In some cases, people come down with a serous illness that can last for months but often people experience only a mild illness and some have no symptoms at all.

Some forms of viral hepatitis go away on their own, but others, like Hepatitis B and Hepatitis C, can go one to become chronic, lifelong infections, which can lead to serious health problems including liver damage, cirrhosis, liver cancer, and even death, the CDC warns.

Most people with chronic hepatitis do not know they are infected and can go 20 or 30 years without showing symptoms.

A simple blood test can determine whether you have hepatitis.

The month of May has been designated Hepatitis Awareness Month in the United States, and tomorrow, May 19th, is being recognized as the first ever Hepatitis Testing Day in the United States.

The National Digestive Diseases Information Clearinghouse has prepared the following material to explain about the different kinds of hepatitis, how to avoid infection and what you can do if you are infected.

Viral Hepatitis: A through E and Beyond

What is viral hepatitis?

Viral hepatitis is inflammation of the liver caused by a virus. Several different viruses, named the hepatitis A, B, C, D, and E viruses, cause viral hepatitis.

All of these viruses cause acute, or short-term, viral hepatitis. The hepatitis B, C, and D viruses can also cause chronic hepatitis, in which the infection is prolonged, sometimes lifelong. Chronic hepatitis can lead to cirrhosis, liver failure, and liver cancer.

Researchers are looking for other viruses that may cause hepatitis, but none have been identified with certainty. Other viruses that less often affect the liver include cytomegalovirus; Epstein-Barr virus, also called infectious mononucleosis; herpesvirus; parvovirus; and adenovirus.

Key Points

• Viral hepatitis is inflammation of the liver caused by the hepatitis A, B, C, D, or E viruses.

• Depending on the type of virus, viral hepatitis is spread through contaminated food or water, contact with infected blood, sexual contact with an infected person, or from mother to child during childbirth.

• Vaccines offer protection from hepatitis A and hepatitis B.

• No vaccines are available for hepatitis C, D, and E. Reducing exposure to the viruses offers the best protection.

• Hepatitis A and E usually resolve on their own. Hepatitis B, C, and D can be chronic and serious. Drugs are available to treat chronic hepatitis.

What are the symptoms of viral hepatitis?

Symptoms include

• jaundice, which causes a yellowing of the skin and eyes

• fatigue

• abdominal pain

• loss of appetite

• nausea

• vomiting

• diarrhea

• low grade fever

• headache

However, some people do not have symptoms.

Hepatitis A

How is hepatitis A spread?

Hepatitis A is spread primarily through food or water contaminated by feces from an infected person. Rarely, it spreads through contact with infected blood.

Who is at risk for hepatitis A?

People most likely to get hepatitis A are

• international travelers, particularly those traveling to developing countries

• people who live with or have sex with an infected person

• people living in areas where children are not routinely vaccinated against hepatitis A, where outbreaks are more likely

• day care children and employees, during outbreaks

• men who have sex with men

• users of illicit drugs

How can hepatitis A be prevented?

The hepatitis A vaccine offers immunity to adults and children older than age 1. The Centers for Disease Control and Prevention recommends routine hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus. Avoiding tap water when traveling internationally and practicing good hygiene and sanitation also help prevent hepatitis A.

What is the treatment for hepatitis A?

Hepatitis A usually resolves on its own over several weeks.

Hepatitis B

How is hepatitis B spread?

Hepatitis B is spread through contact with infected blood, through sex with an infected person, and from mother to child during childbirth, whether the delivery is vaginal or via cesarean section.

Who is at risk for hepatitis B?

People most likely to get hepatitis B are

• people who live with or have sexual contact with an infected person

• men who have sex with men

• people who have multiple sex partners

• injection drug users

• immigrants and children of immigrants from areas with high rates of hepatitis B

• infants born to infected mothers

• health care workers

• hemodialysis patients

• people who received a transfusion of blood or blood products before 1987, when better tests to screen blood donors were developed

• international travelers

How can hepatitis B be prevented?

The hepatitis B vaccine offers the best protection. All infants and unvaccinated children, adolescents, and at-risk adults should be vaccinated. For people who have not been vaccinated, reducing exposure to the virus can help prevent hepatitis B. Reducing exposure means using latex condoms, which may lower the risk of transmission; not sharing drug needles; and not sharing personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis B?

