CSMC: Cancer Prevention & Control Information

Cancer Prevention and Control

Centers for DiseaseControl and PreventionDivision of CancerPrevention and Control4770 Buford Hwy, NEMS K-64Atlanta, GA 30341-3717 Call: 1 (800) CDC-INFOTTY: 1 (888) 232-6348FAX: (770) 488-4760 E-mail: cdcinfo@cdc.gov


As a leader in nationwide efforts to ease the burden of cancer, CDC works with national cancer organizations, state health agencies, and other key groups to develop, implement, and promote effective strategies for preventing and controlling cancer.

United States Cancer StatisticsThe official federal cancer statistics on new cancer cases and deaths for 2005, the most recent year for which data are available.


Inside Knowledge: Get the Facts About Gynecologic CancerLearn more through CDC's public awareness campaign and Gynecologic Cancer Web site.


NPCR–MERP CyberviewThis new presentation tool provides a refined view of cancer registry processes to help the day-to-day efficiency of operations.


African American Women and Mass Media (AAMM)The AAMM campaign uses radio and print media to make more women aware of the importance of getting mammograms to find breast cancer early.


Don't Pass on This Test PodcastLearn the importance of regular screening tests and the warning signs of colorectal cancer, the second leading cause of cancer-related deaths.


Cancer Incidence and Death Rates DeclineA recent report finds decreases in rates for all cancers combined, but large state and regional differences in lung cancer trends.


HPV-Associated CancersHuman papillomavirus (HPV) is associated with several types of cancer: cervical, vulvar, vaginal, penile, anal, and some head and neck cancers.


Prevención y control del cáncerThe greatly expanded Cáncer en Español site provides accurate, evidence-based cancer health information in Spanish.


Cancer in American Indians and Alaska NativesCircumstances of culture, location, history, and health care produce unique patterns of cancer occurrence in these populations.


Breast Cancer ScreeningMammograms are the best method to detect breast cancer early. Find out if you qualify for a free or low-cost mammogram.

CSMC: Birth Defects

Birth Defects

Birth defects affect about one in every 33 babies born in the United States each year. They are the leading cause of infant deaths, accounting for more than 20% of all infant deaths. Babies born with birth defects have a greater chance of illness and long term disability than babies without birth defects. In early 1998, Congress passed the Birth Defects Prevention Act of 1998, which became Public Law 105-168. This bill authorized CDC to (1) collect, analyze, and make available data on birth defects; (2) operate regional centers for applied epidemiologic research on the prevention of birth defects; and (3) inform and educate the public about the prevention of birth defects.

Tracking Birth Defects


CDC believes that it is important to have a system to track birth defects to see when and where they happen. CDC uses different systems to look for changes and then tells the public about these trends. We base our research studies, for example causes of certain birth defects, on what we learn from tracking. In addition, our systems guide how we plan and evaluate ways to prevent birth defects.CDC is driven by our vision—to promote optimal health and development for all children. More specifically, we work to prevent or reduce the adverse consequences of birth defects. We have several major systems that track birth defects in the United States. CDC also partners with other groups in the U.S. and the world to share information and to work on projects that will help prevent birth defects throughout the world.

The Metropolitan Atlanta Congenital Defects Program (MACDP)CDC has been tracking birth defects closely for over 40 years. Established in 1967, MACDP is a population-based surveillance system for birth defects that was established in 1967 by the CDC, Emory University, and the Georgia Mental Health Institute


State Birth Defects Surveillance SystemsCDC guides and fund states to set up and improve their systems to track birth defects.


National Birth Defects Prevention Network (NBDPN)CDC supports the mission of the National Birth Defects Prevention Network (NBDPN). The mission of the NBDPN is to establish and maintain a national network of state and population-based programs for birth defects.

International Clearinghouse for Birth Defects Monitoring Systems (ICBDMS)CDC supports and collaborates with the ICBDMS as a way to gain knowledge and expertise on birth defects information worldwide and to further our goals and those of the international community.

