Large-scale Pumping Can Return Oxygen To Deep Waters, Scientists Say

Yale Environment 360 - February 23, 2015
A team of Danish and Swedish scientists reports that they have restored oxygen to the waters

Deploying instruments in Byfjord, Sweden. of a deep fjord that had suffered from a long-term lack of oxygen. The researchers used large pumps to mix oxygen-rich surface water into the deeper parts of the fjord's water column — which had long been anoxic due to its depth and geological setting — and after only two months higher oxygen concentrations became detectable in the bottom waters. "In the later phase of the experiment the entire water column began to look healthy," the researchers said, noting that bacterial species that live in well-oxygenated waters had begun to appear. Low oxygen levels make waters uninhabitable to most forms of life, and anoxic waters often harbor only a few types of bacteria, some of which produce significant levels of greenhouse gases.
Categories: Environment, Health

Practicing medicine in an era of antibiotic resistance: Duodenoscope edition

Pump Handle - February 23, 2015

Last week, FDA warned healthcare providers that the complex design of a piece of endoscopy eqiupment may make it hard to fully disinfect — which means that using it, even in accordance with the manufacturers’ instructions, might allow dangerous bacteria to spread between patients. The warning follows reports of seven patients from UCLA’s Ronald Reagan Medical Center becoming infected with the drug-resistant “nightmare bacteriaCRE (Carbapenem-Resistant Enterobacteriaceae) after undergoing procedures using ERCP endoscopes, or duodenoscopes. Of these seven patients, two died, and “the infection was a contributing factor in the death of two patients,” UCLA said in a statement. The health system notified 179 patients that they may have been exposed to CRE bacteria during diagnostic or treatment procedures performed between October 3rd and January 28th, and offered free home testing kits to see if they are infected.

In a piece for National Geographic’s Phenomena, Maryn McKenna notes that the UCLA episode follows outbreaks in other states, and that the weeks or months that can elapse between patients’ exposures and infection symptoms can make it hard to stop outbreaks quickly. She also interviewed CDC medical epidemiologist Dr. Alexander J. Kallen, who highlighted these alarming aspects of recent duodenoscope-associated CRE outbreaks (emphasis added):

… the outbreak we investigated in Illinois in 2013, which we reported in the Journal of the American Medical Association, is the first time that we know of where there was transmission of a highly resistant pathogen, from a scope, unrelated to an infection-control breach. You almost always see that someone forgot this step or that step. But in these last three outbreaks, there was persistent contamination despite not identifying a breach, and that is fundamentally different. It starts to raise the suspicion this is more a fundamental issue with these types of scopes, rather than just failures to adhere to recommendations for cleaning.

It appears that UCLA followed the FDA-validated disinfection instructions for the scopes, but two of the facility’s seven scopes harbored CRE bacteria anyway. Kallen also told McKenna that certain cleaning procedures might work to disinfect new equipment during FDA’s lab tests, but the same procedures might not be sufficient with older equipment as used and cleaned in practice. In any case, it’s a frigthening thought that a facility’s staff can do exactly what they’re supposed to do, but their patients can still end up with fatal infections.

FDA has recommendations for facilities, staff, and healthcare providers — and also for patients. “Discuss the benefits and risks of procedures using duodenoscopes with your physician,” the FDA Safety Communication suggests. “For most patients, the benefits of ERCP outweigh the risks of infection. ERCP often treats life-threatening conditions that can lead to serious health consequences if not addressed.”

As McKenna warned in her excellent and terrifying Medium piece “Imagining the Post-Antibiotics Future,” the spread of antibiotic-resistant bacteria means that medical procedures that are routine today, from dialysis to hip replacements, could become far more likely to result in fatal infections. FDA reports that US healthcare providers perform more than 500,000 ERCP procedures using duodenoscopes each year, because these are procedures are “the least invasive way of draining fluids from pancreatic and biliary ducts blocked by cancerous tumors, gallstones, or other conditions.” If cases of duodenoscope-linked CRE infections keep mounting, though, patients and providers might have to start rethinking treatments.