Drugs approved for the treatment of chronic hepatitis B include alpha interferon and peginterferon, which slow the replication of the virus in the body and also boost the immune system, and the antiviral drugs lamivudine, adefovir dipivoxil, entecavir, and telbivudine. Other drugs are also being evaluated. Infants born to infected mothers should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection.

People who develop acute hepatitis B are generally not treated with antiviral drugs because, depending on their age at infection, the disease often resolves on its own. Infected newborns are most likely to progress to chronic hepatitis B, but by young adulthood, most people with acute infection recover spontaneously. Severe acute hepatitis B can be treated with an antiviral drug such as lamivudine.

Cirrhotic liver showing scarring (Photo by Nephron under a Creative Common license).

Hepatitis C

How is hepatitis C spread?

Hepatitis C is spread primarily through contact with infected blood. Less commonly, it can spread through sexual contact and childbirth.

Who is at risk for hepatitis C?

• People most likely to be exposed to the hepatitis C virus are

• injection drug users

• people who have sex with an infected person

• people who have multiple sex partners

• health care workers

• infants born to infected women

• hemodialysis patients

• people who received a transfusion of blood or blood products before July 1992, when sensitive tests to screen blood donors for hepatitis C were introduced

• people who received clotting factors made before 1987, when methods to manufacture these products were improved

How can hepatitis C be prevented?

There is no vaccine for hepatitis C. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing exposure means avoiding behaviors like sharing drug needles or personal items such as toothbrushes, razors, and nail clippers with an infected person.

What is the treatment for hepatitis C?

Chronic hepatitis C is treated with peginterferon together with the antiviral drug ribavirin.

If acute hepatitis C does not resolve on its own within 2 to 3 months, drug treatment is recommended.

Hepatitis D

How is hepatitis D spread?

Hepatitis D is spread through contact with infected blood. This disease only occurs at the same time as infection with hepatitis B or in people who are already infected with hepatitis B.

Who is at risk for hepatitis D?

Anyone infected with hepatitis B is at risk for hepatitis D. Injection drug users have the highest risk.

Others at risk include

• people who live with or have sex with a person infected with hepatitis D

• people who received a transfusion of blood or blood products before 1987

How can hepatitis D be prevented?

People not already infected with hepatitis B should receive the hepatitis B vaccine. Other preventive measures include avoiding exposure to infected blood, contaminated needles, and an infected person’s personal items such as toothbrushes, razors, and nail clippers.

What is the treatment for hepatitis D?

Chronic hepatitis D is usually treated with pegylated interferon, although other potential treatments are under study.

Hepatitis E

How is hepatitis E spread?

Hepatitis E is spread through food or water contaminated by feces from an infected person. This disease is uncommon in the United States.

Who is at risk for hepatitis E?

People most likely to be exposed to the hepatitis E virus are

• international travelers, particularly those traveling to developing countries

• people living in areas where hepatitis E outbreaks are common

• people who live with or have sex with an infected person

How can hepatitis E be prevented?

There is no U.S. Food and Drug Administration (FDA)-approved vaccine for hepatitis E. The only way to prevent the disease is to reduce the risk of exposure to the virus. Reducing risk of exposure means avoiding tap water when traveling internationally and practicing good hygiene and sanitation.

What is the treatment for hepatitis E?

Hepatitis E usually resolves on its own over several weeks to months.

What else causes viral hepatitis?

Some cases of viral hepatitis cannot be attributed to the hepatitis A, B, C, D, or E viruses, or even the less common viruses that can infect the liver, such as cytomegalovirus, Epstein-Barr virus, herpesvirus, parvovirus, and adenovirus.