The Health and Environment Linked for Information Exchange (HELIX-Atlanta)CDC supports and collaborates with the Health and Environment Linked for Information Exchange (HELIX-Atlanta). HELIX is a local level project of environmental public health tracking. The HELIX-Atlanta birth defect team works to develop strategies to be used in environmental public health tracking by state birth defects programs.

Date: Content source: National Center on Birth Defects and Developmental Disabilities


Birth Defects Research

Most birth defects are thought to be caused by a complex mix of factors. These factors include our genes, our behaviors, and things in the environment. For some birth defects, we know the cause. But for most, we don’t. And we don’t understand well how factors work together to cause birth defects. Research helps us answer many of these questions. CDC has been doing research in this field for over 40 years. And we have funded other scientists to do research in the US and abroad. This page gives an overview of birth defects research.

· Why we do birth defects research
· What we’ve learned
· Centers for Birth Defects Research and Prevention
· National Birth Defects Prevention Study
· U.S.-China Collaborative Project
· Select CDC Specific Research

Why We Do Birth Defects ResearchBirth defects can cause lifelong problems with health, growth, and learning. We want to find ways to prevent birth defects. To do that, we need to know what causes them. Research gives us important clues about the factors that might raise or lower the risk of having a baby with a birth defect. Those clues help us develop sound public health policies for prevention.

What We’ve LearnedSo far, we have learned a lot about birth defects through research. Here are some examples:

· Mothers who are obese when they get pregnant have a higher risk of serious birth defects of the brain and spine (neural tube defects). This tells us that helping mothers to reach a healthy weight before they get pregnant could prevent birth defects.

· Taking folic acid before getting pregnant and in early pregnancy lowers the risk of having a baby with a neural tube defect. This finding led to the advice that all women who can get pregnant should take 400 micrograms of folic acid daily. A study by CDC and researchers in China helped with this finding.

· When a mother smokes a lot in the month before getting pregnant through the third month of pregnancy, her baby has a higher risk of having cleft lip, cleft palate, or both. This finding tells us that women who smoke and are planning to have a baby should quit smoking and get help with quitting if they need it.

· Taking Accutane™ (isotretinoin), a drug used to treat severe acne, during pregnancy causes severe birth defects. This finding has led to efforts to lower a woman’s risk of having a pregnancy affected by the drug.

Centers for Birth Defects Research and Prevention

To find genes, behaviors, and things in the environment that are linked with a certain birth defect, you need many cases of that defect. Each year in the United States, 120,000 babies are born with birth defects. But, the number of babies with each kind of defect is often quite low. That means you need a very large study group to have enough cases of each birth defect to find meaningful data. A study that large takes a network of researchers working together across the nation. The Centers for Birth Defects Research and Prevention (CBDRP) provide that network. These centers, funded by CDC, have been set up in Arkansas, California, Iowa, Massachusetts, New York, North Carolina, Texas, and Utah.

National Birth Defects Prevention Study

The research centers take part in the National Birth Defects Prevention Study (NBDPS). This study is the largest ongoing, population-based study of its kind. Case mothers are women who have had babies or pregnancies affected by birth defects and control mothers had babies with no birth defects. The goal of each center is to talk to 300 case mothers [Table 1] and 100 control mothers per year. The study has three parts: 1) specialized doctors review all cases, 2) talk to the mothers, and 3) collect cheek cell samples from the families. The doctors make sure that the defect the child has belongs in our study. When we talk to the mother we ask questions about the pregnancy. Things we ask about are: earlier pregnancies, illnesses, medications, work place, lifestyle factors, etc. The cheek cells that are collected from the families are used for genetic studies.

The NBDPS started interviewing mothers of children born after October 1, 1997 and is ongoing. It provides a rich data source for rare birth defects. Many families worry about the health of their babies and this study will address some of their questions. By helping with this study these families hope we can find some of the answers. CDC oversees the research centers and is the ninth site for the study.

CBDRP researchers have been studying combined data from all the sites participating in the study. The first projects focused on common birth defects like cleft lip, cleft palate, hypospadias (a defect of the penis), and some types of heart defects. Researchers looked for links between those defects and common exposures such as smoking, infection, medication use, and intake of certain nutrients. Many findings have been published in science and health journals. Many more are forthcoming.