In his FY 2016 budget, President Obama has proposed a $1.2 billion federal investment in combating and preventing antibiotic resistance. That seems like reasonable sum to spend on something that could let us slow the arrival of the post-antibiotics future.

Categories: Health

Why U.S. East Coast Should Stay Off-Limits to Oil Drilling

Yale Environment 360 - February 23, 2015
It’s not just the potential for a catastrophic spill that makes President Obama’s proposal to open Atlantic Ocean waters to oil exploration such a bad idea. What’s worse is the cumulative impact on coastal ecosystems that an active oil industry would bring. BY CARL SAFINA
Categories: Environment, Health

CDC: Work to limit occupational silica exposure must continue

Pump Handle - February 20, 2015

While silicosis-related deaths have declined, it remains a serious occupational health risk and one that requires continued public health attention, according to recent data from the Centers for Disease Control and Prevention.

In the Feb. 13 issue of CDC’s Morbidity and Mortality Weekly Report (MMWR), researchers noted that while annual silicosis deaths have dropped from 164 in 2001 to 101 in 2010, dangerous silica exposure has been newly documented in occupations related to hydraulic fracturing (fracking) and the installation of engineered stone countertops. Overall during the 2001-2010 time period, the report documented a total of 1,437 U.S. deaths with silicosis as an underlying or contributing cause. Preventable when workers are provided with adequate personal protective equipment, tools and training, silicosis is an occupational lung disease caused by inhaling respirable crystalline silica dust.

In analyzing the 2001-2010 mortality data for which silicosis was reported as an underlying or contributing cause, researchers found that 28 of the 1,437 deaths were among people ages 15 to 44 and men accounted for more than 95 percent of the deaths. Whites accounted for more than 1,200, or 86 percent, of the deaths; however, the rate of silicosis deaths among blacks was significantly higher than for white and other races. The researchers wrote that the disparities in sex and race “reflect differences in the composition of the workforces in the industries and occupations placing workers at risk for exposure to crystalline silica dust.”

The report notes that workplace exposure to crystalline silica dust has long been documented in sectors such as mining, quarrying, sandblasting, pottery making, rock drilling, road construction, stone masonry and tunneling construction. However, such exposure is being documented in additional occupations as well, such as among technicians responsible for sandblasting in dental labs, workers involved in the fabrication and installation of certain kitchen and bathroom countertops, and those employed in the fracking industry. Report authors Ki Moon Bang, Jacek Mazurek, John Wood, Gretchen White, Scott Hendricks and Ainsley Weston write:

Because of the serious health and socioeconomic consequences of silicosis, new operations and tasks placing workers at risk for silicosis, and the continuing occurrence of silicosis deaths among young workers, effective primary prevention through elimination of exposure to respirable crystalline silica is critical. At the same time, because of the sometimes long latency of silicosis, with cases diagnosed years after exposure and often in retirement, ongoing silicosis surveillance is needed to track its prevalence in the United States.

The authors did caution that the MMWR report is subject to some limitations. For instance, work history is not reported on death certificates and so it’s not possible to report in which occupational industries the deceased were exposed to crystalline silica. Also, exposure to crystalline silica can cause diseases other than silicosis, such as lung cancer and chronic obstructive pulmonary disease. This MMWR report only focused on silicosis deaths.

In 2013, OSHA proposed lowering the allowable silica exposure limit — the Pump Handle’s Celeste Monforton wrote about that proposal here and here. It’s estimated that about 2 million U.S. workers continue to be exposed to the dangerous dust.

To read the full MMWR report, click here. Visit OSHA for more on the agency’s new silica proposal.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health

Wind Produced 10 Percent of Texas Electricity in 2014, Grid Operator Says

Yale Environment 360 - February 20, 2015
More than 10 percent of the electricity used in Texas last year came from wind turbines, according to the Electric

General locations of wind plants in Texas. Reliability Council of Texas, which operates the state's electric grid. Wind's share of the Texas electric mix grew from just over 6 percent in 2009 to 10.6 percent in 2014. During that period, wind power generation actually doubled — rising from 18.8 million megawatt-hours to 36.1 million — while total electricity generation in Texas also rose by 11 percent. The share of electricity generated by wind power in Texas is more than double the U.S. figure of 4.4 percent. The growth in wind generation in Texas is a result of new wind plants coming online and grid expansions that have allowed more wind power to flow through the system to consumers, the council said.
Categories: Environment, Health