These cases are called non-A–E hepatitis. Scientists continue to study the causes of non-A–E hepatitis.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases, through its Division of Digestive Diseases and Nutrition, supports basic and clinical research into the nature and transmission of the hepatitis viruses, and the activation and mechanisms of the immune system. Results from these basic and clinical studies are used in developing new treatments and methods of prevention.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

For More Information

American Liver Foundation

75 Maiden Lane, Suite 603

New York, NY 10038–4810

Phone: 1–800–GO–LIVER (465–4837), 1–888–4HEP–USA (443–7872), or 212–668–1000

Fax: 212–483–8179

Email: info@liverfoundation.org

Internet: www.liverfoundation.org

Centers for Disease Control and Prevention

Division of Viral Hepatitis

1600 Clifton Road

Mail Stop C–14

Atlanta, GA 30333

Phone: 1–800–CDC–INFO (232–4636)

Fax: 404–371–5488

Email: cdcinfo@cdc.gov

Internet: www.cdc.gov/hepatitis

Hepatitis Foundation International

504 Blick Drive

Silver Spring, MD 20904–2901

Phone: 1–800–891–0707 or 301–622–4200

Fax: 301–622–4702

Email: hfi@comcast.net

Internet: www.hepatitisfoundation.org

You may also find additional information about this topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult your doctor for more information.

by Charles Ornstein and Tracy Weber

A version of this story was published in The Washington Post.

As the U.S. Senate Finance Committee launched an investigation Tuesday into makers of narcotic painkillers and groups that champion them, a leading pain advocacy organization said it was dissolving “due to irreparable economic circumstances.”

The American Pain Foundation, which described itself as the nation’s largest organization for pain patients, was the focus of a December investigation by ProPublica in The Washington Post that detailed its close ties to drugmakers.

The group received 90 percent of its $5 million in funding in 2010 from the drug and medical-device industry, ProPublica found, and its guides for patients, journalists and policymakers had played down the risks associated with opioid painkillers while exaggerating the benefits.

It is unclear whether the group’s announcement Tuesday evening — that it would “cease to exist, effective immediately” — was related to letters sent earlier in the day from Sens. Max Baucus, D-Mont., the finance panel chairman, and Charles Grassley, R-Iowa, to the foundation, drug companies and others.

In the letters, the senators cited an “an epidemic of accidental deaths and addiction resulting from the increased sale and use of powerful narcotic painkillers,” including popular brand names like Oxycontin, Vicodin and Opana.

The American Pain Foundation’s website carried a statement Tuesday night saying its board had voted May 3 to dissolve the organization because it couldn’t stay “operational.” The foundation did not respond to requests for comment Tuesday.

The senators are targeting a who’s who of the pain industry, seeking extensive records and correspondence documenting the links, financial and otherwise, between them and the makers of the top-prescribed narcotic painkillers.

Letters went to three pharmaceutical companies, Purdue Pharma, Endo Pharmaceuticals and Johnson & Johnson, as well as five groups that support pain patients, physicians or research: the American Pain Foundation, American Academy of Pain Medicine, American Pain Society, Wisconsin Pain & Policy Studies Group, and the Center for Practical Bioethics.

The Federation of State Medical Boards, the trade group for agencies that license doctors, received a letter, as did The Joint Commission, an independent nonprofit that accredits hospitals nationwide and made pain management a national priority in 2001.

A report by the U.S. Government Accountability Office in 2003 noted that the commission partnered with Purdue Pharma, the maker of Oxycontin, to distribute pain educational materials nationwide. The committee’s letter to Purdue noted that the company pleaded guilty in 2007 to federal criminal charges that it misled regulators, physicians and consumers about Oxycontin’s risk of addiction.

The senators requested payment information since 1997 to 10 groups and eight people, including two doctors featured in ProPublica’s December report.

They asked about any influence the companies had on a 2004 pain guide for physicians that was distributed by the Federation of State Medical Boards; on the American Pain Society’s guidelines; and on the American Pain Foundation’s Military/Veterans Pain Initiative.

In addition to citing ProPublica’s work, the letters also mention the reporting of the Milwaukee Journal Sentinel and MedPage Today.

Patients in serious pain need access to opioids, the senators wrote, but drugmakers and health-care groups “must distribute accurate information about these drugs in order to prevent improper use and diversion to drug abusers.”

“The problem of opioid abuse is bad and getting worse,” Sen. Grassley said in a statement. “Something has to change.”

Earlier Coverage:

“When it comes to these highly addictive painkillers, improper relationships between pharmaceutical companies and the organizations that promote their drugs can put lives at risk,” Baucus said in a prepared statement.

Dr. Andrew Kolodny, chairman of psychiatry at Maimonides Medical Center in Brooklyn, N.Y., and president of Physicians for Responsible Opioid Prescribing, applauded the investigation.

