The latest issue of the journal Health Affairs focuses on children’s health, and one of the major topics is health insurance for children. A look at the Kaiser Family Foundation’s coverage statistics shows that in 2013, 49% of children ages 0 – 18 had employer-sponsored coverage, 39% were covered by Medicaid or another public program, 5% had other private coverage, and 8% were uninsured. There are three main ways US children get health insurance coverage:
Medicaid: The federal government pays a portion of healthcare costs for Medicaid beneficiaries, and in exchange requires that states extend coverage to certain populations, including children living below the poverty level. (In 2014, the FPL is $11,670 for a one-person household, $23,850 for a household of four.) KFF reports on the state income cutoffs for 2014, which include:
- Ages 0 – 1: All states cover children ages 0 – 1 whose family incomes are at or below 144% of the FPL; seven states and the District of Columbia set the limit at various points above 300% FPL. Utah has the lowest limit, at 144% FPL; five other states have it below 150%; Iowa’s limit is the highest, at 380%.
- Ages 1 – 5: All states cover children ages 1 – 5 whose family incomes are at or below 138% FPL; five states and DC set the limit at various points above 300% FPL. Oregon has a limit of 138% FPL, while 15 other states have limits below 150%; Hawaii’s limit is 359%.
- Ages 6 – 18: All states cover children ages 6 – 18 whose family incomes are at or below 138% FPL (with 17 states using that as the limit); four states and DC set the limit at various points above 300% FPL, including Hawaii at 359%.
CHIP: The Children’s Health Insurance Program, which Congress established with 1997 legislation and reauthorized with a 2009 law, allows states to use federal funding to provide or purchase coverage for children whose family incomes are above the Medicaid eligibility limits but still too low to afford private insurance. Unlike federal Medicaid funding, which is available for as many eligible beneficiaries enroll in the program, federal CHIP funds come in fixed amounts, and states can cap the number of CHIP beneficiaries. CHIP coverage also does not need to include all of the benefits specified for Medicaid-covered children, and allows beneficiaries to be charged for premiums and cost-sharing (although these charges are still lower than those in most private plans). Income cutoffs for CHIP coverage range from 175% FPL in North Dakota to 405% FPL in New York.
Private coverage: Families can get coverage through an employer-sponsored plan, or they can buy coverage from an exchange (marketplace). Those who are eligible for subsidies under the Affordable Care Act can get financial assistance with premiums for exchange-purchased plans. The basic rule is that people with household incomes between 100% and 400% FPL are eligible for premium subsidies. However, there are important exceptions. If an employee is offered employer-sponsored coverage and that coverage qualifies as affordable, that employee’s family is not eligible for subsidies. The determination of an “affordable” plan — one whose premiums cost no more than 9.5% of the person’s income — is based on what is affordable for the employee as an individual, not what is affordable for the employee’s family. NPR’s John Ydstie recently offered an illustration of how this rule can leave lower-income families without affordable insurance options:
Suzanne Shugart and her family face a similar situation in McPherson, Kan. Her husband works for a cabinetmaker, earning around $32,000 a year. He can get health insurance through his employer for a little more than $50 a month, just for himself.
That’s also affordable coverage, according to Obamacare rules, so Shugart’s family isn’t eligible for subsidies in the online marketplace. But the employer’s family coverage is too expensive for them, says Shugart.
“If he were to increase it to a family plan, which would include me, it goes up to about $380 a month, which is nearly our mortgage payment,” Shugart says.
She and her husband can’t afford that, she says. Luckily, their children qualify for insurance through a state plan.
“That’s how we’ve lived for the last eight years,” Shugart says. “He has insurance through work and the kids have state insurance, and I just live on hope and a prayer that nothing bad will happen.”
If Shugart’s family could get subsidized coverage on the Obamacare exchange, the premium for a benchmark plan would be a little more than $200 a month, making coverage for her much more affordable.
