiotherapists and nurses, can prescribe PA if they have sufficient knowledge about the patient’s current state of health, how PA can be used for promotion, prevention and treatment and are trained in patient-centred counselling and the FaR method. The prescription is followed individually or by visiting local FaR providers. These include sport associations, patient organisations, municipal facilities, commercial providers such as gyms, sports clubs and walking clubs or other organisations with FaR educated staff such as health promoters or personal trainers. In clinical practice, the FaR method increases the level of PA in primary care patients, at 6 and at 12 months. Self-reported adherence to the prescription was 65% at 6 months, similar to the known compliance for medications. In a randomised controlled trial, FaR significantly improved body composition and reduced metabolic risk factors. It is suggested that a successful implementation of PA in healthcare depends on a combination of a systems approach (socio-ecological model) and the strengthening of individual motivation and capability. General support from policymakers, healthcare leadership and professional associations is important. To lower barriers, tools for implementation and structures for delivery must be readily available. Examples include handbooks such as FYSS, the FaR system and the use of pedometers.

Abstract 18709: Older Former Smokers with &lt;32 Pack-Years of Prior Smoking and &lt;15 Years of Abstinence Have Lower Risk of Incident Heart Failure and Cardiovascular Mortality But Not of All-Cause Mortality: Findings From a Prospective Population Study

Background: According to the US Surgeon General, the cardiovascular (CV) risk of former-smokers may become similar to that of never-smokers after 15 years of abstinence. We have previously demonstrated that former heavy smokers (≥32 pack-years) may still be at increased risk of incident heart failure (HF) despite &gt;15 years of abstinence (Circulation 2010; 122: A17788 and Circulation 2011; 124: A18263 ). In the current study, we examined the risk of incident HF and mortality in former light and heavy smokers who quit ≤15 years ago. Methods: Of the 3410 community-dwelling adults, age ≥65 yrs, free of baseline HF, in the Cardiovascular Health Study, 2557 were never-smokers and 853 were former-smokers who quit ≤15 (median, 8) years ago. Heavy smoking was defined as ≥32 PY of smoking. Cox regression models were adjusted for age, sex and race only as other baseline confounders were likely affected by prior smoking and acted as mediators. Results: Unadjusted and age-sex-race adjusted associations of former smoking with outcomes during 13 years of follow-up are displayed in the Table . Conclusions: We found no evidence of higher risk for incident HF and CV mortality among former light smokers who quit 15 or fewer (median, 8) years ago when compared with never smokers, although the risk for all-cause and non-CV mortality was higher. Former heavy smokers had significantly higher risk for all outcomes.

Why Race Still Matters 50 years After the Enactment of the 1964 Civil Rights Act

With the presidential election and re-election of Barack Obama and the increasing presence of successful black people in all spheres of life, one could be justified in seeing this as evidence that 50 years after the enactment of the 1964 Civil Rights Act, race is no longer a barrier to success for black people in contemporary America. Indeed, there are many who believe that America is now in a post-racial era where class is more relevant than race in determining the life chances of black people. To be sure, black people have made unprecedented strides in the 50 years since the enactment of the 1964 Civil Rights Act. In higher education, a record of 4.5 million black people has a 4-year college degree. Moreover, from 1985 to 2005/6, the number of black people with a professional degree (e.g., medicine, law, dentistry, etc.) or master's degree doubled and quadrupled respectively. Furthermore, more than 100,000 living black people hold doctoral degrees, also a record-high number (The Journal of Blacks in Higher Education 2013). Equally impressive is the unprecedented number of blacks that have or do a hold a key presidential cabinet position. For example, since 1990, two black people have held the position of US Security of Defense, four have held the position of US Surgeon General, and Eric Holder currently holds the office of US Attorney General, the first black person to do so. Finally, the term black middle class has entered the lexicon of discourse to describe the sizeable number of educated black people who, by virtue of movement into a wider range of professions and higher income brackets than what was possible prior to the 1964 Civil Rights Act, are increasingly differentiated economically from the so-called black underclass (Harris 2010). Yet as tempting as it is to embrace the notion that these developments are evidence of a post-racial era, a black/white comparison across some of the most significant quality of life indicators suggest that the gains some black people have made has not vanquished American prejudice, injustice, or the racial disparities in access to resources. Rather, they have obfuscated them, making them less apparent but no less J Afr Am St (2014) 18:251–259 DOI 10.1007/s12111-013-9264-3

Position Statement on Tobacco Exposures in Children and Families

Tobacco use was declared a “pediatric disease” in 1995 by the US Food and Drug Administration due to the strong connection between tobacco use/exposure in children (Kessler et al., 1997). Tobacco use and exposure are the single most preventable causes of morbidity and mortality in the United States and worldwide. The health consequences during childhood have been clearly documented, and the US Surgeon General stated in 2006 there are no safe levels of tobacco exposure (US Department of Health and Human Services, 2010a). The first position statement on tobacco exposures was developed by the Society of Pediatric Nurses (SPN) Public Policy Committee in 2004. Tobacco use, particularly among childbearing and childrearing families, has decreased slightly since 2004, though tobacco use and exposure remains a critical health issue for vulnerable populations of children and families. SPN is dedicated to supporting its members in their practice, as well as promoting the health and wellbeing of children and families. Pediatric nurses can play a pivotal role in reducing tobacco use and children’s tobacco exposure. Interventions to reduce tobacco use and exposure can include clinical advice, counseling, referral to smoking cessation, and policy changes. While most pediatric nurses may conduct these interventions in health-related settings, attention must be directed to other settings that serve children, such as preschool programs, schools, recreational programs, community settings, and others. Working together we, as pediatric nurses, can strive for the goal that all children have the right to grow up in a smokefree and healthy environment. Tobacco exposures—that is, tobacco use, secondhand smoke, or thirdhand smoke exposure—are highly prevalent