“These groups, these pain organizations … helped usher in an epidemic that’s killed 100,000 people by promoting aggressive use of opioids,” Kolodny said. “What makes this especially disturbing is that despite overwhelming evidence that their effort created a public health crisis, they’re continuing to minimize the risk of addiction.”

Concerns about the overuse and abuse of painkillers have intensified in recent years. As sales of the powerful drugs have boomed — rising 300 percent since 1999 — so, too, have overdose deaths.

Opioids were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined, according to the U.S. Centers for Disease Control and Prevention.

In 2009, the use and misuse of the drugs were cited in more than 475,000 emergency department visits, nearly doubling the 2004 number, the CDC said.

Pain doctors and patient groups say that while drug overdoses are a legitimate concern, only a small percentage of deaths involves patients who receive them from their doctors. Most deaths involve illicitly obtained drugs, statistics show.

The groups also say that patients’ risk is low if they do not have addictive personalities, and that any restrictions should not punish patients who suffer from serious pain.

In recent weeks, two articles in medical journals have documented different aspects of abuse.

According to a paper published online this week by the Archives of Pediatrics & Adolescent Medicine, one of every eight high school seniors surveyed said they had used prescription opioids for nonmedical reasons.

A paper released last month by The Journal of the American Medical Association found that the rate of newborns diagnosed with drug withdrawal jumped threefold from 2000 to 2009.

And the rate of mothers using opioids at the time of delivery was five times higher in 2009. (Not all babies born to mothers using the drugs exhibit signs of withdrawal.)

Janssen Pharmaceuticals, a Johnson & Johnson subsidiary that makes the painkiller Nucynta, said in a statement that it “is committed to the responsible prescribing and appropriate use of opioid pain medications” and has supported educational websites about safe use.

The company is reviewing the senators’ letter and “will work with them to fulfill their request for information,” spokesman Mark Wolfe said via email.

Purdue Pharma acknowledged in a statement that it had received the letter, was reviewing it and looked forward to “cooperating with the committee on this matter.”

Endo did not return a request for comment. A spokeswoman for The Joint Commission said the group had just received the senators’ letter and had no comment yet. The Federation of State Medical Boards responded but did not offer immediate comment.

Want to know more? Follow ProPublica on Facebook and Twitter, and get ProPublica headlines delivered by e-mail every day.

This story was produced in collaboration with 

Since first lady Michelle Obama made childhood obesity her signature project almost two years ago, the issue has had the kind of highly visible national leadership that it previously lacked.

But that isn’t enough, say public health leaders frustrated with the slow progress in stemming America’s obesity epidemic.

Something more ambitious is needed, they argue — something more like the anti-tobacco movement.
The similarities between the two public health challenges are compelling. Tobacco use is the nation’s No. 1 cause of preventable deaths in the U.S., killing 467,000 people in 2005, according to a landmark study by Harvard University researchers.

Being obese or overweight caused an estimated 216,000 deaths from heart disease, diabetes and other conditions, researchers estimated, while another 191,000 deaths resulted from being physically inactive – another key contributor to expanding waistlines.

In terms of health care costs, obesity is now the larger concern, accounting for $147 billion to $190 billion in yearly expenditures, compared to $96 billion for tobacco.

After decades of lawsuits, damning reports about industry practices, and stop-smoking campaigns, smoking rates have plummeted, from a high of 42 percent of adults in 1965 — a year after the first Surgeon General’s report on smoking and health — to just over 19 percent today.

Meanwhile, obesity has been soaring since the 1980s and only last year reached a plateau, which experts say may be only temporary. Currently, 45 million American adults are smokers, while 78 million adults and almost 13 million youngsters are counted as obese.

Some public health advocates see other parallels.

“When I look at what’s going on with obesity, it reminds me of what was going on with tobacco in the 50s, 60s, and 70s, when there was a lot of emphasis on personal responsibility, voluntary self-regulation, and trying to make safe cigarettes,” saidStanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco.

That approach didn’t work, and efforts to reduce smoking didn’t really have much success until advocates shifted their emphasis from changing individual behavior to community-based activism and holding cigarette manufacturers accountable for harmful products, Glantz said.

A similar shift is needed today in the fight against America’s expanding waistlines, many experts believe. Instead of approaching obesity as a personal issue, it needs to be redefined as a community challenge that calls for collective action and wide-ranging policy changes such as more informative food labels, limits on marketing to children, and taxes on unhealthy products, they argue.