CHIP doesn’t necessarily fill the gap in such situations, explain Sara Rosenbaum of the George Washington University Milken Institute School of Public Health (where I also work) and Genevieve M. Kenney of Urban Institute’s Health Policy Center in the latest issue of Health Affairs:
As a result, workers whose own coverage meets the affordability threshold are barred from securing premium subsidies for their children, no matter how out of reach dependent coverage might be in relation to family income. This problem, termed the “family glitch,” deprives families of help, potentially leaving millions of children without access to affordable insurance in the absence of CHIP. But CHIP alone is no panacea for the family glitch. CHIP covers more than eight million children at some point each year. However, half of the states set income eligibility standards at less than 255 percent of poverty. In these states, children caught in the glitch but with household incomes higher than their state’s relatively low CHIP upper income threshold yet nonetheless below the premium tax credit threshold of 400 percent of poverty cannot receive tax subsidies. Because of the family glitch, children in these states are at increased risk of lacking a pathway to affordable coverage.
Over the past few decades, Congress has been able to reach bipartisan agreement about the need to improve health-insurance coverage for children. Might they act to fix the “family glitch”? John Ydstie talked to the Urban Institute’s Linda Blumberg, who was not optimistic:
Blumberg says it’s likely that in a more amenable political environment, the family glitch would be fixed, with Congress adding more focus on the affordability of family coverage.
“But I think that because of the political volatility around this law, there was never an opportunity to sit down and say, ‘OK, let’s make a policy change here that takes this into account,’ ” she says.
Blumberg says Democrats have been hesitant to open debate on the law at all, because of fear it would be eviscerated during the legislative process. With the Republican takeover in Congress, the chance of eliminating the family glitch seems unlikely to improve anytime soon.
An 8% uninsurance rate for children is lower than it used to be and better than the 19% rate for adults ages 19 – 64, but it’s still shameful.
Read Hilton's analysis.
Draft Climate AcDraft Climate Accord Reached In Lima Leaves Many Doubts in Its Wakecord Leaves Many Doubts in Its Wake
San Francisco passes nation’s first Retail Workers Bill of Rights, addressing erratic scheduling and part-time work
The week of midterm exams is stressful for any college student. For San Francisco State student Michelle Flores, it was another stress-filled example of the unfair conditions she and millions of other retail workers face on a regular basis.
Flores, a 20-year-old labor studies and public policy undergrad, is a cashier at a national grocery store chain and usually works a 24-hour week, though she’d like to work more. Just before midterms, she found out her supervisor expected her to work 30 hours the same week as her exams — and he gave her just two days notice.
“I said I’d work them,” she said. “I’m poor and I need the hours.”
But the late notice left Flores scrambling to rearrange her schedule to leave her enough time to study. She got it done, but had to skip a few nights of sleep. Some mornings she’d wake up at 5 to squeeze in a few more hours of study before her 9 a.m. shift began. Flores is going to school on scholarships, but pays for all of her living expenses — rent, food, utilities — on her own. The income is critical to her being able to finish her education.
“I need to pay my rent, I need to eat and jobs don’t fall out of trees,” Flores told me. “It was really hard for me to get hired as a 20-year-old kid with no experience.”
Getting such short notice of work hours isn’t out of the ordinary, either. While her union contract at the grocery store guarantees her at least 24 hours a week, Flores’ schedule still fluctuates from one week to the next and she rarely gets more than a couple days notice. It’s a scheduling practice that leaves Flores little leeway to budget both her time and income.
Fortunately, that’s all about to change. On Dec. 5, a Retail Workers Bill of Rights officially became law following two unanimous votes of the San Francisco Board of Supervisors. The law, which will go into effect Jan. 5 and is expected to impact 40,000 hourly employees, is a first of its kinds and could help set precedent for struggling workers throughout the country. It applies to businesses with 20 or more locations worldwide and 20 or more employees in San Francisco. The Retail Workers Bill of Rights consists of two pieces of legislation — one that addresses hours and retention protection and another that addresses fair scheduling.
