Cigarette smoking in all-time low among U.S. adults

According to a report from the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration and the National Cancer Institute cigarette smoking has reached the lowest level ever recorded among U.S. adults. 

Only 14 percent of adults – around 34 million people – smoked within the past 30 days. That is down from 15.5 percent in 2016.  It is remarkable that adult smoking rates have declined by 67 percent since 1965.  

The report also showed about 10 percent of young adults aged 18 to 24 years smoked cigarettes in 2017, down from 13 percent in 2016.

 This new all-time low in cigarette smoking among U.S. adults is a tremendous public health accomplishment.

Caesarean section births nearly doubled since 2000

A study published in The Lancet by Boerma et al found that the rates of caesarean section (CS) births nearly doubled between 2000 and 2015 – from 12 to 21 percent worldwide.

The paper was based on data from 169 countries that includes 98% of the world's births.  The authors estimated that 29·7 million or 21% births occurred with CS in 2015, which was almost double the number of births by CS in 2000 16 million or 12·% births. C-section use in 2015 was up to ten times more frequent in the Latin America and Caribbean region, where it was used in 44% of births, than in the west and central Africa region, where it was used in 4% of births. 

C-section births varied from 0·6% in South Sudan to 58% in the Dominican Republic. Markedly high CS use was used even among low obstetric risk births, especially among more educated women in Brazil and China; and CS use was 1·6 times more frequent in private than in public facilities.

The researchers report that CS is unavailable to women in poor countries while often over-used in richer ones. The authors found that in 15 countries in North America, Western Europe and Latin America and the Caribbean more than 40 percent of all babies born are delivered by C-section. 

C-section use in excess of the 10-15% which is considered optimal is concerning because the procedure is associated with sort-term and long-term effects without offering any significant maternal benefits.

Rates of unvaccinated children have quadrupled since 2001

The Centers for Disease Control and Prevention (CDC) reports that a small but increasing number of children in the United States are not getting some or all of their recommended vaccinations with 1.3 percent of children born in 2015 having not received any vaccinations, up from 0.3 percent in 2001. 

Though the number remains small it is something that CDC is concerned about.  CDC data show children in rural areas and those without insurance had significantly higher rates of not being vaccinated.  The CDC estimates that 100,000 young children have not had a vaccination against any of the 14 diseases for which vaccines are recommended. 

Although 70 percent of the children have been vaccinated the new estimate of 1.3 percent of the children born in 2015 were completely unvaccinated is very concerning because young children are especially vulnerable to complications from vaccine-preventable diseases, some of which can be fatal.

Screening for Cervical Cancer

The U.S. Preventive Services Task Force issued new guidelines that were published in JAMA regarding cervical cancer screening, suggesting that women can get a test that looks for the human papilloma virus.

The task force recommends that screening should begin for women age 21-29 with a Pap test every three years, which they may continue from age 30 to 65, or they can get screened every five years with a test that looks for the high-risk types of HPV that cause cervical cancer or get both tests every five years.

The USPSTF guidelines say that women over 30 can safely wait five years between cervical cancer screenings thus reducing false alarms that lead to invasive follow-up tests and unnecessary treatment.

The new guidelines “are based on a now-solid body of evidence showing that almost all cases of cervical cancer are caused by the human papilloma virus.

Sleeping more than eight hours increases risk of death from heart disease and/or stroke.

In a study by Kwok et al published in the Journal of the American Heart Associationthe researchers found that sleeping more than eight hours a night may increase the risk of death from heart disease or stroke, while sleeping fewer than seven hours did not affect one’s likelihood of death.

The authors searched MEDLINE and EMBASE databases and identified seventy‐four studies that included 3,340,684 participants.  In those studies 242,240 deaths were reported among 2,564,029 participants. Self‐reported duration of sleep of more than 8 hours was associated with a moderate increased risk of all‐cause mortality, with risk ratio, 1.14 (1.05–1.25) for 9 hours, risk ratio, 1.30 (1.19–1.42) for 10 hours, and risk ratio, 1.47 (1.33–1.64) for 11 hours. No significant difference was identified for periods of self‐reported sleep of less than 7 hours, whereas similar patterns were observed for stroke and cardiovascular disease mortality. Subjective poor sleep quality was associated with coronary heart disease (risk ratio, 1.44; 95% confidence interval, 1.09–1.90), but no difference in mortality and other outcomes.

The authors concluded that divergence from the recommended 7 to 8 hours of sleep is associated with a higher risk of mortality and cardiovascular events. 

Moderate alcohol consumption increases the risk of cardiovascular events and death.

A study by Wood et al published in Lancet suggests that the risks of drinking vis-à-vis cardiovascular events and death are significant.

The authors analyzed data from 599 912 current drinkers without previous cardiovascular disease.  They characterized dose–response associations per 100 gram per week of alcohol across 83 prospective studies, adjusting for age, sex, smoking, and diabetes.

They recorded 40 310 deaths and 39 018 incident cardiovascular disease events among the 599 912 drinkers in high-income countries that were included in their study. For all-cause mortality, they recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk at or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke, coronary disease excluding myocardial infarction, fatal hypertensive disease and fatal aortic aneurysm. By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction. In comparison to those who reported drinking >0–≤100 g per week, those who reported drinking >100–≤200 g per week, >200–≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1–2 years, or 4–5 years, respectively.

The threshold for lowest risk of all-cause mortality was about 100 gram per week or one drink per day. The study concludes that there are no overall health benefits from moderate drinking which according to current guidelines is 196g per week or two drinks per day.  

An egg a day reduces cardiovascular and stroke risk

Qin et al in a study publish by British Medical Journal examined survey data from individuals that were followed for nine years and found that compared to people who never ate eggs, individuals who ate an average of 0.76 eggs per day were at less risk to develop cardiovascular diseases (CVD) and less likely to die from ischemic heart disease (IHD), major coronary events, hemorrhagic and ischemic strokes.

Among 461 213 participants free of prior cancer, CVD and diabetes, a total of 83 977 CVD incident cases and 9985 CVD deaths were documented, as well as 5103 major coronary events (MCE).

 Among the participants 13.1% reported daily consumption (usual amount 0.76 egg/day) and 9.1% reported never or very rare consumption (usual amount 0.29 egg/day). Compared with non-consumers, daily egg consumption was associated with 11 percent lower risk of developing CVD disease and cut the risk of stroke by 26 percent while also decreasing the risk of dying from CVD conditions to 18 percent compared to non-consumers.  Daily consumers also had a 28% lower risk of hemorrhagic stroke death compared to non-consumers.

The researchers concluded that a moderate level of egg consumption (up to <1 egg/day) was significantly associated with lower risk of CVD and largely independent of other risk factors.