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April 15, 2010 Volume VI, No. 46

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In this day and age, while young adults may believe themselves invincible, their current health behaviors will affect them later in life. This week's issue offers some examples, from the link between adolescent drinking and breast cancer, to the consequences of gaining too much weight during the younger years.

On a positive note though, smoking prevalence among New Hampshire's youth has decreased from 2001.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Adolescent Drinking & Breast Cancer
  2. Obesity Generation Shift
  3. Shared Savings in Medical Homes
  4. Motivation for Behavior Change
  5. Healthcare Case Manager Work Locations
  6. Cost of Chronic Disease
  7. Smoking Prevalence in New Hampshire
  8. Obesity and Weight Management 2010

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Adolescent Drinking Adds to Risk of Breast Disease, Breast Cancer

Girls and young women who drink alcohol increase their risk of benign (noncancerous) breast disease, says a study by researchers at Washington University School of Medicine in St. Louis and Harvard University. Benign breast disease increases the risk for developing breast cancer.

The researchers studied girls aged 9 to 15 years at the study’s start and followed them using health surveys from 1996 to 2007. A total of 6,899 participants reported on their alcohol consumption and whether they had ever been diagnosed with benign breast disease. The participants were part of the Growing Up Today Study of more than 9,000 girls from all 50 states who are daughters of participants in the Nurses’ Health Study II, one of the largest and longest-running investigations of factors that influence women’s health.

The study showed that the more alcohol consumed, the more likely the participants were to have benign breast disease. Girls and young women who drank six or seven days a week were 5.5 times more likely to have benign breast disease than those who didn’t drink or who had less than one drink per week. Participants who reported drinking three to five days per week had three times the risk. The participants who were diagnosed with benign breast disease on average drank more often, drank more on each occasion and had an average daily consumption that was two times that of those who did not have benign breast disease. They also had more episodes of binge drinking. The study is unique because it asked about alcohol intake while participants were adolescents instead of asking them to recall many years later how often they drank.

According to Graham Colditz, M.D., Dr.P.H., associate director of prevention and control at the Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital, “Our study clearly shows that the risk of benign breast disease increased with the amount of alcohol consumed in this age group. This study is an indication that alcohol should be limited in adolescence and early adult years and further focuses our attention on these years as key to preventing breast cancer later in life. There’s growing evidence that physical activity can lower breast cancer risk, and we also know that diet and weight are important factors. Now it is clear that drinking habits throughout life affect breast cancer risk as well.” About 80 percent of breast lumps are benign. But these benign breast lesions can be a step in a pathway leading from normal breast tissue to invasive breast cancer. The condition is an important marker of breast cancer risk, Dr. Colditz indicates.

To learn more about this research, please visit:

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Getting Heavier, Younger: Study Shows Generational Shift in Obesity

It was a provocative prediction that due to the obesity epidemic, baby boomers may outlive their children. However, a new study by the University of Michigan (U-M) Health System on obesity trends shows that Americans are getting heavier younger and carrying the extra weight for longer periods over their lifetime. As a result, the study suggests the impact on chronic diseases and life expectancy may be worse than previously thought.

Researchers used a wide range of national data on children and adults born between 1926 and 2005 to reveal the troubling trend of younger generations becoming obese earlier in life than their parents and grandparents. According to the study, 20 percent of those born between 1966 and 1985 were obese by ages 20-29. Among their parents, those born 1946-1955, that level of obesity was not reached until ages 30-39, not until ages 40-49 for individuals born between 1936 and 1945, and obesity prevalence was even later — during the 50’s — for those born between 1926 and 1935. The federally funded U-M study also shows that obesity trends were worse for women and blacks, a bad sign for reversing racial disparities in health, U-M authors say. Among 20-29-year-olds, born 1976-1985, 20 percent of whites were obese compared to 35 percent of blacks in that age group. Further research is needed to understand the future effect the obesity trend will have on diabetes rates and mortality.

“Many people have heard that Americans are getting heavier,” says lead author Joyce Lee, M.D., M.P.H., a pediatric endocrinologist at the U-M C.S. Mott Children’s Hospital and assistant professor in the Department of Pediatrics and Communicable Diseases at the U-M Medical School. “But it’s very important to understand who the obesity epidemic is affecting. Our research indicates that higher numbers of young and middle-age American adults are becoming obese at younger and younger ages.”

To learn more about this research, please visit:

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Shared Savings in the Medical Home

The patient-centered medical home is at the heart of Mesa County, Colorado's shared savings model, explains David West, M.D., a hospitalist, family physician and healthcare consultant from Grand Junction, Colorado. Dr. West describes how the shared savings model can be adapted across markets, including the conditions and factors that must be present for this approach to be feasible. He also shares a unique provider incentive that is keeping hospital stays of Medicare patients at less than one-third the national average, one of the factors that has the nation touting this area as a model for efficient healthcare delivery.