The law’s five major provisions will require corporate retailers to offer more hours to part-time employees before hiring additional part-time workers; curb erratic scheduling practices by requiring employers to post schedules at least two weeks in advance; require employers provide two to four hours of pay at a worker’s regular rate if the worker is required to be on-call, but the employer cancels the shift with less than a day’s notice; requires equal treatment of part-time workers with respect to starting pay and access to unpaid time off and promotion opportunities; and lets workers keep their jobs for at least a 90-day pay period after a company is bought or sold. The bill of rights also protects contracted employees who work at the covered businesses, such as janitors and security guards. (At the federal level, the proposed Schedules That Work Act, H.R. 5159, would also address the erratic scheduling practices facing hourly workers.)
“All families need strong wages, stable hours and sane schedules to build a good life,” said Gordon Mar, executive director of Jobs With Justice San Francisco. “But too many of our neighbors who serve our food, stock our shelves and sweep our floors have jobs that grant too few hours on too short notice and require them to be at the beck and call of their employers.”
Jobs With Justice San Francisco was a leader in a large coalition of community activists, labor groups and unions that organized in support of the bill. According to Michelle Lim, a strategic campaign organizer with Jobs With Justice San Francisco, passage of the landmark bill is about a year in the making. She noted that the number of involuntary part-time workers (those who want to work more hours) in California has tripled since 2006 and now stands at 1.1 million. Nationwide, the number of involuntary part-time workers is 7 million, up from 4.5 million in 2008.
The movement to improve retail work conditions isn’t just about more hours, Lim said, it’s also about eliminating unpredictable scheduling practices that often leave workers scrambling to meet needs outside of work. These days, retailers are increasingly using technology that uses real-time revenue data to develop and manipulate scheduling to maximize profits, leaving workers at the whim of a program that doesn’t account for their personal needs and lives. In fact, a recent study from researchers at the University of Chicago found that 48 percent of part-time workers received their schedules a week or less in advance.
“It wreaks havoc on mothers, fathers, students and workers in general,” Lim told me. “Predictable scheduling means being able to take care of yourself and your family, being able to plan in advance, having regularly scheduled doctor’s appointments, getting enough sleep — and at the end of the day, all of that affects your health. When we choose more predictable scheduling, we’re choosing a healthier life.”
San Francisco may have been the perfect place to first pass a Retail Workers Bill of Rights. The city is already home to an active movement organizing in support of low-wage workers, and Lim noted that the coalition benefited from the momentum of other recent successes, such as the minimum wage increase that voters approved in November.
“We know that San Francisco is a worker-conscious city,” she said. “But this bill wouldn’t have been possible without the workers. They’re the ones who have to deal with what’s going on. Workers are absolutely crucial in developing these policies so we know exactly what the issues are.”
Of course, not everyone happily embraced the Retail Workers Bill of Rights. The business community organized considerable opposition and is “pushing back even now,” Lim told me. With the business community actively lobbying against the new law, Lim said Jobs With Justice and its coalition partners are developing a two-year plan to monitor enforcement. The San Francisco Office of Labor Standards Enforcement will also be charged with enforcement and of investigating worker complaints. Lim noted that Jobs With Justice and its partners also hope enforcement and monitoring activities will build an “on-ramp” for ongoing organizing and help create long-term change within the retail industry.
“It’s a huge victory,” Lim said about the bill’s passage. “Everyone is so excited because they know how much it will impact their lives. Workers are excited, their children are excited, their families are excited. It affects the whole community.”
Flores is excited, too. She predicts the Retail Workers Bill of Rights will completely change the dynamic at her workplace and she’ll be able to consistently plan ahead so that her studies won’t suffer.
“We should not all be living at the grace of corporate greed,” she said.
To learn more about San Francisco’s Retail Workers Bill of Rights, visit http://retailworkerrights.com. For more in-depth coverage of retail scheduling practices, check out this New York Times article.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Feeling tired? You’re not alone. A new study finds that many U.S. workers aren’t getting enough sleep, which is essential to optimal health, and that people who work multiple jobs are at heightened risk of getting less than the recommended hours of nightly rest.