But there are many hurdles. The scope of the obesity problem is much larger than tobacco ever was: it touches on the food we eat, the beverages we drink, the amount of television we watch, how much we exercise, the way our cities are designed, and more.

While the variety of policy changes proposed are therefore broader, the political will to enact them has not materialized, in part because “people don’t yet perceive a significant personal threat,” said Dr. William Dietz, director of the division of nutrition, physical activity and obesity at the U.S. Centers for Disease Control and Prevention.

The issue will take center stage in the nation’s capitol this coming week, as the Institute of Medicine releases a new report on strategies to combat the obesity epidemic, the U.S. Centers for Disease Control and Prevention hosts a major conference highlightingefforts to control obesity, and HBO prepares to air a four-part documentary on the obesity crisis.

As public health experts committed to stemming obesity study the history of the anti-tobacco movement and look to it for guidance, it is helpful to consider some key similarities and differences between these issues.

Children are central. The vast majority of people who use tobacco take up the habit as teenagers, and one-third of kids who smoke daily will eventually die prematurely of tobacco-related illnesses, according to the Campaign for Tobacco Free Kids.

The health impact of obesity is similar: seriously overweight children are at greater risk of developing a multitude of health problems that can continue through adulthood, including diabetes, liver disease, heart disease, joint problems and asthma, and are more likely to become obese adults, a wide body of research has demonstrated.

Preventing harm to young people is a central goal of both anti-tobacco and anti-obesity campaigns.

“First, let’s protect our children,” said Dr. David Ludwig, a child obesity expert at Harvard Medical School, noting that the calorie-laden foods and drinks that kids consume in abundance “are not just neutral — they actively undermine our health by overwhelming fundamental biological pathways that regulate appetite and body weight and by manipulating dietary preferences that may be difficult to change over a lifetime.”

Changing social norms is the goal. Dr. Jeffrey Koplan, former head of the CDC and vice president for global health at Emory University in Atlanta, remembers smoking a pipe while writing up patient notes at a prestigious New York hospital in the 1970s. (He gave up the habit more than 30 years ago.)

Today, that would be inconceivable: Smoking rates have been cut by more than half, intolerance of smoking in public places is widespread and anti-smoking policies are in place at hospitals, workplaces, and venues across the country.

Koplan is convinced the same shift in social norms is called for — and achievable — when it comes to childhood obesity.  ”Our (eating and physical activity) tastes, our preferences and our behaviors are learned and can be changed,” he said.

It isn’t going to be easy and it isn’t going to be fast, but “we’re dealing with a population that would like to be thinner and that works in our favor,” he said.

We can’t just say no to food. “Tobacco we can get rid of entirely. We don’t need it. It has no intrinsic value. But we have to eat to live and make terms with food as the enemy,” said Dr. David Katz, director of Yale University’s Prevention Research Center.

That makes curbing childhood obesity a much more complicated issue than tobacco use, Katz and other experts agree. The message to kids and their families can’t be “stop, don’t do this,” which is clear and easy to understand. Instead it has to be “make good choices, do this in moderation, set boundaries,” a message that is considerably more difficult to convey.

Our biology works against us. Throughout most of history, humans lived in an environment where food was scarce and hard to get. As a result, we’re primed, biologically, to eat food when it’s available and “we’re very good at storing calories and defending calories once we’ve got them,” said Dr. Stephen Daniels, chair of the department of pediatrics at the University of Colorado School of Medicine.  ”In some ways, you could say that our biology is our own worst enemy when it comes to being overweight or obese.”

While smoking is highly addictive, the biological responses attached to eating food are even more deeply rooted in human evolution, Katz and other experts said.

A sense of shame and denial is greater. People’s self-image is intimately associated with their body weight in a way that isn’t true of smoking.

“When you talk to kids who are excessively heavy and break through their protective shells, what you find is that they feel terrible about their weight — they feel in many ways that they’ve failed,” Daniels said.

“Obesity is seen as a pejorative term that people don’t connect with. They think ‘I’m just 30 or 40 pounds overweight, but I’m not obese,’” said Dietz of the CDC. That suggests the entire way of talking about the issue may need be reframed before personal and social change becomes possible, he suggested.