Not an “accident”: Norberto Galicia Romero, 49, suffers fatal work-related injury in Marrietta, GA

Pump Handle - February 19, 2015

Norberto Romero, 49, suffered fatal traumatic injuries on Monday, February 16, 2015 while working at Thomas Concrete on Canton Road in Marrietta, GA. The Examiner reports

  • The incident occurred at about 3:05 pm “when someone called 911 to report that someone was trapped inside a concrete silo”
  • Firefighters worked “throughout the evening to free the man’s trapped body….[it] was recovered around 9 pm”

WXIA explains that Romero, 49, was one of

  • “two subcontractors from Texas [who] were cleaning the inside of the cement silo. …Romero attempted to unclog a ‘hopper’ in the silo, he fell into and there was a collapse. The second worker tried to help him and there was another collapse, burying Romero.”

The Marietta Daily-Journal offers information provided by a spokesperson with the Cobb County Fire Department:

  • “…the man worked for a company hired to clean the inside of the silo”
  • “…the silo was about 40 feet tall and about 20 feet across”
  • “…the sand and gravel mixture was so unstable that rescuers couldn’t safely get inside the silo. ‘We ended up having to basically dismantle the bottom of the silo where the drain was, or the hopper,’ said the spokesperson, ‘and that’s how we were able to recover the body.’”

I’ve been unable to determine yet the name of Mr. Romero’s employer. The silo in which he was working belongs to Thomas Concrete. The firm says

“we’re one of the largest producers in Georgia dedicated exclusively to ready mix concrete and we’ve expanded our operations in the Carolinas.”

In 2012, a Thomas Concrete plant in Raleigh, NC was cited by North Carolina OSHA (NC-OSHA) for numerous serious safety violations, including for hazards related to workers entering confined spaces. The agency proposed a penalty of $5,775. Through a formal settlement with NC-OSHA, the company paid a $525 penalty for two serious violations.

Each year, dozens of workers in Georgia are fatally injured on-the-job. The Bureau of Labor Statistics reports 70 work-related fatal injuries in Georgia during 2013 (preliminary data, most recent available.) Nationwide, at least 4,405 workers suffered fatal traumatic injuries in 2013.

The AFL-CIO’s annual Death on the Job report notes:

  • Federal OSHA has 49 inspectors in Georgia to cover more than 214,000 workplaces.
  • The average penalty for a serious OSHA violation in Georgia is $2,061.

Federal OSHA has until mid- August 2015 to issue any citations and penalties related to the incident that stole Norberto Romero’s life. It’s likely they’ll determine that Romero’s death was preventable. It was no “accident.”

Categories: Health

New York City Set for Major Sea Level Rise By 2050s, Report Concludes

Yale Environment 360 - February 19, 2015
The waters surrounding New York City are on track to rise 11 to 21 inches by the 2050s, according to an analysis based on


Future NYC flood zones NASA climate change models. The city's average temperature, which has increased by 3.4 degrees F since 1900, is set to rise another 5 degrees F by the 2050s, the report says, and annual precipitation is also likely to rise significantly over that period. New York City has already seen sea levels rise by over 1 foot since 1900 — nearly twice the average global rate, according to the report, which was published by the New York City Panel on Climate Change. Mayor Bill de Blasio said the report highlights the urgency of mitigating climate change and adapting to its risks, and he announced a commitment to cut the city's emissions by 80 percent by 2050.
Categories: Environment, Health

DIY Don't

EWG Toxics - February 18, 2015
Categories: Health

Disease-Carrying Ticks Expand Range and Emerge Earlier in Warmer Climate

Yale Environment 360 - February 18, 2015
Warmer spring temperatures in the northeastern U.S. are leading to shifts in the emergence of ticks that carry Lyme