To conduct the study, which was published in the December issue of the Sleep journal, researchers examined the responses of nearly 125,000 Americans ages 15 years old and older and who participated in the American Time Use Survey between 2003 and 2011. They found that work was the dominant reason for reporting less sleep across nearly all sociodemographic groups. Those who reported sleeping six hours or less (described in the study as “short sleepers”) also worked 1.55 hours more on weekdays and 1.86 hours more on weekends and holidays when compared to normal sleepers. (The American Academy of Sleep Medicine recommends that adults get about seven to nine hours of sleep per night for optimal health, productivity and daytime alertness.) Short sleepers also reported starting work earlier in the morning and working later into the evening. Adults who work multiple jobs were found to be 61 percent more likely to report sleeping six hours or less on weekdays.
In the study’s introduction, authors Mathias Basner, Andrea Spaeth and David Dinges highlight the importance of adequate sleep to health, noting that “sleep is a biological imperative,” with habitual short sleep associated with a variety of poor health outcomes, such as obesity, diabetes, hypertension, heart disease and all-cause mortality. In fact, sleep is so important to health that the Centers for Disease Control and Prevention increased its collection of information on sleep-related behaviors in recent years, stating that “insufficient sleep is an important public health concern.” The study also noted that adequate sleep is a core contributor to safety, pointing to the 83,000 traffic crashes that occur in the U.S. every year and that involve drowsy drivers. They write:
Despite the apparent benefits of sufficient sleep for cognitive performance, safety, and health, current representative surveys indicate that 35% to 40% of the adult US population report sleeping less than the usually recommended 7-8 hours on weekday nights, and about 15% report sleeping less than 6 hours. The high prevalence of habitual short sleep and its association with morbidity and mortality warrant the identification of populations at risk for habitual short sleep as well as the identification of behaviors that predispose to short sleep and that could be targeted in intervention programs.
Specifically, the study found that those 15- to 24- years-old are getting the most daily sleep when compared to older respondents. Those between the ages of 35 and 64 reported the least amount of daily sleep and were significantly more likely to be short sleepers. On average, black, Hispanic and Asian respondents slept longer than white respondents. However, black respondents were also more likely to be short sleepers than white respondents. On average, those with a college degree experienced significantly less sleep than those with a high school degree; however, those with higher educational attainment also experienced fewer changes in sleep patterns than high school graduates. Full-time high school students got significantly less sleep during weekdays when compared to private-sector workers, but got more sleep on the weekends and holidays. People working multiple jobs got significantly less sleep, were more likely to be short sleepers, and less likely to be long sleepers on weekends and holidays.
Overall, short sleepers worked more hours, starting working earlier and continued working later into the day. The study stated: “Working ranked as the primary waking activity that was performed instead of sleep across all sociodemographic strata, with the exception of respondents retired, unemployed, or otherwise not in the labor force.” So, what’s an appropriate intervention — how do we find a good balance between work and the health-protective benefits of sleep? The study authors offered a number of possible answers, such as making work start times more flexible, reducing the prevalence of multiple jobs and finding ways to reduce commuting times (for example, more reliable public transit could be one way to help workers get more sleep).
In accompanying editorial published in the same issue of Sleep, author Lauren Hale, an associate professor in the Program in Public Health at Stony Brook University, described the study as “another opportunity to raise concerns about sleep patterns as both an unmet public health and a social justice problem.” Citing the study’s findings that those with lower levels of social status are more likely to sleep too little or too much — both of which are associated with negative health issues — she wrote that the distribution of adequate sleep tends to favor the more advantaged.
“We must respect the reality that many time-use allocation decisions are not factors over which people have total control, due to both structural and psychological barriers,” Hale writes. “While it is tempting to attribute sleep duration and timing patterns to active choices that can be altered through well-meaning targeted interventions, we must think deeply about the underlying structural and psychological factors that determine sleep patterns.”
Visit the American Academy of Sleep Medicine newsroom to read more and request a full copy of the study.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
“Too many oil and gas industry workers are being hurt or killed on the job,” said Assistant Secretary of Labor for Occupational Safety and Health, David Michaels in remarks delivered to the more than 2,000 people who gathered last week in Houston for the 2014 OSHA Oil & Gas Safety and Health Conference. As part of efforts to address industry safety issues, the US Occupational Safety and Health Administration (OSHA) has announced a new effort to improve the safety of workers employed in the oil and gas industry.