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Motivation for Behavior Change

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's experts are Ruth Wolever, clinical health psychologist and director of research at Duke Integrative Medicine, and Karen Lawson, program director for the health coaching track at the Center for Spirituality and Healing at the University of Minnesota.

Question: How do you engage your clients and keep them motivated to change their behavior?

Response: (Dr. Ruth Wolever) The first thing to do is to assess where they are in the stages of change. The way in which you would engage somebody differs according to the stage of change they are in.

(Dr. Karen Lawson) It’s important to recognize the incentive and where the motivation is coming from because it’s not the coach’s job to get them to change or to get them motivated. It’s a matter of trying to facilitate an individual doing what they want for themselves. You wouldn’t have a client without some desire to work in a direction of change themselves unless they’d been assigned or sent to you by an outside entity. That is one of the conflicts that arises: If someone’s being told that they need to participate in a program because of a work indication or a third-party payor, and they have no desire to be there themselves, you can’t motivate them. You can’t give a patient motivation that they don’t have.

For more information on behavior change, please visit:

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Decreasing Smoking Prevalence Among New Hampshire High School Students

The smoking prevalence for New Hampshire high school students has significantly declined from 25.3 percent in 2001 to 16 percent in 2009, according to a 2007-2009 Youth Tobacco Survey (YTS) from the New Hampshire Department of Health and Human Services (DHHS), Division of Public Health Services, Tobacco Prevention & Control Program (TPCP). The survey provides comprehensive data from both middle school and high school students.

YTS is funded by a cooperative grant from the CDC. The report is conducted every two years by the TPCP and contains tobacco-related questions that are supplemental to other surveys, such as the Youth Risk Behavior Survey, which provides only prevalence data. There are 74 tobacco questions in the YTS that cover tobacco use (i.e., handrolled cigarettes, or bidis, cigarettes, cigars, kreteks, tobacco pipes and smokeless tobacco); exposure to secondhand smoke; smoking cessation; school curriculum; minors’ ability to purchase or obtain tobacco products; and knowledge and attitudes about tobacco and familiarity with pro-tobacco and anti-tobacco media messages.

Some of the major findings from the YTS conducted during the years 2001 through 2009 include:

  • There is no significant difference in the smoking prevalence between male and female students; 15.8 percent of female high school students smoke compared with 16.5 percent of male students.
  • High school males were more likely than high school females to smoke other tobacco products, such as cigars, tobacco in a pipe, bidis, or kreteks (cigarettes made with a blend of tobacco, cloves and other flavors) or to use spit tobacco.
  • Most high school current smokers obtained cigarettes by giving someone else money to buy cigarettes (33.2 percent) or by “bumming” them (29.0 percent). Twelve percent of high school current smokers reported purchasing their own cigarettes from a store or vending machine, which in most cases means underage access to tobacco.
  • Forty percent of current high school smokers said that they would like to quit, 52 percent said that they tried to quit and 39 percent of former smokers said that they have remained tobacco free.
  • About 84 percent of high school students reported seeing images of tobacco used by actors on television or in the movies and 25.5 percent reported seeing tobacco used by athletes on television or in the movies in the past year.
  • The proportion of high school students who have been exposed to secondhand tobacco smoke by being in a room or in a car with a smoker declined significantly from 72 percent in 2001 to 54.2 percent in 2009, indicating changing attitudes and an increasing number of smoke-free homes in New Hamsphire.

"We are making progress and seeing a reduction in the use of some tobacco products, such as cigarettes," said Dr. José Montero, director of public health at DHHS. "This is important from a prevention standpoint because tobacco is a leading cause of cancer and a number of chronic diseases in our population. Still there are concerns that young people may be increasing their use of other tobacco products such as smokeless tobacco, which opens the door to nicotine addiction and future smoking."

To learn more about this research, please visit:

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Obesity and Weight Management 2010

Despite early indicators of success on the management front, obesity is still tied to an estimated $117 billion in healthcare costs. New healthcare reform will reward prevention-related initiatives, and first lady Michelle Obama's Let's Move campaign hopes to solve the childhood obesity epidemic within a generation. Describe how your organization is working to prevent and reduce obesity and related conditions and costs in your population by taking the Obesity and Weight Management survey by April 30, and receive a free e-summary of the results. More than 75 organizations have responded so far; your responses will be kept confidential.

To participate in this survey and receive its results, please visit:

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