Showing papers by "Thomas E. Novotny published in 2009"

Cigarettes butts and the case for an environmental policy on hazardous cigarette waste.

Abstract: Discarded cigarette butts are a form of non-biodegradable litter. Carried as runoff from streets to drains, to rivers, and ultimately to the ocean and its beaches, cigarette filters are the single most collected item in international beach cleanups each year. They are an environmental blight on streets, sidewalks, and other open areas. Rather than being a protective health device, cigarette filters are primarily a marketing tool to help sell 'safe' cigarettes. They are perceived by much of the public (especially current smokers) to reduce the health risks of smoking through technology. Filters have reduced the machine-measured yield of tar and nicotine from burning cigarettes, but there is controversy as to whether this has correspondingly reduced the disease burden of smoking to the population. Filters actually may serve to sustain smoking by making it seem less urgent for smokers to quit and easier for children to initiate smoking because of reduced irritation from early experimentation. Several options are available to reduce the environmental impact of cigarette butt waste, including developing biodegradable filters, increasing fines and penalties for littering butts, monetary deposits on filters, increasing availability of butt receptacles, and expanded public education. It may even be possible to ban the sale of filtered cigarettes altogether on the basis of their adverse environmental impact. This option may be attractive in coastal regions where beaches accumulate butt waste and where smoking indoors is increasingly prohibited. Additional research is needed on the various policy options, including behavioral research on the impact of banning the sale of filtered cigarettes altogether.

Dyslipidemia and Adherence to the Mediterranean diet in Croatian HIV-infected Patients during the First Year of Highly Active Antiretroviral Therapy

Abstract: We investigated the association of adherence to the Mediterranean diet and other risk factors for dyslipidemia in HIV-infected Croatian patients during the first year of highly active antiretroviral therapy (HAART). Adherence to the Mediterranean diet was determined by a 150-item questionnaire; a 0 to 9-point diet scale was created that stratified respondents as having low adherence ( or = 4 points). We interviewed 117 participants between May 2004 and June 2005 and abstracted their serum lipid measurements taken during the first year of HAART The values of total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides increased most prominently in the first 3 to 6 months after initiation of HAART (average increase at 3 months: 25% for total cholesterol, 22% for LDL-cholesterol, 18% for HDL-cholesterol and 43% for triglycerides). A Mediterranean diet and physical activity had no effect on serum lipids. The mean total cholesterol was higher in participants receiving a combination of a non-nucleoside reverse transcriptase inhibitor and a protease inhibitor compared to participants receiving a combination of nucleoside analogs with a non-nucleoside analog or a combination of nucleoside analogs and a protease inhibitor Among individual drug treatments, indinavir/ritonavir had the most unfavorable lipid profile. We conclude that adherence to a Mediterranean diet does not influence serum lipid profiles during the first year of HAART.

Filtered Cigarettes and the Case for an Environmental Policy on Cigarette Waste

Abstract: Discarded cigarette filters are a form of non-biodegradable litter. Carried as runoff from streets to drains, to rivers, and ultimately to the ocean and its beaches, cigarette filters are the single most collected item each year in international beach cleanups. They are an environmental blight on streets, sidewalks, and other open areas. Rather than being a protective health device, cigarette filters are primarily a marketing tool to help sell 'safe' cigarettes. They are perceived by much of the public (especially current smokers) to reduce the health risks of smoking through technology. Filters have reduced the machine-measured yield of tar and nicotine from burning cigarettes, but there is controversy as to whether this has reduced the disease burden of smoking to the population. Filters actually may serve to sustain smoking by making it seem less urgent for smokers to quit and easier for children to initiate smoking because of reduced irritation from early experimentation. Several options are available to reduce the environmental impact of cigarette butt litter, including developing biodegradable filters, increasing fines and penalties for littering filters, monetary deposits on filters, increasing availability of butt receptacles, and expanded public education. It may even be possible to ban the sale of filtered cigarettes altogether on the basis of their adverse environmental impact. This option may be especially attractive in coastal states where beaches

Adherence to the Mediterranean diet is associated with a lower risk of body-shape changes in Croatian patients treated with combination antiretroviral therapy.