Described as an “alliance,” the initiative involves a two-year agreement signed onto by OSHA, the National Institute of Occupational Safety and Health (NIOSH) and what’s called the National STEPS Network – a volunteer organization founded in 2003 in south Texas by OSHA and oil and gas industry companies aimed at improving industry safety in that region. The goal of the new alliance, said OSHA in its announcement, is to prevent “injuries, illnesses and fatalities among workers in the exploration and production sector of the oil and gas industry.
The oil and gas industry is one of the three most dangerous in the US. Last year, 112 oil and gas industry workers were killed on the job and about 9,000 suffered non-fatal, work-related injuries and illnesses, according to data gathered by the US Bureau of Labor Statistics (BLS). Numbers available thus far for 2014 from OSHA reflect more than 60 incidents in which oil and gas industry workers died on the job. There have been at least four fatal oil and gas industry incidents since the beginning of November.
“The rapid growth of employment in this industry has been coupled with an increase in worker fatalities,” said OSHA in announcing the new oil and gas industry safety program.
While there were about 30 fewer such deaths in 2013 than in 2012, the oil and gas industry continues to have one of the highest workplace fatality rates of any US industry sector. For much of the past ten years, according to the US Centers for Disease Control and Prevention (CDC), the industry has had a collective fatality rate seven times higher than for all US workers. The CDC also notes that BLS industry fatality rates may not include all oil and gas industry work-related deaths as some people working on or servicing offshore oil platforms may be classified as working in other industries, such as transportation or material moving.
“These tragedies are preventable and we need to work together to address hazards, prevent injuries and save lives,” said Michaels.
When it comes to non-fatal work-related injuries and illnesses, the overall rate of such incidents in the oil and gas industry is about on a par with other private industries. But injuries suffered by oil and gas workers are more serious. This is reflected by the time workers need to recover from these injuries. Oil and gas workers are off work three times longer – 24 days as opposed to 8 – than the median days off for all industries. This, explains the BLS, is because of the type of injury common in the oil and gas industry – such as fractures incurred when people are struck by heavy objects. Other frequent industry hazards include motor vehicle crashes, fires, electrocution and explosions.
Addressing chemical and silica exposure
But physical dangers are not the only hazards that imperil oil and gas industry workers. Recent studies by NIOSH and others show that workers in this industry are at widespread risk of exposure to hazardous chemicals, including benzene and other carcinogenic volatile organic compounds. An investigation by NIOSH has also shown that workers at hydraulic fracturing sites are exposed to respirable crystalline silica that can cause incurable lung disease. Among the other chemical hazards of this work is the potential of exposure to naturally occurring radioactive materials that can be released during oil and gas extraction and can contaminate equipment used in these processes.
Not clear from details available thus far on the new safety alliance, is how much of this effort will focus on chemical hazards and illnesses associated with these exposures. The agreement as shared by OSHA, outlines in broad strokes what the alliance will do. It emphasizes information-sharing, developing educational materials – including a video on struck-by injuries – and raising awareness about industry hazards and leading causes of occupational fatalities.
OSHA meanwhile has released a new publication on responding to hazards in hydraulic fracturing other than respirable silica, including strategies to prevent exposure to VOCs and hydrogen sulfide. According to OSHA spokesperson Mary Brandenberger, the publication was produced in collaboration with industry and released during the safety conference held last week in Houston.
Meanwhile, NIOSH explained via email that the alliance would “primarily focus on promoting best practices for reducing injuries and fatalities.” Asked about work-related illnesses resulting from chemical and other exposures, NIOSH said, “The alliance will not be used to support the ongoing NIOSH fieldwork to characterize chemical hazards to workers.” (emphasis added)
Yet discussing the effort in a phone interview, STEPS Network chair Rick Ingram said the program would look “holistically at the industry” and that chemical exposures would be included. The STEPS Network work-plan for the alliance notes that NIOSH and OSHA will participate in meetings discussing chemical and silica exposure.