Adult blacklegged tick disease, and milder weather is allowing ticks to spread into new geographic regions, according to findings published this week. The data — which span 19 years and include observations of more than 447,000 ticks — show that the insects emerged nearly three weeks earlier in warmer years. And when fall temperatures were mild, a smaller percentage of larval ticks entered dormancy and waited until spring to feed, the study found. "Here in the Northeast, warming is already having an effect, and people need to be tick-vigilant before May, as potentially infected nymphal ticks are searching for their blood meals earlier and earlier," said co-author Richard S. Ostfeld, an ecologist at the Cary Institute.
Categories: Environment, Health

DeLauro and Murray re-introduce Healthy Families Act; Philly finally gets paid sick days

Pump Handle - February 18, 2015

Last week, US Representative Rosa DeLauro (D-CT) and Senator Patty Murray (D-WA) reintroduced the Healthy Families Act, which would allow workers in businesses with 15 or more employees to earn one hour of job-protected sick time for each 30 hours worked, up to 56 hours (seven 8-hour days) per year.

DeLauro has been introducing this bill in every Congress since 2004, and Murray has been an original co-sponsor since then. What’s new this time around, though, is that the legislation has the president’s explicit support. Last month, President Obama urged Congress to pass the Healthy Families Act; he also included a President’s Budget item to fund state efforts to create paid medical and family leave programs, and took steps in support of paid parental leave for federal employees.

As Liz Ben-Ishai of the Center for Law and Social Policy (CLASP) notes in a blog post, February 12th wasn’t just the date of the Healthy Families Act’s reintroduction; it was also the day when Philadelphia became the 21st jurisdiction to pass a law letting workers earn paid sick time. Given that Philadelphia Mayor Michael Nutter vetoed paid-sick-days bills twice before finally signing this one, it seems that the movement to prevent workers from having to choose between their health and their jobs may have reached a tipping point.

The Philadelphia Inquirer’s Tricia L. Nadolny reports of Mayor Nutter’s reversal, “Asked if he regretted vetoing similar legislation in 2011 and 2013, Nutter said he never opposed sick leave but could not support the measure during the economic recession.” Many opponents of paid-leave laws cite economic concerns, but it’s important to note that the lack of paid sick days in most US cities and states disproportionately harms low-income workers. Wages Lost, Jobs at Risk, a new policy brief from CLASP, summarizes some of the impacts:

  • A majority of low-income mothers lose wages when they must care for a sick child. Two-thirds of women with family incomes below 200 percent of the federal poverty level and three-quarters of women living below the poverty line do not get paid when they need to miss work to care for a sick child.
  • Parents worry about losing pay to care for a sick child. One-third of parents with young children are concerned about losing pay when they need to care for their sick children; nearly two-thirds said their children could not attend child care because of illness in the past year.
  • For single parents, lost wages quickly wreak havoc. Assuming she earns the average wage for workers without paid sick time, a single working parent of two children cannot miss more than three days of work in a month without falling below the federal poverty line.
  • Many low-wage workers, especially mothers, lose their jobs due to lack of paid sick days. One in seven low-wage workers reports losing a job in the past four years because they were sick or needed to care for a family member.9 Almost one in five low-wage working mothers has lost a job due to sickness or caring for a family member.

Public health also suffers when workers have to drag themselves to their jobs while sick, or send sick children to school, because they can’t afford the resulting loss of pay. The American Public Health Association supports the Healthy Families Act and has adopted a policy position calling on Congress to pass legislation that would expand paid medical and family leave for U.S. workers. Legislation fitting that description has (once again) been introduced in Congress, and advocates for public health and low-income families will be watching their members carefully to see whether they support it.

Categories: Health

Why Ocean Health Is Better And Worse Than You Think

Yale Environment 360 - February 18, 2015
The good news is the world’s oceans have not experienced the extinctions that have occurred on land. But as ecologist Douglas McCauley explains in a Yale Environment 360 interview, marine life now face numerous threats even more serious than overfishing. BY FEN MONTAIGNE
Categories: Environment, Health

New York City’s restaurant letter-grading system improved food safety, researchers find

Pump Handle - February 17, 2015

In 2010, New York City health officials launched a new food safety tactic that assigned restaurants an inspection-based letter grade and required that the grade be posted where passersby could easily see it. So, did this grading make a difference? A new study finds that it has, with the probability of restaurants scoring in the A-range up by 35 percent.