Abstract: Lipoatrophy and lipohypertrophy have been observed during long-term combination antiretroviral therapy (CART). We investigated whether consumption of a Mediterranean diet is associated with lower risk of body-shape changes in Croatian patients treated with CART. Between May 2004 and June 2005, we conducted a cross-sectional study of 136 adults with HIV-1 infection who were treated with CART for at least 1 year. Lipoatrophy and lipohypertrophy were assessed by self-report and physical examination. Adherence to a Mediterranean diet was determined by a 150-item questionnaire; a 0–9 point diet scale was created that stratified respondents as having low adherence (<4 points) and moderate to high adherence (≥4 points). Lipoatrophy was present in 41% and lipohypertrophy in 32% of participants. Non-smokers with a dietary score ≥4 had the lowest risk for lipoatrophy. Stavudine use, female gender, and duration of CART were also independently associated with a higher risk of lipoatrophy. A dietary score of ≥4 was associated with lower risk of lipohypertrophy (adjusted OR 0.3, 95% CI 0.1–0.7; P = 0.012). Female gender, longer duration of CART, and longer known duration of HIV infection prior to CART were also independently associated with higher risk of lipohypertrophy. In conclusion, Croatians who did not smoke and moderately or highly adhered to the Mediterranean diet were least likely to have the clinical syndrome of lipoatrophy. Moderate to high adherence to a Mediterranean diet was associated with a lower risk of lipohypertrophy.

Policy coherence in US tobacco control: beyond FDA regulation.

Abstract: As the Obama administration moves to enact meaningful and comprehensive health care reform in the United States, tobacco control must be elevated as a public health priority [1]. Though tobacco control efforts have been recognized as a top public health achievement of the 20th century [2], tobacco use continues to be the leading preventable cause of death in the US [3]. As Box 1 shows, the US bears a heavy burden from the health and fiscal effects of smoking. Thus, continued progress in preventing tobacco use and promoting smoking cessation must be a leading priority for health care reform under the new administration. This policy paper gives the current status of tobacco control policies, initiatives, and legislative action at the time of going to press. Box 1. Health and Economic Burdens of Smoking, United States Tobacco use… …is the leading preventable cause of death. At least 443,000 annual premature deaths in the United States from 2000–2004 were attributable to smoking [33]. …leads to premature death. During 2000–2004, 5.1 million years of productive life were lost due to cigarette smoking and exposure to passive smoking per year [33]. …contributes to health disparities. African Americans, Native Americans/Alaska Natives, the poor, and people with lower educational attainment suffer from a higher burden of disease and disability from smoking. …is a major cause of cancer in the lung, larynx, pharynx, mouth, and bladder. It also causes cancer in the pancreas, cervix, kidney, and stomach. …causes deaths from heart disease, stroke, and chronic obstructive pulmonary disease. …is a fiscal burden. Cigarette smoking and exposure to tobacco smoke results in productivity losses of $96.8 billion annually [33] and over $75 billion in annual US medical expenditures [6].

Economic sanctions towards North Korea

Abstract: A violation of the right to health and a call to action On 12 June 2009, the United Nations Security Council approved its strictest economic sanctions to date against North Korea in response to a series of provocative acts, including the detonation of a nuclear device.1 The United States is also considering expanding sanctions and has appointed a high level task force to coordinate military, political, and financial strategies against North Korea. However, economic sanctions are being considered with virtually no public discussion of their potential effects on the North Korean people. Notably, even the health community has been silent. In contrast, during the lead up to the Iraq war, health professionals contributed invaluable insights to public discourse regarding the effects of economic sanctions on health.2 3 Prominent health associations published position papers and issued statements opposing their use.2 4 In fact, economic sanctions have been shown to violate the fundamental right to health.2 5 Furthermore, they do not achieve political change—60 years of US sanctions against North Korea have failed to do so. The health …

A vision of hope for US domestic and international health policy

Abstract: ‘The time has come – this year, in this new Administration – to modernize our health care system for the twenty-first century; to reduce costs for families and businesses; and to finally provide affordable, accessible health care for every American.’ Barack Obama, President-elect of the United States, 11 December 2008 ‘It's time we once again put science at the top of our agenda and worked to restore America's place as the world leader in science and technology.’ Barack Obama, President-elect of the United States, 20 December 2008 With the election of a youthful, inspirational and first-ever African American to the Presidency of the United States, voters in this robust democracy asserted a collective intention to change the way government responds to their needs. These changes signal the end of an incompetent administration that presided over an unwinnable war; permitted ill-advised economic policies that led to recession; allowed environmental policies that ignored global warming; supported foreign policies that alienated US friends and foes alike; fought against science policies that could stimulate innovation; blurred the boundaries of state and church with ‘faith-based initiatives’; and failed to reform a healthcare system that left us with 47 million uninsured and an unmanaged health budget. With the January inauguration, Americans recaptured a moral compass for their governance. This compass is even more important given the concurrent, horrendous global economic downturn. Even with the economic crisis and war in Iraq, health reform was on the minds of US voters last November, and it is now squarely on the agenda of the new administration. This article frames a few of the issues germane to the health and science agenda for this administration, and it will summarize some of the major recommendations now being made to President Obama. With a large sigh of relief from the scientific community, …