More About the Centers for Birth Defects Research and Prevention and the National Birth Defects Prevention Study

Future Directions for Birth Defects Research for the Centers for Birth Defects Research and PreventionThrough the Centers for Birth Defects Research and Prevention and the NBDPS, we have been building the infrastructure for birth defects research for a decade. We have found some important clues about the causes of birth defects. But there is still much to learn. More resources are vital if we are to understand fully the complex factors and mechanisms that lead to birth defects.Some of the activities for future research include:

· Studies of how genes and the environment work together to cause birth defects.

· Studies of how common medicines used during pregnancy affect the risk of birth defects.

· Genetic mapping—looking at the DNA (genetic make-up) of family members affected by a particular birth defect to find out what role genes play.

· Environmental sampling—testing samples of air, water, and soil in an area to find substances that could be related to birth defects.

· Studies of biomarkers—finding signs that the body has been exposed to toxic substances. Scientists often look for these signs in a person’s blood or hair.

The ultimate goal of the CBDRP’s work is to share findings that can inform recommendations, laws, messages, and programs to prevent birth defects. The data can also be used to measure how well prevention efforts are working. U.S.-China Collaborative ProjectFor over 20 years CDC and the Peking University Health Science Center (PUHSC) have collaborated on birth defects research. In the mid 1990’s, CDC and PUHSC began evaluating a large-scale community intervention program in China. In this program, they tested whether giving women 400 micrograms of folic acid before and during early pregnancy prevents neural tube defects (NTDs).

Among the babies of women who took the daily recommended amount of folic acid, the risk of having a NTD dropped 85% in high-prevalence areas and 41% in areas with prevalence similar to the United States. In addition, research from this community intervention program showed that folic acid use before and during early pregnancy did not increase a woman’s risk for miscarriage or multiple births. We are now using our China collaboration to explore topics such as folic acid and infant death rates, congenital heart defects (CHD), changes in blood level of folic acid with different folic acid doses, and long-term evaluation of the women and children from the community intervention program. Select CDC Specific ResearchIn addition to collaborating with state and international partners to look at birth defects risk factors, CDC staff also conducts other research projects.

· Some study findings are showing that babies with birth defects are living longer. To further look at this issue, we linked CDC’s birth defects tracking data with the Georgia death certificates and the National Death Index. We found that long-term survival of infants with spina bifida, encephalocele, and Down syndrome improved over time. We now are looking at the survival of babies with other birth defects.

· Obesity before or during pregnancy can contribute to poor birth outcomes such as preterm delivery, low birth weight, and some birth defects. CDC recently used data from the Baltimore-Washington Infant Study to look at whether a woman’s weight could be a risk factor for giving birth to babies with poor birth outcomes. Our results showed that obese women are more likely to have babies that are very heavy (more than about 8.8 lbs.) or heavier than expected given the length of the pregnancy. Also, we also found an increased risk of preterm delivery among women with very low weight. This study shows that women should try to maintain a healthy weight before becoming pregnant.

· The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to evaluate the health and nutritional status of adults and children in the United States. The survey is unique in that it com¬bines interviews and physical examinations. The CDC uses information from this study to look at the population’s folic acid intake as well as their blood levels of folic acid.

Preventing Birth Defects

Although we do not know the cause of most birth defects, the good news is that we know how to prevent some birth defects. CDC is working to find out how to prevent others. Scientists study data gathered from our birth defects monitoring systems to learn more. Click on links below to see some of CDC’s activities to help prevent birth defects:

· Folic Acid Helps Prevent Some Birth Defects
· Having a Healthy Pregnancy
· Preventing Alcohol Exposed Pregnancies.
· Lymphocytic Choriomeningitis Virus (LCMV) and Pregnancy: Facts and Prevention
· Diabetes and Pregnancy
· Preventing Infections during Pregnancy

Date: October 5, 2005Content source: National Center on Birth Defects and Developmental Disabilities

CSMC: Asthma & Allergies

Asthma and Allergies

Asthma is a disease that affects the lungs. It is one of the most common long-term diseases of children. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma can be controlled by following a medical management plan and by avoiding contact with environmental “triggers,” such as cockroaches, dust mites, furry pets, mold, tobacco smoke, and certain chemicals.