To conduct the study, researchers with the New York City Department of Health and Mental Hygiene examined data from more than 43,400 restaurants inspected between 2007 and 2013. A restaurant’s score is based on how well it complies with local and state food safety requirements, such as food handling, food temperature, personal hygiene and pest control. Each violation is assigned a set of points, which when tallied up result in a letter grade of either A, B or C. The lower the score, the better the grade. (Click here for more on how the grades are tallied.)

The study, which was published in the March issue of the American Journal of Public Health, found that the proportion of restaurants with A-range scores rose from 28 percent in July 2008 to 31 percent in July 2010 to 46 percent in July 2013. In addition, the median initial inspection score went from 21 points in July 2008 to 17 points in July 2013 (remember, a lower score is better).

Regarding specific food safety regulations, researchers found that when compared to the two years before grading began, many restaurants were in better compliance. For example, the study found that average points given to all restaurants substantially declined for evidence of pests, such as rats, mice or roaches as well as for inadequate hand-washing facilities and not having a food safety-certified supervisor on site. Overall, fewer inspection points were also given for improper storage and inadequate food worker hygiene. However, average points went up for improperly maintaining food contact surfaces and increased slightly for inadequate protections against food contamination. Still, the proportion of C-range restaurants declined from 29 percent in July 2008 to 22 percent in July 2013.

In addition, the study found that more restaurants acted to correct cited violations — in July 2013, 45 percent of restaurants requiring reinspection received an A grade, up from 34 percent in July 2011. Study authors Melissa Wong, Wendy McKelvey, Kazuhiko Ito, Corinne Schiff, J. Bryan Jacobson and Daniel Kass write:

The NYC Health Department launched the restaurant letter-grading program to motivate restaurants to improve food safety, inform the public about inspection results, and reduce illness associated with dining out. …Our restaurant hygiene analysis suggests that the program provided an effective incentive for operators to comply with regulations and improve practices. We also found that there is an incentive to maintain hygiene practices, with the majority of A-grade restaurants earning A grades on their next inspection cycle.

The researchers also assessed public perceptions about the letter-grading program, using results from two independent telephone surveys. They found that more than 91 percent of New Yorkers approved of the program and 88 percent considered the inspection grades when deciding where to dine in 2012.

According to recent data from the Centers for Disease Control and Prevention, more than 1,600 foodborne disease outbreaks occurred in 2011-2012, including more than 29,000 illnesses and 1,750 hospitalizations. Restaurants were the most common source of outbreaks traced back to a single known food preparation setting.

To learn more about the letter-grading study, visit the American Journal of Public Health.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health

Demand for Indonesian Timber Far Outpaces Sustainable Supply, Study Says

Yale Environment 360 - February 17, 2015
More than 30 percent of wood used by Indonesia’s industrial forest sector stems from illegal sources rather than

Deforestation in Aceh, Indonesia, for palm oil. well-managed logging concessions or legal tree plantations, according to a new report based on data from industry and the Indonesian Ministry of Forestry. If Indonesian forestry industries operated at capacity, 41 percent of the wood supply would be illegal, the analysis found, and if companies were to go forward with plans for new mills, the supply would be 59 percent illegal. The source of this illegal wood is unclear, but the report suggests it is likely harvested by clear-cutting natural forests for new oil palm and pulp plantations. Part of the problem, the report says, is that Indonesia's sanctioned forestry plantations — the country's primary source of legal wood — are not currently sustainable because they are producing wood at only half the predicted rate.
Categories: Environment, Health

Humanely treated: I care about chickens, but more about people

Pump Handle - February 16, 2015

Our local grocery store chain, H.E.B., sells packaged poultry under the private label “Natural Chicken.” It’s meant to appeal to customers who want to know that the chicken they intend to eat was treated more humanely than your typical chicken. The package label on H.E.B.’s Natural Chicken says:

  • No cages ever!! Unlimited access to feed, water, and freedom of movement
  • No additives or preservatives
  • Always vegetarian fed
  • No added growth stimulants or hormones
  • No antibiotics
  • Raised cage free

I stood in the refrigerator aisle and stared at the package for a while. I thought about the label and treating chickens well. But what about the workers who processed the chickens? What symbol could be on the label to signify that the workers had unlimited access to restrooms, just like the chickens had “unlimited access to feed and water”?

