Main sources of sodium include many common foods

From the CDC

Nearly all Americans consume much more sodium than they should, according to a report from the Centers for Disease Control and Prevention.  Most of the sodium comes from common restaurant or grocery store items.

The latest Vital Signs report finds that 10 types of foods are responsible for more than 40 percent of people’s sodium intake.

The most common sources are breads and rolls, luncheon meat such as deli ham or turkey, pizza, poultry, soups, cheeseburgers and other sandwiches, cheese, pasta dishes, meat dishes such as meat loaf, and snack foods such as potato chips, pretzels and popcorn.

Some foods that are consumed several times a day, such as bread, add up to a lot of sodium even though each serving is not high in sodium.

“Too much sodium raises blood pressure, which is a major risk factor for heart disease and stroke,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “These diseases kill more than 800,000 Americans each year and contribute an estimated $273 billion in health care costs.”

The report notes that the average person consumes about 3,300 milligrams of sodium per day, not including any salt added at the table, which is more than twice the recommended limit for about half of Americans and 6 of every 10 adults.

Top Sources of Sodium in Our Diet

• Breads and rolls

• Cold cuts and cured meats

• Pizza

• Poultry

• Soups

• Sandwiches

• Cheese

• Pasta dishes

• Meat dishes

• Snacks

The U.S. Dietary Guidelines recommend limiting sodium intake to less than 2,300 milligrams per day.  The recommendation is 1,500 milligrams per day for people aged 51 and older, and anyone with high blood pressure, diabetes, and chronic kidney disease, and African Americans.

Key points in the Vital Signs Report:

• Ten types of foods account for 44 percent of dietary sodium consumed each day.

• 65 percent of sodium comes from food sold in stores.

• 25 percent of sodium comes from meals purchased in restaurants.

• Reducing the sodium content of the 10 leading sodium sources by 25 percent would lower total dietary sodium by more than 10 percent and could play a role in preventing up to an estimated 28,000 deaths per year.

Reducing daily sodium consumption is difficult since it is in so many of the foods we eat.  People can lower their sodium intake by eating a diet rich in fresh or frozen fruits and vegetables without sauce, while limiting the amount of processed foods with added sodium.

Individuals can also check grocery food labels and choose the products lowest in sodium.  CDC supports recommendations for food manufacturers and restaurants to reduce the amount of sodium added to foods.

“We’re encouraged that some food manufacturers are already taking steps to reduce sodium,” said Dr. Frieden. “Kraft Foods has committed to an average 10 percent reduction of sodium in their products over a two year period, and dozens of companies have joined a national initiative to reduce sodium.

The leading supplier of cheese for pizza, Leprino Foods, is actively working on providing customers and consumers with healthier options.  We are confident that more manufacturers will do the same.”

To learn more:

• To learn more about ways to reduce sodium, visit www.cdc.gov/salt.

• For more information on heart disease and stroke, visit http://www.cdc.gov/heartdisease/.

• Reducing sodium is also a key component of the Million Hearts™ initiative to prevent a million heart attacks and strokes over the next five years.

• To learn how to reduce sodium using the DASH eating plan, visithttp://www.nhlbi.nih.gov/health/health-topics/topics/dash/.

Photo: Sigurd Decroos

The good news: Teen pregnancies are at their lowest rate in nearly 40 years, resulting in fewer abortions and births, according to data from the Guttmacher Institute, a research organization focused on sexual and reproductive health.

The report shows that about 7 percent of U.S. teen girls between the ages of 15 to 19 were pregnant in 2008 — a decline from the high of more than 11 percent in 1990.

Abortions among teen girls fell from a peak of more than 4 percent in 1988 to about 1.8 percent in 2008, the lastest year for which data is available.

The bad news: While overall rates have dropped, there is still a major gap among white, Hispanic and black teenagers. Non-Hispanic white teen pregnancy rates fell by 50 percent from their peak; Hispanic teen pregnancy rates, 37 percent; black teen pregnancy rates, 48 percent.

Yet, according to the report, “the abortion rate among black teenagers was four times the rate for non-Hispanic whites, while the rate among Hispanic teenagers was twice the rate for non-Hispanic white teenagers.”

“The disparity has pretty much been unchanged,” said Kathryn Kost, co-author of the report. “If you think of these rates as lines on a graph, they are all going down, but the distance between them is pretty much unchanged.”