About the ProgramCDC’s National Asthma Control Program supports the goals and objectives of Healthy People 2010 for asthma: to reduce the number of deaths, hospitalizations, emergency department visits, school or work days missed, and limitations on activity due to asthma ... (Read More)





Data and Surveillance Asthma surveillance data includes collection of state-level adult asthma prevalence rates; data on days of restricted activity, days in bed, days of work or school lost, physician visits, and hospitalizations due to asthma; and collection of in-depth state and local asthma data through development and testing of a National Asthma Survey ... (Read More)


General Information Asthma is a disease that affects your lungs. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma can be controlled by taking medicine and avoiding the triggers that can cause an attack. You must also remove the triggers in your environment that can make your asthma worse ... (Read More)


Interventions Information on potentially effective interventions for asthma control, including methodology for identification of the interventions, results, lessons learned, information on the interventions themselves, a bibliography, and sample case studies of interventions ... (Read More)


Legislation and Policy Many federal and state government agencies as well as non-profit organizations, commissions, and networks carry out asthma-related activities and are involved in policy issues such as pending legislation and children’s rights at school ... (Read More)


Resources A listing of useful documents and FAQs about asthma and indoor/outdoor air pollution from federal and state agency resources ... (Read More)


Asthma’s Impact on Children and Adolescents
Provides information on CDC control programs and activities, school health… (Read More)


Healthy Youth: Asthmain Schools
Information from the National Center for Chronic Disease Prevention and Health Promotions provides asthma fact sheet, data and statistics, science-based strategies, links to other resources… (Read More)





Asthma & Allergies in the Workplace


Millions of people suffer from allergies caused by every day exposures to agents such as dust mites, cat dander, and pollens. Agents encountered by workers can also cause allergic problems such as asthma, nasal and sinus allergies, hives, and even severe anaphylactic reactions. Examples of these work-related agents include animal proteins, enzymes, flour, natural rubber latex, and certain reactive chemicals.


NIOSH Safety and Health Topic: Asthma and Allergies Provides links to NIOSH publications and surveillance information on occupational asthma and allergies, including information on agricultural workers, Diisocyanates, and animal handling.


NIOSH Safety and Health Topic: Occupational Latex Allergies Provides information for health care and other workers on allergic reactions from Latex gloves.





NIOSH Safety and Health Topic: Indoor Environmental QualityIncludes information on air quality and other factors that may contribute to health complaints by building occupants.


NIOSH Safety and Health Topic: Skin Exposures and Effects Includes information on allergic and irritant Dermatitis and other occupational skin conditions.


NIOSH Safety and Health Topic: IsocyanatesProvides links to NIOSH publications, Heath Hazard Evaluations, and analytical and sampling methods for isocyantes.

CSMC: African Amercian Media Resource

African-American Media Resources

The needs of African-American journalists are often community-driven, just like the health issues facing African-Americans. CDC recognizes that you need quick access to credible information on how issues like HIV, diabetes, and obesity are affecting your readers. The African-American Media Resources page is designed to provide credible health information and helpful links for African-American media outlets, as well as mainstream media that reach audiences of color. Here you will find up-to-date story ideas with African-American readers in mind; biographies of African-American experts at CDC; and links to other sources of health information. You can also find free, ready-to-print articles on health issues affecting African Americans.

Prostate Cancer and African Americans


Prostate cancer is the second leading cause of cancer deaths among men in the United States. While it isn’t known why African American men have higher rates of getting and dying from prostate cancer, CDC believes that what you know can help you. African American men should know the facts about prostate cancer.

Some medical experts believe all men should be offered regular screening tests for prostate cancer. Other medical experts do not. Given the uncertainty about the benefit of screening, CDC supports informed decision making about screening. When a man understands the nature and risks of prostate cancer and the risks, benefits, and alternatives to screening, he can make a decision consistent with his preferences and values.