“We will look at all primary causes of fatalities,” said Ingram but also at diseases, including those stemming from exposure to hazards that include respirable crystalline silica, VOCs and naturally occurring radioactive materials. “Our team is really determined to make this a meaningful and productive alliance and reduce fatalities and chronic diseases,” said Ingram.
The STEPS Network’s Respirable Crystalline Silica Focus Group is being renamed as the Emerging Issues Group, Ingram explained, to reflect its work on hazards other than silica inhalation.
Industry investigation of silica exposure in fracking – confidentiality guaranteed
Notes from a June 2012 STEPS Network Respirable Crystalline Silica Focus Group meeting suggest that NIOSH first became aware of this crystalline silica issue in the summer of 2008. Samples collected that summer indicated potential personal exposures. The fieldwork that went into NIOSH’s 2012 report that found silica exposures exceeding current NIOSH and OSHA safety limits, began in the summer of 2010 and continued through the fall of 2011. Worth noting is that current OSHA silica standards were established 40 years ago and efforts to make them more stringent have been met with resistance by various industry groups, including the American Chemistry Council’s Crystalline Silica Panel of which the American Petroleum Institute is a member.
As the meeting minutes noted of conditions at that time, “If you observe fracking operations, you can notice there really aren’t any engineering controls for sand. The differences you see are in controls for safety vs. health (i.e.- when workers go up on a sand master, there are rails built in for fall protection or if you are wearing fall protection, there is a big wire that goes across the top of it). But there are no dedicated controls for sand dust…” in such an operation that “typically involves hundreds of thousands of pounds of sand being moved per zone every day.”
Since then, explained Ingram, the industry has made progress in reducing potential silica exposures by raising awareness of the issue among both employers and workers, and by developing new engineering controls. It’s an issue the industry takes very seriously, said Ingram. But there is still more work to do, he said.
NIOSH has not done any additional silica sampling since its fieldwork conducted in 2010 and 2011, explained NIOSH spokesperson Nura Sadeghpour via email. The only other silica-related work NIOSH has done since then, she wrote “is field evaluation for the NIOSH engineering control (the NIOSH mini baghouse retrofit) for silica.” And the only additional hydraulic-fracturing related work by NIOSH, wrote Sadeghpour, is its work examining hazards during what’s called “flowback,” the investigation that showed VOC exposure during this process. “We hope to continue that work, but don’t have any definite plans at this time,” wrote Sadeghpour.
The oil and gas industry, however, is now conducting a survey to gather additional information about crystalline silica exposure in hydraulic fracturing operations. A “blind” study by the American Petroleum Institute, National STEPS Network and Bureau Veritas was launched in August 2013 with a data submission deadline of August 2014. Data is being submitted to Bureau Veritas under an agreement that will keep survey participants’ information – including company names and sampling locations – confidential. The confidentiality agreement promises destruction of original data and related correspondence following its transfer to the database.
Available documents don’t indicate if sampling results will be shared with workers. The survey asks for shift-length (in minutes) but does not indicate if this information-gathering will ask companies to specify if workers are full- or part-time employees or hired through a contractor – details that would be relevant in determining individual worker exposure over time.
NIOSH has also kept its silica data exposure sources confidential. Documents NIOSH shared in response to a FOIA request by The Pump Handle redacted all information that could identify companies at whose gas extraction site the sampling for respirable crystalline silica was conducted. Clearly sharing this information is something that worries the companies involved.
“Our industry has come a long way, working very diligently to reduce fatalities and chronic illness in our industry to protect workers and their families. It’s been a long but productive journey. We’re not there yet but are working very hard to protect workers and their families,” said Ingram. “The people I work with in this industry, the teams that we work with,” he said, “really care about the people in the industry.”
A question to be asked, however, is how not disclosing where harmful exposures are occurring – whether of respirable silica, VOCs or other chemical hazards – benefits worker protection.
Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Yale e360, Environmental Health Perspectives, Mother Jones, Ensia, Time, Civil Eats, The Washington Post, Salon and The Nation.