Kost said the increase in contraceptive marketing has helped to reduce pregnancies, but Heather Boonstra, a senior public policy associate at Guttmacher said the cost of contraceptives continues to be a factor. Boonstra said increasing the age limit for dependent health care coverage to 26 will increase access to birth control for many teens.

“There’s plenty of evidence that shows that if you take away cost in the equation,there is going to be better contraceptive use, fewer unintended pregnancies, fewer abortions, better birth outcomes,” she said. “The health care reform law was not designed with teens in mind, but … the more parents that are insured, the more teens or their dependents are insured, so certainly that will help.”

Bill Albert, the chief program officer of The National Campaign to Prevent Teen and Unplanned Pregnancy, said the decreased rates are a sign of progress, but more remains to be done. He noted that three out of 10 girls are pregnant by the age of 20.  Among the campaign’s initiatives is one focused on the Latino community and a new website geared to educating young women about birth control.

“In a way the message is let’s celebrate today, and then get back to work this afternoon,” Albert said. “I think this underscores the need to continue to invest as the current admin has in proven efforts to prevent teen pregnancy.”

Photo by Sigurd Decroos of CobraSoft.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By Carolyn M. Clancy, M.D.

February 7, 2012

With Valentine’s Day around the corner, hearts shapes are everywhere – on cards, candy, and clothing. But every day of the year, your heart plays a big role in your health and well-being. And conditions or habits that harm our hearts, like high blood pressure or smoking, put our hearts at risk.

The risk is serious. Heart disease and strokes kill more than 800,000 Americans each year and cost $445 billion each year, according to the Department of Health and Human Services (HHS) (PDF File, PDF Help). People with heart disease are often unable to work or enjoy normal activities. They are also at higher risk of early death.

To help combat heart disease, especially heart attack and stroke, HHS recently joined several groups that include doctors, nurses, pharmacists, insurance companies, and drug stores in a campaign called Million Hearts.

Over the next 5 years, the partners aim to help millions of Americans improve their heart health by preventing and treating high blood pressure, high cholesterol, and tobacco use.

The goals are ambitious. But the good news is that heart disease can be prevented or reduced with two approaches.

The first is making healthy choices, like quitting smoking (or never starting), and lowering the amount of salt and trans fats we consume. Today, 19 percent of the U.S. population smokes; in 5 years, the partnership aims to cut that to 17 percent.

The second approach is making treatment for heart disease available for people who need it. Simple but effective techniques, known as the “ABCS,” help focus these efforts. The ABCS stand for: Aspirin for people at risk, Blood pressure control, Cholesterol management, and Smoking cessation.

We have good tools to treat heart disease, but they’re not used enough. Today, less than half (47 percent) of people at risk for heart disease take a daily aspirin. The Million Hearts campaign hopes to increase that to 65 percent by 2017. Reducing salt intake, a factor in high blood pressure, by 20 percent, is another goal.

HHS is working with partners to help attain the Million Hearts goals. The partners include:

• The American Heart Association  is offering access to online tools , including one that helps you understand your heart health.

• America’s Health Insurance Plans  and its members are hosting programs to reduce heart disease with programs that promote fitness, lower obesity and manage chronic disease.

• The Y is expanding coverage of its diabetes prevention program  and other national disease prevention programs to better address risks for diabetes, heart attack, and stroke.

My Agency, the Agency for Healthcare Research and Quality (AHRQ), supports the Million Hearts campaign and has tools and knowledge that can support its goals.

For example, one AHRQ-funded resource that highlights innovative practices describes how pharmacists can help people lower their risk for heart disease.

In the HealthyHeartClub.com program, pharmacists educate patients to lower their heart risk by changing their diet, exercising more, and taking the right medicines. Working with primary care doctors, pharmacists meet with patients, email them weekly, and provide access to classes and tools that support their goals. It works! After 3 months, patients’ weight, blood pressure, and daily activity all improved.

AHRQ’s Effective Health Care Program produces free, plain-language booklets that can help you learn about treatment options for high blood pressure and high cholesterol. They describe treatment options, discuss risks and benefits, and identify areas where more research is needed.