Is prostate cancer screening right for you? The decision is yours. To help African American men understand both sides of the issue, CDC has developed a helpful guide specific for African American men.

Prostate Cancer Screening:

A Decision Guide for African Americans


For further information about prostate cancer, please visit the CDC's Division of Cancer Prevention and Control Web site at www.cdc.gov/cancer/prostate. You can also subscribe to be alerted by e-mail when our website offers new information on a cancer topic of interest to you.

Breathe Easier When You Know More About Asthma

Did you know that 1 in 10 Americans has, or has had asthma at some point in their lives?
Most people don’t die from asthma, but there is concern for African Americans because asthma is more likely to cause death. The reason for this disparity is not known. But there are asthma control techniques to help people manage their condition successfully. The Centers for Disease Control and Prevention (CDC) offers this important advice to everyone with asthma – have an asthma action plan and exercise it. The CDC has a variety of information that patients and health-care providers asthma.

What is asthma?

Asthma, a disease that affects your lungs, is the most common long-term disease of children, but it also affects adults. Each day, 30,000 people have an asthma attack, 1,000 are admitted to the hospital, and 11 people die. Asthma causes repeated episodes of wheezing, breathlessness, chest, nighttime coughing.

What is an asthma attack?

An asthma attack happens in your body’s airways, which are the paths that carry air to your lungs. During an asthma attack, the sides of the airways in your lungs swell, and the airways shrink. The attack may include coughing, breathing.

How is asthma diagnosed?

Asthma can be hard to diagnose, but regular physical checkups that include checking lung function and allergies can help your health-care provider make the right diagnosis. During a checkup, your health-care provider will ask whether you cough a lot, especially at night, and whether your breathing problems are worse after physical activity or during a particular time of year. Health-care providers will also ask about other symptoms such as chest tightness, wheezing, and colds that last more than 10 days and if anyone in your family has or has had asthma or other breathing

How is asthma treated?

Your health-care provider will help you make an asthma action plan and stick to it. He or she may recommend a combination of medication, environmental changes and behavior modification. Not everyone with asthma has the same needs, and your needs may change as you get older, so it’s important to get regular check-ups.


For More Information:


Call 1-800-CDC-INFO (1-800-232-4636) or visit http://www.cdc.gov/asthma.

What triggers asthma attacks?

It’s important to learn what triggers your asthma attacks so you can avoid the triggers whenever possible and be alert for a possible attack when the triggers cannot be avoided. Below are some of the common triggers:

Environmental tobacco smoke
Dust mites
Air pollution
Mold
Other triggers

Parents, friends, and relatives of children with asthma should try to stop smoking and avoid smoking near a person with asthma or in their house or car.

Dust mites are in almost everybody’s home, but they don’t cause everybody to have asthma attacks. Use mattress covers and pillow case covers, avoid down-filled pillows, quilts, or comforters and remove stuffed animals and clutter from your bedroom. Clean blinds and curtains on a regular basis.

Pay attention to air quality forecasts on radio and television and plan your activities when air pollution levels are lowest.

Get rid of mold in all parts of your home. Keep the humidity level in your home between 35 and 50 percent. In hot, humid climates, you may need to use an air conditioner or a dehumidifier or both. Fix water leaks, which allow mold to grow behind walls and under floors.

Strenuous physical exercise; strong emotional states some medicines; bad weather such as thunderstorms, high humidity, or freezing temperatures; and some foods and food additives can trigger an asthma attack. Allergens such as pet dander, pollen, mold or cockroaches may also trigger attacks.

African-American Story Ideas

Featured story ideas with African-American readers in mind.
Take Time to Save Your Life: Get Screened for Breast and Cervical Cancer Early

Getting screened for some cancers can actually help prevent them from occurring. Screening also helps find other cancers – such as breast cancer – at an early stage, when treatment can be most effective. CDC′s African-American Women and Mass Media (AAMM) campaign uses radio and print media to make women aware of getting mammograms to find breast cancer early. And CDC′s National Breast and Cervical Cancer Early Detection Program provides access to critical breast and cervical cancer screening services for underserved women in the United States. Women can also find out if they qualify for a free or low-cost mammogram by calling their local NBCCEDP program contact.