Fatal work injury that killed Ricardo Ramos, 49, was preventable, Michigan OSHA cites Hillshire Brands
Ricardo Ramos’ work-related death could have been prevented. That’s how I see the findings of Michigan OSHA in the agency’s citations against his employer, Hillshire Brands. The 49-year-old was working in May 2014 on the overnight cleaning crew at the company’s Zeeland, Michigan plant when he was caught and pulled into a piece of machinery. The facility prepares and packages Jimmy Dean sausage. I wrote about the incident shortly after it was reported by local press.
Inspectors with Michigan OSHA conducted an inspection at the Hillshire plant following Ramos’ death. The agency recently issued citations to the firm for two serious violations and proposed a $12,600 penalty. The violations involve failing to ensure that when machinery is being repaired or cleaned that the power is locked off (408.11412(3)), and guarding of machine shafting (408.10722(1)).
While the post-fatality inspection was ongoing, MIOSHA received a referral from a credible source about other safety hazards at the plant. The company was again cited for not having or using proper lockout/tagout procedures. The violation was classified as serious and a $4,500 penalty has been proposed. Hillshire Brands has contested all the citations issued in the wake of Ricardo Ramos’ death.
When some local press initially reported Ricardo Ramos’ death, they called it an accident. An “accident” suggests the circumstances were unforeseen or could not have been avoided. Michigan OSHA’s findings tell a different story. Call it cutting corners, call it poor management, call it breaking the law. Whatever you want to call it, Ricardo Ramos’ work-related death could have been prevented, it was no accident.
In ongoing public health efforts to curb the obesity epidemic, better menu and nutrition labeling is often tapped as a low-cost way to help make the healthy choice, the easy choice. And while the evidence on the effectiveness of such interventions is still emerging, a recent study found that educating young people on the calories in sugar-sweetened beverages did make a positive difference.
Published in the December issue of the American Journal of Public Health, the study focused on an experiment inside six corner stores located near middle and high schools within low-income, predominantly black neighborhoods in Baltimore. (According to the Centers for Disease Control and Prevention, black youth experience significantly higher obesity rates than white children.) To gauge whether providing calorie information changed youth’s purchasing habits, researchers posted one of four randomly assigned, bright-colored signs on beverage cases. The signs read: “Did you know that a bottle of soda or fruit juice has about 250 calories?”; “Did you know that a bottle of soda or fruit juice has about 16 teaspoons of sugar?”; “Did you know that working off a bottle of soda or fruit juice takes about 50 minutes of running?”; and “Did you know that working off a bottle of soda or fruit juice takes about 5 miles of walking?” Altogether, researchers collected data on more than 4,500 purchases made by black adolescents.
The results are very promising. Compared to baseline data (i.e. beverage purchases before the signs were posted), providing any calorie information reduced the number of total beverage calories purchased, reduced the likelihood of adolescents buying sugar-sweetened beverages and reduced the chance of buying a sugar-sweetened beverage bigger than 16 ounces. Specifically, the study found that prior to the intervention, adolescent purchases averaged 149 calories; after the intervention, beverage purchases fell to an average of 121 calories. And what’s really interesting is that researchers found that differences in purchasing behavior continued weeks after the signs were removed. Authors Sara Bleich, Colleen Barry, Tiffany Gary-Webb and Bradley Herring write:
Understanding the potential for environmental interventions, which are increasingly seen as essential for obesity prevention, to motivate reductions in (sugar-sweetened beverage) consumption among groups at high risk of obesity is important. Clinical obesity interventions are not easily accessible to all adolescents, and most adolescents who begin obesity treatment do not complete it, with poor and minority youths at even higher risk for discontinuing treatment.
Regarding the different signs, researchers found that the sign about the miles of walking it takes to burn off a bottle of soda resulted in fewer calories purchased when compared with the sign about teaspoons of sugar and the sign about running. The study also found that after posting the informational signs, the frequency of soda and sports drink purchases were significantly lower. However, purchases of fruit drinks went up, though researchers said the difference was not statistically significantly. Overall, the frequency of not buying a beverage at all was much higher. Also, after the signs were posted in the corner stores, many more youth decided to buy a smaller bottle of sugar-sweetened beverage — before the intervention, 27 percent bought large-volume sodas versus 16 percent post-intervention.