All these resources for the Million Hearts initiative have one thing in common—they are an excellent source of information to share with your health care provider. Together, you can discuss steps you need to take to be sure you’re healthy for many more Valentine’s Days in the future.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

U.S. Department of Health and Human Services: Million Hearts

New public-private initiative aims to prevent 1 million heart attacks and strokes in five years
http://millionhearts.hhs.gov/docs/Million_Hearts_Press_Release.pdf [PDF Help]

Million Hearts
http://millionhearts.hhs.gov/

Heart Disease Prevention: Million Hearts
http://millionhearts.hhs.gov/about-hd-prevention.shtml

Agency for Healthcare Research and Quality

AHRQ Innovations Exchange: Innovation Profile
http://innovations.ahrq.gov/content.aspx?id=3182

Effective Health Care Program

Choosing Medications for High Blood Pressure: A Review of the Research on ACEIs, ARBs, and DRIs
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=75

Treating High Cholesterol: A Guide for Adults
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=351

American Heart Association

AHA
http://www.heart.org/HEARTORG/

American Heart Association/American Stroke Association 

My Life Check
http://50.56.33.51/mlc01/main_en_US.html

America’s Health Insurance Plans (AHIP)

AHIP Statement on Million Hearts Initiative
http://www.ahip.org/News/Press-Room/2011/AHIP-Statement-on-Million-Hearts-Initiative.aspx

The Y

The Y Joins CDC, HHS, CMS in Million Hearts Initiative
http://www.ymca.net/news-releases/20110913-cdc.html

Current as of February 2012

Internet Citation:

Million Hearts Campaign Aims to Lower Risk, Improve Care. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, February 7, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc020712.htm

By Michelle Andrews

Photo by Mad Max

One in 500 kids has an inherited disorder that causes high levels of LDL (“bad”) cholesterol that may require medication to control.However, since the problem doesn’t create observable symptoms, as many as half of these kids don’t know they have the condition.

To help identify these children, late last year an expert panel convened by the National Heart, Lung, and Blood Institute recommended that all children be screened for high cholesterol, once between the ages of 9 and 11 and again between ages 17 and 21.

Reaction to the guidelines, which were included as part of a larger NHLBI report on improving cardiovascular health in children and adolescents, has been mixed.

Some clinicians and researchers say universal screening is an important tool not only to help identify children who are genetically predisposed to high cholesterol, a condition called familial hypercholesterolemia, but also to pinpoint others who could benefit from treatment, including those with high LDL related to being overweight or obese.

Working with these kids to eat more healthfully and to exercise more may reduce the cumulative negative effect of high cholesterol on their cardiovascular systems and lead to fewer heart attacks and strokes later in life, the experts say.

Others, including clinicians who authored a pair of articles in the Journal of the American Medical Association last month, express concerns that screening may do more harm than good.

To learn more read the LocalHealthGuide article: Should kids with high cholesterol be put on drugs? 

To identify the relatively small number of kids who really need medical treatment, doctors cast a wide and expensive net that identifies many children as at risk who will never develop  premature cardiovascular disease, says Matthew Gillman, director of the obesity prevention program at Harvard Medical School, who co-authored one of the articles. Some of those children will probably be needlessly put on cholesterol-lowering medications, he says.

The U.S. Preventive Services Task Force, an independent group of primary-care providers that evaluates the evidence for clinical care, concluded in 2007 that there isn’t enough evidence to recommend for or against routine lipid screening in children and adolescents.

Research has shown that 10 to 13 percent of children have elevated cholesterol levels. Treatment for the vast majority should focus on lifestyle interventions, says Stephen Daniels, chairman of the Department of Pediatrics at the University of Colorado School of Medicine, who led the NHLBI panel. A much smaller number of those children, the ones with a genetic predisposition to high cholesterol, may need to take a statin, he says.

Until the new guidelines were released, the American Academy of Pediatrics recommended cholesterol screening in children primarily based on family history. If a child had a father who had heart disease or a heart attack before age 55, for example, screening would be indicated. Children who had risk factors such as obesity or diabetes were also candidates for screening. The AAP has since endorsed the new NHLBI guidelines.

More From This Series: Insuring Your Health

“Family history doesn’t really catch everybody” with familial hypercholesterolemia, says Sarah de Ferranti, a member of the AAP committee on nutrition and the director of preventive cardiology at Children’s Hospital Boston.

In addition, she says, “Anecdotally, I can tell you that when someone comes to my office and they know they have high cholesterol values, they’re much more focused.”

That’s the case with the McFeeley family. Bill and Carolyn McFeeley, of Mullica Hill, N.J., had always considered themselves very healthy – until Bill had a heart attack two years ago at age 47.

The pediatrician for their three children checked the kids’ cholesterol and found that while levels for the two girls – Chelsea, now 17, and Chandler, 13 – were normal, Chase, 10, had slightly higher values: His total cholesterol was roughly 210. (In general, anything over 200 is considered high.)