The variety of products is larger. Tobacco is a single substance, with a limited set of companies that produce cigarettes and related products.

By contrast, the food and beverage industry is enormous and makes a huge array of goods that extend into every home, restaurant, convenience store, and grocery store in America.

“That makes the [struggle against childhood obesity] much more difficult than the fight against tobacco,” Dietz said.

There is no second-hand smoke equivalent. The American public was alarmed when it learned that the cigarette smoke non-smokers breathed in airplanes, bars and restaurants was dangerous, and that no amount of second-hand smoke was safe.

“The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people’s intolerance of smoking and their willingness to see the government take action,” said Michael Eriksen, director of the Institute of Public Health at Georgia State University.

There is no equivalent in the fight against obesity.  ”Your being obese does not affect me in the same direct way,” Eriksen said.

The best argument might be that obesity consumes enormous health care resources, driving up the cost of medical care for everyone, suggested Dr. Robert Lustig, a professor of pediatrics and director of the Weight Assessment for Teen and Child Health Program at the University of California, San Francisco. But others think that is too abstract and will never yield the same sense of personal outrage that the second-hand smoke issue created.

The role of industry is less clear. In the anti-tobacco fight, tobacco companies were painted as an enemy willing to lie and manipulate the American public for the sake of profits. In turn, the demonization of Big Tobacco — made possible by bitterly fought lawsuits and the release of thousands of company documents — cultivated a common sense of threat.

By contrast, public health advocates aren’t willing to turn food and beverage into enemies in the fight against obesity.

“With obesity (as compared to tobacco), there’s a much more nuanced relationship with industry,” said Dr. James S. Marks, director of the health group at the Robert Wood Johnson Foundation. Food and beverage manufacturers, restaurants, and grocery stores all have a vital role to play in making healthier food more widely available, he noted.

“We can’t regulate our way out of this,” said Jeff Levi, executive director of the Trust for America’s Health.  ”We need to work with industry cooperatively to help change consumers’ tastes and habits.”

Others are much less certain that the food and beverage industry can be trusted to be helpful partners.

“Some companies are making huge profits off obesity,” said Stan Dorn, a senior fellow at the Urban Institute, a public policy research center in Washington, D.C., “and I worry that people who are focused on anti-obesity strategies aren’t being tough enough on them.”

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.

Up to half of the people who are treated at hospital emergency departments and trauma centers are under the influence of alcohol, experts say.

That may be a sobering statistic, yet a recent study found that emergency departments can capitalize on this “teachable moment” to discourage problem drinking in the future.

But laws in more than half the states permit insurers to deny payment for medical services related to alcohol or drug use and that can derail hospitals’ best intentions, experts say.

Faced with the prospect of not getting paid for care, some emergency department personnel may sidestep the problem by simply not testing patients’ blood or urine for alcohol.

In the study, published online in the Annals of Emergency Medicine in March, nearly 600 emergency department patients who were identified as hazardous or harmful drinkers (defined for men as drinking more than 14 drinks per week or more than four on any single occasion, and for women as more than seven weekly drinks or three on any one occasion) took part in a seven-minute interview.

During the interview, an emergency department staff member discussed the link between a patient’s injuries and alcohol, as well as guidelines for low-risk drinking, and encouraged the patient to discuss what was stopping him from drinking less and to set a drinking goal.

Compared with those who received standard care, patients who took part in the sessions reduced their average number of weekly drinks significantly as well as their episodes of binge drinking and drinking and driving over the next 12 months.

“In the emergency department on a weekend, all the cases may be drug or alcohol related, and yet we don’t do” screening and intervention, says Gail D’Onofrio, the study’s lead author who is chair of emergency medicine at Yale University School of Medicine. ”Our goal is to normalize this in the emergency department.”

Although some of the nearly 4,000 emergency departments screen patients for drug or alcohol use, it’s not required. Level 1 and 2 trauma centers, however, which are typically equipped to handle emergency patients suffering from serious injuries sustained, for example, in major car accidents, must screen for problem drinkers. Level 1 trauma centers must also be able to provide counseling.

More From This Series: Insuring Your Health

Such screening and counseling can be effective, says Larry Gentilello, a trauma surgeon who has published studies on injury prevention and substance abuse.