· CDC Breast Cancer Home Page
· CDC Cervical Cancer Home Page
· Formatted Article: CDC Encourages Screening for Breast, Cervical and Colorectal Cancers
· African-American Women and Mass Media (AAMM) campaign
· National Breast and Cervical Cancer Early Detection Program

The Power to Prevent and Control Diabetes is in Our Hands

Diabetes is a disease that affects millions of people and their families -- especially African Americans who are at an even higher risk for this serious chronic condition. An estimated 3.7 million or 14.7 percent of all non-Hispanic blacks age 20 and older have diabetes. While diabetes is a leading cause of heart disease, stroke, high blood pressure, and kidney disease and can cause blindness and lower limb amputation, there is hope. People with diabetes can take steps to control the disease and lower their risks of complications. Studies have shown that people with pre-diabetes who lose weight, eat right and increase their physical activity can prevent or delay diabetes and return their blood glucose levels to normal. Working together, people with diabetes, along with their support networks like family and church members, and their health care providers can reduce the occurrence of these and other diabetes complications. These preventive steps can control the levels of blood glucose, blood pressure, and blood lipids when they are practiced in a timely manner. If you or a loved one has diabetes, the links below are just some of the resources about diabetes that puts the power to prevent and control diabetes into your hands!

· CDC Diabetes Home Page
· National Diabetes Education Program
· Power to Prevent
· New Beginnings: A Discussion Guide for Living Well with Diabetes


Hepatitis C: Know. Prevent. Educate.

Hepatitis C is a contagious liver disease that results from infection with the hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Today, most people become infected with the hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, hepatitis C was also commonly spread through blood transfusions and organ transplants. There is no vaccine for hepatitis C. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use.

· More about hepatitis C
· The difference between Acute and Chronic Hepatitis C
· How hepatitis C is spread
· How hepatitis C is treated


Keeping it in the Family

You might not realize that your father′s diabetes or your cousin′s sickle cell disease could affect your child, but knowing your family′s medical history could help save your child′s life. Learn more about how family history includes these factors, can affect a person′s health:

· Formatted Article: Collecting Your Family′s Medical History Could Save Your Child′s Life
· Family History Awareness Feature

Diseases and genetics links:

o Heart disease
o Colorectal cancer
o Autism
o Stroke
o Mental health
o Skin cancer
o Obesity and genetics


HIV: Know Your Status, Get Tested

HIV and AIDS have unfortunately hit African Americans particularly hard. Nearly half of the people who are infected with HIV/AIDS are African American. The reasons for this disparity are not directly related to race or ethnicity, but rather to some of the barriers faced by many African Americans. These barriers can include poverty (being poor), sexually transmitted diseases, and stigma (negative attitudes, beliefs, and actions directed at people living with HIV/AIDS or directed at people who do things that might put them at risk for HIV). CDC has developed a variety of helpful resources in response to this issue:

· HIV/AIDS and African Americans: includes charts and breakdowns of HIV/AIDS in African Americans versus other racial groups
· Fact Sheet: HIV/AIDS among African Americans
· Prevention Challenges Faced by African Americans
· The Heightened National Response to the HIV/AIDS Crisis among African Americans
· What African Americans Can Do
· Webcast: Mobilizing Against the HIV/AIDS Crisis Among African Americans


Add Years, Gain Life, Lose Weight

Obesity is on the rise -- more than 72 million adults in this country weigh more than they should and it′s making us sick. Heart disease, type 2 diabetes, stroke, high blood pressure, breast and colon cancers, and many other diseases can be prevented or managed with the important decision to lose weight. The health statistics for African Americans point to the need for an individual and communal response to the problem of obesity. Forty-five percent of African-American adults are obese and the numbers are equally alarming for African-American children. The good news is that there is help for those who are struggling to maintain a healthy weight. The link below provides information about a variety of HHS and CDC programs designed to combat obesity and help people maintain a healthy weight.