Julie Brothers, medical director of the lipid heart clinic at Children’s Hospital of Philadelphia, sees Chase once a year now and says she hopes they can manage his cholesterol without medication. “None of us wants to slap medication on anyone,” she says.

Maybe not. “But if you’re going to test every child, it’s a sure bet you’re going to be medicating more kids,” says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, who has written extensively on the problems created by aggressive screening.

Research on the safety and effectiveness of statins in children is scant; studies that have looked at statin use haven’t enrolled more than a few hundred kids, and none has followed them for more than two years, say experts.

“We don’t know what taking a 10- to 11-year-old kid and putting them on statins long term will do,” says Frederick Rivara, division chief of general pediatrics at Seattle Children’s Hospital and co-author of one of the JAMA articles.

Gillman says that while early intervention to prevent heart disease is critical, screening all children may not be the best way to do it. As an example, he cites a study that he co-authored last year examining the cost-effectiveness of blood pressure screening in adolescents.

“The bottom line of that study is that population approaches like taking the salt out of food are more effective and less costly than any screening program,” he says.

PHOTO by Mad Max – GNU Free Documentation License

Please send comments or ideas for future topics for the Insuring Your Health column to questions@kaiserhealthnews.org.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

This story was produced in collaboration with 

Provena Saint Joseph postcard offering lung scans for $169.

When the oversized postcard arrived last August from Provena St. Joseph Medical Center promoting a lung cancer screening for current or former smokers over 55, Steven Boyd wondered how the hospital had found him.

Provena didn’t send the mailing to everyone who lived near the hospital, just those who had a stronger likelihood of having smoked based on their age, income, insurance status and other demographic criteria.

The nonprofit center is one of a growing number of hospitals using their patients’ health and financial records to help pitch their most lucrative services, such as cancer, heart and orthopedic care.

As part of these direct mail campaigns, they are also buying detailed information about local residents compiled by consumer marketing firms — everything from age, income and marital status to shopping habits and whether they have children or pets at home.

Hospitals say they are promoting needed services, such as cancer screenings and cholesterol tests, but they often use the data to target patients with private health insurance, which typically pay higher rates than government coverage.

At an industry conference last year, Provena Health marketing executive Lisa Lagger said such efforts had helped attract higher-paying patients, including those covered by “profitable Blue Cross and less Medicare.”

Strategy Draws Fire

While the strategies are increasing revenues, they are drawing fire from patient advocates and privacy groups, who criticize the hospitals for using private medical records to pursue profits.

Doug Heller, executive director of Consumer Watchdog, a California-based consumer advocacy group, says he is bothered by efforts to “cherry pick” the best-paying patients.

“When marketing is picking and choosing based on people’s financial status, it is inherently discriminating against patients who have every right and need for medical information,” Heller says. “This is another example of how our health system has gone off the rails.”

Deven McGraw, director of the health privacy project at the Center for Democracy and Technology in Washington, says federal law allows hospitals to use confidential medical records to inform patients about things that may help them.

“You want health providers to communicate to patients about health options that may be beneficial to their health,” McGraw says. “But sometimes this is about generating business for a new piece of equipment that the hospital just bought.”

Using such information for marketing “creeps closer to the line,” between what is legal and what is not, she says.

Hospital officials such as Denise Beaudoin of Detroit’s Henry Ford Health System, say what they do is legal and that the sophisticated targeting approach– called “customer relationship marketing” – simply helps them deliver information to the people most likely to use it.

They say hospitals are adopting strategies used for decades by the retail, travel and communications industries, which have flourished with the growth of online companies such as Amazon and Google. Buy a book on Amazon and it will suggest a title with similar subject. Search for information on Alaskan vacations on Google, and an ad pops up for a cruise line.

HCA, Trinity Use Approach

At a time when government and private insurers are tightening reimbursements, more hospitals are turning to the same approach to drive admissions.  An estimated 20 percent of them, including large academic medical centers and large chains, such as Nashville-based HCA and Novi, Mich.-based Trinity Health, now use the strategy. And the trend is expected to accelerate as more hospitals adopt electronic health records, says Guy Miller, a Chicago health care consultant.