“Most of the people who are injured don’t need to go into treatment,” he says. “They aren’t alcoholics or alcohol dependent. That’s why one counseling session can help them by talking about the risks of drinking.”

The extent to which so-called alcohol-exclusion laws deter emergency medical personnel from screening and counseling patients for alcohol or drugs is unknown.

The laws have a long history. Since 1947, more than 40 states have passed measures allowing health plans to refuse to pay for care if the patient’s injuries occurred while he was under the influence of alcohol or, in some states, drugs, say experts.

As people came to understand alcohol addiction and the possibility of treatment, however, it became clear that the laws were counterproductive. In 2001, the National Association of Insurance Commissioners recommended against them.

Since then, at least 15 states have repealed or amended their laws and now prohibit exclusions of coverage for drinking or drugs, according to data from the National Institute on Alcohol Abuse and Alcoholism. Maryland and the District of Columbia are among them; Virginia’s law remains in place.

Regardless of state law, self-insured companies that pay their employees’ health care costs directly can refuse to cover employees for alcohol-related claims.

The laws have ensnared both problem and occasional drinkers.

In Washington state a law, RCW 48.20.385, specifically bars insurers from denying coverage solely because an injury was sustained as a result of the insured being intoxicated or under the influence of a narcotic. http://apps.leg.wa.gov/rcw/default.aspx?cite=48.20.385.

Gentilello describes the case of a Seattle woman who was celebrating her 25^th wedding anniversary and had a few glasses of champagne at dinner with her family.

It was a rainy night and she was dressed up and wearing high heels. As she and her husband tried to hail a cab, she tripped on a curb, fell and broke her ankle. In the emergency department, her chart noted that she had a few drinks.

Her insurer refused to pay. Washington subsequently adopted a prohibition on alcohol-related claims exclusions in 2004.

It’s unclear how frequently insurers continue to apply such laws to avoid paying claims. Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade organization, says the group doesn’t know what member practice is.

Cynthia Michener, a spokeswoman for Aetna, says that “to our knowledge” the company doesn’t apply such exclusions. Other insurers, including UnitedHealthcare and Humana, didn’t provide information about their practices.

But a professor who has written about such laws says there are indications that health plans continue to use them to deny payment.

“There are tons of these cases,” says Sara Rosenbaum, a professor of health law and policy at George Washington University’s School of Public Health and Health Services.  ”The only evidence we have suggests that these cases go on.”

“There’s no reason to think that insurers, eager to hold down costs, wouldn’t continue” to deny payment based on such exclusions, she adds.

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

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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.

Teens who received emotional intelligence training in school had improved scores on several measures of emotional well-being, including less anxiety, depression and social stress, according to a new study in the Journal of Adolescent Health.

Improvements from the training lasted up to six months after the program ended.

Emotional intelligence, or EI, refers to the ability to accurately appraise, express and regulate emotion. “The ability to handle emotions is essential for one’s physical and psychological well-being,” said study lead author Desiree Ruiz-Aranda.

In addition, adolescents who are healthier mentally are healthier physically and may engage in fewer risky behaviors.

Key Points:

• The inability to regulate emotional states has been linked to mental health problems, such as anxiety and depression.

• Many mental health disorders appear during adolescence.

• Teens who receive emotional intelligence training have lower measures of depression and social stress, even up to six months later.

“Emotional abilities need to begin as early as possible and preventive interventions should ideally be provided prior to developing significant symptoms,” said Ruiz-Aranda.

The study examined about 300 Spanish students who participated in 24 one-hour training sessions during a two-year period.

Teens in the study group participated in games, role-playing, art and discussion designed to promote the recognition of emotions in different contexts and to build empathy and emotional problem solving.

When compared with a control group, these teens had lower measures of depression, social stress, and other negative feelings, even up to six months later.

Successful programs need to be catered to individual cultures and ages and be applied to everyday settings, Ruiz-Aranda said.

Schools have not done well in preparing students for life with things such as emotional intelligence training, said Gary Low, Ph.D., professor emeritus of education at Texas A&M University in Kingsville.

He added that schools often don’t help students learn to cope with fears, stresses, relationships and other areas of life.

“We just hope that people learn that as they grow older, and I think we’ve not paid attention to developing a curriculum that would really help young people experience more success in life,” he said.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.