· CDC Obesity Home Page
· Body and Soul: A Celebration of Healthy Eating and Living for African Americans
· Healthy Weight: Its Not a Diet, It′s a Lifestyle
· Assessing Your Weight
· Nutritional Health Campaigns


Article from: http://www.cdc.gov/media/subtopic/resources/aaresource.htm

CSMC: ADHD

Attention-Deficit / Hyperactivity Disorder (ADHD)

ADHD is a neurobehavioral disorder characterized by pervasive inattention and/or hyperactivity-impulsivity and resulting in significant functional impairment. CDC estimates 4.4 million youth ages 4-17 have been diagnosed with ADHD by a healthcare professional, and as of 2003, 2.5 million youth ages 4-17 are currently receiving medication treatment for the disorder. In 2003 7.8% of school-aged children were reported to have an ADHD diagnosis by their parent.
CDC supports the National Resource Center (NRC) on AD/HD, a program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). The NRC is a national information resource center dedicated to providing evidence-based information about ADHD to the public. If you have a question about ADHD for yourself, your child, or a family member, please contact the NRC at:

· National Resource Center website: http://www.help4adhd.org/
Toll-free at 1-800-233-4050 to speak with a knowledgeable Health


Project to Learn about ADHD in Youth (PLAY)Oklahoma and South Carolina PLAY


Current research efforts designed to investigate prevalence and treated prevalence of ADHD in school-age children, rates of co-occurring conditions among children with ADHD, types and rates of health risk behaviors, and community treatment patterns of children with ADHD.
CDC Funds Two Research Institutions to Conduct Population-Based Research on ADHD in ChildrenBecause of increasing concern and awareness among health professionals and the public alike, the Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities (NCBDDD) has awarded two cooperative agreements, to the University of South Carolina (principal investigator, Robert E. McKeown, PhD) and the University of Oklahoma Health Sciences Center (principal investigator, Mark L. Wolraich, MD), to conduct population-based research on Attention-Deficit/Hyperactivity Disorder (ADHD) among school-aged children. The result of this collaboration will be one of the largest community-based, epidemiologic studies of ADHD in the United States.

Recognizing that many uncertainties remain concerning prevalence, etiology and treatment patterns of ADHD, this research will shed light on: (1) the prevalence and treated prevalence of ADHD in children, (2) the existence of comorbid and secondary conditions in children with ADHD, (3) the types and rates of health risk behaviors in children with ADHD, and (4) current and previous treatment patterns of children with ADHD. This data collection will provide sorely needed epidemiologic data on ADHD and information critical to understanding the magnitude of the disorder, the expression of ADHD in diverse population groups, the receipt and quality of community care, and factors associated with differential outcomes in children with the disorder. The studies are a result of a joint collaboration between NCBDDD and the three grantee research teams. Study findings will not only enhance our understanding of ADHD in children, but will also increase our ability to make the most informed decisions and recommendations concerning potential public health prevention and intervention strategies. For more information on the National Center on Birth Defects and Developmental Disabilities and the Centers for Disease Control and Prevention see www.cdc.gov/ncbddd and http://www.cdc.gov/, respectively.
ADHD: A Public Health Perspective Conference

Conclusions

In order to further define and develop a public health research agenda for ADHD, a conference delineating the multitude of public health concerns surrounding the disorder and potential directions for needed research was held in Atlanta, Georgia, September 23-24, 1999. The conclusions from the conference are presented below.

Lesesne, C., Abramowitz, A., Perou, R., & Brann, E. Attention deficit/hyperactivity disorder: A public health research agenda. [2000, March 15]

Attention-Deficit/Hyperactivity Disorder:A Public Health Research Agenda

Attention-Deficit/Hyperactivity Disorder (ADHD) is a serious public health problem because of the large estimated prevalence1 of the disorder; significant impairment in the areas of school performance and socialization; the chronicity of the disorder; the limited effectiveness of current interventions to attend to all the impairments associated with ADHD; and the inability to demonstrate that intervention provides substantial benefits for long-term outcomes. However, because of the evolution of the case definition and differences in how the case definition is operationalized, there is disagreement as to prevalence and precise characteristics of children with the disorder.