Researchers also conducted exit interviews with a quarter of the sample study, finding that a majority understood the information presented and 40 percent said they changed their purchases after seeing the calorie signs.
“The results related to a reduced quantity of (sugar-sweetened beverage) purchases were consistent with our previous work and another recent study that suggested that presenting caloric information in the form of a physical activity equivalent might be more persuasive to consumers than absolute calories,” researchers wrote. “These findings were also consistent with research that suggested that calorie information reduces calorie ordering and consumption.”
To request a full copy of the 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.
Last week, the US Food and Drug Administration published a final rule that updates requirements for what prescription-drug information must disclose about potential effects for pregnant and breastfeeding women and their babies. Under the old labeling rules, drugs were placed in one of five categories — A, B, C, D, or X — depending on research findings (or lack thereof). An “A” designation meant that human studies did not find adverse effects in pregnant women or their babies, while and “X” designation meant that studies in humans or animals found a risk of problems to the baby and that there were no situations in which the potential benefits of the drug would outweigh the risks. The B, C, and D categories were for drugs with varying levels of evidence; see this Office on Women’s Health fact sheet for more details.
“Prescribing decisions during pregnancy and lactation are individualized and involve complex maternal, fetal and infant risk-benefit considerations. The letter category system was overly simplistic and was misinterpreted as a grading system, which gave an over-simplified view of the product risk,” said Sandra Kweder, M.D, deputy director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research, in a news release announcing the final rule’s publication. “The new labeling rule provides for explanations, based on available information, about the potential benefits and risks for the mother, the fetus and the breastfeeding child.” The news release summarizes three subsections that must provide detailed information:
- The Pregnancy subsection will provide information relevant to the use of the drug in pregnant women, such as dosing and potential risks to the developing fetus, and will require information about whether there is a registry that collects and maintains data on how pregnant women are affected when they use the drug or biological product. Information in drug labeling about the existence of any pregnancy registries has been previously recommended but not required until now.
- The Lactation subsection will provide information about using the drug while breastfeeding, such as the amount of drug in breast milk and potential effects on the breastfed child.
- The Females and Males of Reproductive Potential subsection will include information about pregnancy testing, contraception and about infertility as it relates to the drug. This information has been included in labeling, but there was no consistent placement for it until now.
An accompanying consumer update notes that women take an average of three to five medications during pregnancy, and that many women have chronic conditions (such as asthma, depression, and diabetes) that require ongoing medication use.
This isn’t the only recent move from FDA to provide more information about how drugs affect various consumer populations. Last month, the agency released Drug Trials Snapshots, which is part of a pilot project to help consumers learn more about the clinical trials upon which new drugs’ approvals are based. It has posted six examples, for drugs approved during a two-month period earlier this year, and is seeking public feedback on their content and utility. Starting next year, FDA aims to post a Snapshot for each newly approved drug classified as a “new molecular entity” (essentially, drugs that are truly novel rather than new versions or combinations of already-approved drugs).
Each of the six sample notes that “subgroup analyses were conducted for sex, race and age,” and then spells out those findings. For five of the six drugs, the results of the sex subgroup analyses were either that reponse “was consistent between men and women” or that the drug “was shown to be similarly effective in men and women.” For the same drugs, limited numbers of non-white participants in the clinical trials meant differences by racial subgroups could not be determined. For the drug Jublia, which treats toenail fungal infections, the snapshot has different answers, though: “A trend towards greater efficacy was observed in women than men taking JUBLIA,” and “A trend towards greater efficacy was observed in Asians than in Whites or Black/African Americans taking JUBLIA.” The Snapshots also give information about the number and demographics of the clinical trial participants, and report whether the trials compared the new drug to standard therapy or to a placebo. To view the Snapshots yourself, scroll down to the chart at the bottom of this page.
Trying to read the inserts that come with prescription drugs can be frustrating or intimidating. With these new actions, FDA is improving accessibility of information that can let us make informed decisions about the drugs we might take.