An Ounce of Prevention...

A Publication of the
Program on Prevention
In Education & Practice

November 2002 - Volume 1, Number 13

Our Farewell (for a while) Edition

It is with sadness that we present this final edition of "An Ounce of Prevention..." The Program is undergoing changes that will force us to suspend publication for the present.

Co-Director Linda Kinsinger, MD, MPH has accepted a new position with the VA National Center for Health Promotion and Disease Prevention, located in Durham. Linda will be Assistant Director for Policy, Programs, Training and Education. This was a difficult decision for Linda after years of hard work and dedication to develop UNC's Program on Prevention... but she is excited about this new opportunity to work on clinical prevention issues in a national healthcare system.

Because of budget cuts, Amy Ward, Education Coordinator for the Program, will also be leaving the program in December. Amy has been with the Program for about four and a half years and has been instrumental in creating a student presence in the educational programs and projects the Program has created. Amy will finish her Master's degree in public relations at the UNC School of Journalism and Mass Communications in June 2003. She is eager to use her newly acquired public relations skills in addition to her educational training to create health awareness programs for adolescents, particularly in the area of school violence prevention.

Russ Harris, MD, MPH will become sole heir to the Program on Prevention and take over as the Director of the Program. He will continue to provide educational experiences for our UNC medical students during the sessions on "hidden topics," and the Breast Cancer Case Study days, as a small-group leading for Clinical Epidemiology and advisor for the Prevention in ACTion student interest group. He will also become Director of the Health Care and Prevention MPH program and continue his many other roles in the School of Public Health, Sheps Center and providing patient care at Chatham Crossing Medical Center.

We thank you for your continued support of the Program in achieving its goals through the years and hope you will continue to provide your support and encouragement through this change.

Does North Carolina Make the Grade for Prevention?

If your child brought home a report card with D's and F's, it would probably be time for a talk and focus on improvement. That's what North Carolina Prevention Partners (NCPP) is hoping will happen for the state of North Carolina. They recently released their 2002 Prevention Report Card for North Carolina; there is bad news and worse news. The NCPP Report Card Committee focused on three top priorities for this report card: tobacco, nutrition and physical activity. Why these three areas? First, they were interested in zeroing in on critical prevention issues - two-thirds of North Carolina's preventable deaths are related to tobacco, nutrition and physical activity. Second, they were interested in linking behaviors to health outcomes including hospitalizations and deaths. And, thirdly, they wanted to consider issues with a substantial cost to North Carolina.

TOBACCO
So, how'd we do? Let's start with the best news. The grade for tobacco was a D- because of items such as this:
only 13% (15/117) of NC school districts are 100% smoke-free for all campus and school-related events; and
NC sales tax on cigarettes is only 5 cents verses an average of 59 cents for the rest of the nation.

There is reason to be hopeful, however. 75% of NC employees report that smoking is not allowed in the workplace. We know that a smoke-free work site is the number one reason for adults to quit smoking. Also 73% of smokers have been counseled within the past year to quit smoking. Counseling by physicians is the number two reason adults quit. So keep up the good work... just keep it up more. Other good news is that the NC State School Board passed a resolution for all school campuses to be 100% tobacco free. North Carolina's Health and Wellness Trust Commission allocated $6.2 million per year for three years for Tobacco Use Prevention and Cessation youth programs. YEAH!

NUTRITION gets a big F.
Unbelievable... 59% of NC adults, 56% of senior citizens, 20% of children 5-11 years and 26% of children 12-18 years (those served in WIC and local health departments) are overweight or obese.

We're on our way though... 93% of NC counties have a Winner's Circle Healthy Dining Program in local restaurants. Some of these restaurants are Subway, Golden Coral, and Libby Hill Seafood. Also, 65% of NC hospitals offer weight control programs or nutrition centers.

PHYSICAL ACTIVITY also gets a failing grade.
This concern gets mixed reviews because while it appears that adults are getting some physical activity, kids aren't. Forty-two percent of NC adults and 34% of senior citizens get the recommended amount of activity. On the down side, only 43% of overweight or obese adults report that their doctors counseled them about physical activity or exercise within the past year.

Only 50% of public healthcare (ie: the state plan, Medicare) plans provide benefits in these three areas. Private health care plans did somewhat better with about 70% providing benefits in the three areas. And the news gets worse... since NCPP first started releasing the report card in 1998, the grades have gone down.

The data used to give grades were compiled by the NC Prevention Partners Report Card Committee. Grades were calculated using the "Making an "A" in Prevention Grading Wheel" which is based on the Healthy People 2010 objectives for the nation. Details about the Grading Wheel may be found at www.ncpreventionpartners.org/improving.

Breast Self Exam- To do or not to do?

According to a recent study* published in the Journal of the National Cancer Institute, routine breast self exam (BSE) is not effective in reducing mortality from breast cancer. The authors of this study followed a group of 266,064 women in Shanghai, China for 10-11 years to determine whether an intensive program of BSE instruction would reduce mortality due to breast cancer. The women were randomly assigned to a control group or a group that was repeatedly taught BSE procedures. At the end of the study period, 135 women in the BSE instruction group died of breast cancer, compared with 131 in the control group. The results of this study have given rise to a great deal of controversy surrounding BSE.

Part of the problem is that teaching women to do BSE seems like a rational, cheap and simple way to prevent breast cancer. Unfortunately, the evidence doesn't support this belief. It is much more difficult and expensive than it first appears. BSE is very difficult to do well and research done here at UNC shows that it is quite expensive to teach women to do BSE correctly because it involves repeat training by highly trained practitioners.

Drs. Harris and Kinsinger wrote an editorial** that accompanied this study. In their editorial they made the very important point that the results of the study DO NOT mean women should completely ignore their bodies. They say that women who incidentally discover breast abnormalities (in the shower or in the mirror as they dress) should still seek a clinical evaluation. However, the ritualistic monthly exam that often results in guilt, fear and unnecessary procedures isn't an effective prevention measure.

* Thomas D, et al. Randomized trial of breast self-examination in Shanghai: Final results. JNCI. 2002;94:1445-57.
**Harris R & Kinsinger L. Routinely teaching breast self-examination is dead. What does this mean? JNCI. 2002;94:1420-21.

If you have comments or questions about this newsletter or its contents, please e-mail alward@med.unc.edu.

Program Director: Russ Harris, MD, MPH
Education Coordinator & Editor: Amy L. Ward

Go to the Program on Prevention Homepage