What could the label say to indicate that the plant’s working conditions were designed toward freedom from repetitive movement disorders for the workers? The chickens were afforded “freedom of movement.”

A new kind of package label (Look closely in two places)


We’ve written many times here about the harsh working conditions for meatpacking and poultry workers. Employees at most of these plants can’t keep up with the fast pace of the production lines. The owner of one firm told an NPR reporter recently:

“We hire 100 people a week because we have 100 people who quit every week. We’re constantly short.”

Current and former workers testified in March 2014 before the Inter-American Commission on Human Rights and describe what it is like to be employed in the poultry and meatpacking industry. As Liz Borkowski, MPH reported, workers suffer from crippling injuries in their hands, arms and shoulders. Some are in constant pain, but when they complain about their work-related injuries, they are ignored or fired, or they quit. I’ve got to believe that someone who wants to know that the chicken they’re about to eat was humanely treated would want to know the same thing about the poultry plant workers.

Lizzie Grossman wrote here last year about the Equitable Food Initiative (EFI) and its goal

“to ensure not only the safety of food itself but also the health, safety and respect of farm workers and their families.”

EFI focuses on production of fruits and vegetables, but might it serve as a model for other forms of food production? Among its more than 100 performance standards for food safety, environmental and labor stewardship, I see many that could be adapted for poultry and meat production. There are general requirements for appropriate safety training and personal protective equipment, but there are other indicators that go beyond mere compliance with OSHA standards. I think this one would be particularly appealing to poultry and meatpacking workers:

The Leadership Team evaluates each job, process, or operation of identical work activity covered by this section or a representative number of such jobs, processes, or operations of identical work activities involved at the farm and develops a Repetitive Motion Injury (RMI) Elimination Plan.

For any repetitive motions that are deemed to cause RMIs, the Leadership Team develops a work plan to correct the RMI exposure, or, if the exposure cannot be corrected in a timely manner, the exposure is minimized to the extent feasible. The Leadership Team recommends engineering controls, such as work station redesign, adjustable fixtures or tool redesign, and administrative controls, such as job rotation, work pacing or work breaks to minimize the risk of RMIs.

EFI has been pilot testing its standards at two California strawberry farms. It will be revising the standards and developing a certification system which would allow farms that comply with EFI’s standards to display a EFI logo (trust mark) on their products. I know that ramping up such a program will take time, and moving beyond strawberries to other produce will create some hiccups. But I’m holding out hope that the demand for good food by institutions and individual consumers will move beyond produce in the years ahead to meat and poultry processing.


Categories: Health

Space-Based Measurments Can Track Global Ocean Acidity, Researchers Say

Yale Environment 360 - February 16, 2015
An international team of scientists has developed new methods for studying the acidity of the oceans from space,


Global ocean alkalinity measured from space. according to research published in the journal Environmental Science and Technology. Currently, scientists must rely on measurements taken from research vessels and sampling equipment deployed in oceans to determine acidity — which rises as the oceans absorb CO2 from the atmosphere — but this approach is expensive and geographically limited. The new techniques use satellite-mounted thermal cameras to measure ocean temperature and microwave sensors to measure salinity. Together these measurements can be used to assess ocean acidification more quickly and over much larger areas than has been possible before.
Categories: Environment, Health

Will New Obstacles Dim Hawaii’s Solar Power Surge?