St. Anthony’s marketers use patient data to personalize mailings with an individual’s name and a picture of someone of similar age or gender. It is more expensive, but the strategy results in better response rates, she says. From October 2010 through July 2011, St. Anthony’s spent $25,000 on a targeted mailing to 40,000 women for mammogram screenings. The letters led 1,000 women to get the test, which generated $530,000 in revenue from screenings, biopsies and other related services, she says.

To help devise the campaigns, hospitals like St. Anthony’s share patient data with marketing staff and outside consultants.  Anyone with access to patient records is required by federal law to sign nondisclosure agreements.

‘I Am Really Bothered’

While the practice is legal, most people would be shocked to know their records may be shared with nonmedical personnel and outside firms to help hospitals attract business, says Pam Dixon, executive director of the World Privacy Forum, an advocacy group based in California.   “I am really bothered by the overabundance of information that is flowing that is unnecessary and risky,” she says.

While hospitals may profit from offering cholesterol tests and mammograms, the big payoff is in what those screenings may lead to – additional tests and procedures, including surgery.

“It’s all about downstream revenue,” says Patrick Kane, senior vice president of marketing at Cape Cod Healthcare in Massachusetts who used such approaches at Wellmont Health System in Kingsport, Tenn. “The old adage in business is that it’s easier to sell an existing customer new services, rather than find a new customer.”

Provena’s six hospitals in Illinois embraced targeted marketing in 2010, mailing information about screenings and educational events to 293,000 people. The mailings led to more than 50,000 patient visits – a 17 percent response rate, several times that typically seen in direct mail efforts, according to the industry presentation hospital officials made last year in Orlando. After accounting for marketing costs, those visits netted the system $595,000.

Some of its individual hospitals, made much higher returns. Provena St. Mary’s Hospital in Kankakee, Ill., made a $22,000 profit from a school physicals campaign, for instance, after spending $2,000 in marketing, according to the presentation.

Provena’s Lagger says the approach boosted the system’s bottom line so it could serve people regardless of insurance status.  “This is a means to an end,” she says.

Tracking The Results

One of the biggest pluses for hospital executives is that they can track a campaign’s financial success by comparing the amount of services used by targeted consumers against those in a control group with the same demographic and economic characteristics, but who are not sent mailings.

When the Henry Ford Health System promoted mammograms last year in mailings to 30,000 women aged 40 or older, more than 5,700 responded — 304 more than in the control group. The mailings generated $268,000 more in profit than the control group — a return of more than four to one on the cost of the campaign, says Denise Beaudoin, vice president of customer engagement.

“Some doctors used to be leery about the effectiveness of these marketing campaigns, but not when we can show them data like this,” she says.

Beaudoin acknowledges that “it’s kind of scary how much data we have on people, but from our perspective, it’s good because we are reaching the right people at the right time for the service they need.”

Mercy Health Partners in western Michigan, part of the 47-hospital nonprofit Trinity Health system, sent a targeted cardiac screening mailing last year to 7,450 people.  That resulted in 1,729 patient visits, or 7 percent more than in a control group. The campaign, which cost about $10,000, generated about $1 million in revenue and about $50,000 in profit.

“It’s a much more efficient use of marketing dollars,” says Preston Gee, Trinity’s senior vice president of strategic planning. “People like having information tailored to their own needs.”

‘Glad I Had The Test’

Much of the expertise for such campaigns is provided by three consulting firms – CPM Marketing of Madison, Wis., Medseek of Birmingham Ala. and New York-based Thomson Reuters. They typically charge hospitals $100,000 a year or more.

CPM, which merged in November with Denver, Colo.-based HealthGrades, a health ratings firm, added 100 new hospitals last year to give it a total of 400. Medseek works with more than 250 hospitals and Thomson Reuters, with 150.

“There are a lot of very rich data in health care beyond just age and gender that help steer or guide people to health services,” says John Hallick, president of CPM. “All of these things impact health, and some are better than others and you pick and choose.”

Boyd, the Joliet man who works as a home inspector, was not upset that Provena Health used information about him and his wife — both former patients — to pitch screening tests.  “We lost our privacy long ago and I don’t like to think about all the information that’s out there about us.”

Provena Marketing Manager Richard Matula would not say why the Boyds were included in the mailing, citing patient privacy laws.  Patients’ smoking status was not used to develop the mailing list, he says.

The targeting worked in the case of Boyd, who called the number on the back and scheduled the CT scan a few days later. The $169 test showed his lungs were clear, but found potential blockages in coronary arteries that his Provena-affiliated doctor is monitoring.

“In hindsight, I’m glad I had the test,” he says.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.