Yale Environment 360 - February 16, 2015
Blessed with lots of sun and keen to cut its reliance on imported oil, Hawaii has moved to the forefront of residential solar installations in the U.S. But financial and technical hurdles are slowing the state’s drive to generate 40 percent of its electricity from renewable energy by 2030. BY ERICA GIES
Categories: Environment, Health

Study: HPV vaccine does not lead to higher rates of sexually transmitted diseases

Pump Handle - February 13, 2015

When the U.S. Food and Drug Administration approved the first vaccine to protect against cancers caused by certain strains of the human papillomavirus, or HPV, public health advocates cheered its arrival and life-saving potential. Unfortunately, the new vaccine quickly became embroiled in a debate over whether immunizing young girls against HPV, a sexually transmitted disease, would lead to risky sexual behavior. A new study, however, finds that the vaccine is not associated with an uptick in STDs — an indicator that HPV immunization does not promote unsafe sex.

To conduct the study, which was published in February in JAMA Internal Medicine, researchers analyzed an insurance database of young girls ages 12 to 18 from 2005 through 2010. They compared STD rates among girls who were vaccinated against HPV with those who were not — the eventual data set included more than 21,600 girls who received the vaccine and about 186,500 girls who were not vaccinated. While they found that young girls and women vaccinated against HPV typically had higher STD rates before and after immunization when compared to their unvaccinated peers, there was no significant difference in the growth of STD rates between the two groups in the year following vaccination. In other words, the study findings led researchers to conclude that the HPV vaccine is not likely associated with an increase in unsafe sexual behavior.

While previous research has examined the same question, study co-author Anupam Jena, an assistant professor of health care policy and medicine at Harvard Medical School and an assistant physician in the Department of Medicine at Massachusetts General Hospital, told me that this study is the first to examine such a large cohort of vaccinated and unvaccinated girls. Jena noted that HPV vaccination rates in the U.S. are quite low, with less than half of teen girls receiving all three doses of the vaccine. (Considering that this vaccine is the first-ever medical therapy that can prevent cancer, he described such low immunization rates as “somewhat shocking.”) Federal health officials currently recommend that boys and girls receive the vaccine at ages 11 or 12 years old.

Jenna added that prior surveys have found that significant percentages of parents, about 20 to 30 percent, as well as pediatricians, more than 10 percent, do voice personal concerns that HPV vaccination could tacitly approve the initiation of sexual activity or promote unsafe sexual behaviors.

“It’s this context that makes it such an important issue to understand,” he told me. “I think it’s a reasonable concern and not one to automatically dismiss. There are studies that do suggest that sometimes there are unintended consequences of well-intended (medical therapies), so it’s not unreasonable that this can occur. That’s why we turn to science to answer these questions.”

In addition to finding no evidence that HPV vaccination leads to higher rates of STDs, the study also revealed interesting differences and characteristics that could be useful in clinical and public health settings. For example, researchers found that girls and young women living in the South were less likely to be vaccinated. Overall, vaccination rates increased with age. Vaccinated females had higher rates of STDs before and after immunization when compared with unvaccinated females, and vaccinated females were also more likely to be sexually active in the year prior to immunization. Jena noted that these last two findings might be of particular interest to physicians when determining which patients are most in need of safe sex information.

Study authors Jena, Dana Goldman and Seth Seabury write:

We found that, although vaccinated females had higher STI (sexually transmitted infection) rates after vaccination compared with matched controls, these differences existed before vaccination as well. Our difference-in-difference analysis that compared changes in STI rates over time between vaccinated and nonvaccinated females found no evidence of an association between HPV vaccination and higher STI rates. Even among females who were more likely to be sexually active before HPV vaccination as measured by contraceptive medication use, there was no evidence of increased unsafe sexual behavior.

So, how can these findings translate in practice and enhance vaccine promotion and education? I posed this question to Jena, noting that previous messaging research has found that simply providing parents with corrective information on vaccine safety isn’t likely to change any minds (for an example, see this study). Jena said that while it’s true that this study won’t likely result in a sudden rush of girls being vaccinated against HPV, “I do think this kind of study can move the needle a little bit in a few ways.” One way is through media dissemination, he said, and another is by providing pediatricians with a little more leverage during conversations with parents who seem on the verge of saying “yes” to the HPV vaccine.

“What we’ve done is add information to what is already known and hopefully that will be useful,” Jena said. “At the end of the day, the real push is how do you translate that information into something tangible that can actually improve vaccination rates.”

For more on the HPV vaccine study, visit JAMA Internal Medicine or read this news release.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health
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