Because of the lack of a single, consistent, and standard research protocol for case identification, variable and disparate findings have been noted in the literature. Consequently, relatively little is known about the etiology of ADHD, although genetic factors are believed to be important contributors. The basic epidemiology of ADHD needs further research to include the basic prevalence and identification of risk factors for ADHD.

The Division of Birth Defects, Child Development, and Disability and Health (proposed) hosted a conference September 23-24, 1999, entitled, "Attention Deficit Hyperactivity Disorder: A Public Health Perspective". The meeting gathered over 150 individuals from a variety of research, consumer, academic, medical, and mental health disciplines to discuss the public health issues related to this disorder and potential future research. The conference presentations and material from the breakout sessions have been used to help prepare a public health research agenda for ADHD. This document delineates that plan.

Public health issues in ADHD can be divided into three areas: the burden of ADHD in the population, epidemiologic research issues in ADHD, and concerns related to interventions for ADHD. These three topical areas were identified by CDC as crucial for examining ADHD, and necessary to address public health concerns and opportunities for action. The Division of Birth Defects, Child Development, and Disability and Health (proposed) has used the information and suggestions from the conference and highlighted the key issues for each topic as well as the necessary actions to address these public health needs. The formal topical areas are:

· Social and Economic Burden of ADHD through the Lifespan
· Epidemiologic Issues in ADHD
· Interventions for ADHD


Social and Economic Burden of ADHD through the Lifespan

Given the nature of the disorder, ADHD is believed to have a noticeable impact on social, economic, educational, and health care delivery systems. Additionally, it is reasonable to assume the condition affects those socially associated with an ADHD individual, including his/her family members, peers, and co-workers. However, the magnitude of the social and economic burden in these areas has not been systematically documented.
In general, small, clinic-based studies have shown that adults with ADHD consistently exhibit problems with interpersonal relationships, often have difficulty with employment, and frequently have comorbid or secondary conditions that further debilitate. Perhaps many of the disabilities and poorer outcomes associated with ADHD actually are more strongly associated with conditions that are highly comorbid with ADHD (such as Conduct Disorder) and result in significantly higher economic consequences to society. However, this hypothesis has not been tested.

In understanding the full nature of the disorder, it is imperative to understand the effect it has on the families of children with ADHD. These families may be more prone to conflict and increased levels of familial stress. The child with ADHD may also reduce the parents= productive participation in activities outside the family (work and community life). Many parents of children with ADHD themselves have the disorder or considerable levels of the symptomatology. However, the impact this disorder has on the family unit and in adult life needs considerable research effort to clarify what aspects of family it impacts and in what ways.

In addition, there is little concrete knowledge of the degree to which interventions can or do improve the outcome of children with ADHD. Developing ways to improve outcomes must begin with consistent and standardized measures of the impact of the disorder. Such methodical surveying has not occurred. Development of standardized burden measures is critical to beginning this process.

Action to Address Public Health Needs

· Conduct analyses of ADHD public health burden in a way that estimates a broad array of costs outside of those exclusively associated with medical treatment. The burden should be studied from a broad perspective to include estimations of cost to society in a monetary sense as well as to individual-level indicators of well-being such as family functioning and social relationships.

· Develop a standardized way to measure burden associated with ADHD and promote its use across studies. This would enable cross-study comparisons such as meta-analysis to be undertaken. This standardized measure should account for medical/treatment costs, educational costs, family costs, and adult functioning variables.

· Incorporate information on ADHD in efforts to study and prevent unintentional injuries, alcohol and drug abuse, sexual risk-taking, disability, and other health risk behaviors in which ADHD may play an important role.

· Include standardized measurements of burden in all public health research of ADHD.

Future efforts to measure the impact of ADHD across a cohort should be a priority. Understanding if current interventions or future prevention strategies result in burden reduction will depend largely on consistent and accurate estimation of these burdens.

· Efforts must be made to estimate the prevalence and cost of this disorder in adult populations to understand the strict monetary costs as well as to better understand the areas of impairment for adults with ADHD.

· Conduct population-based ADHD research that includes information on comorbid conditions and the burden with which they are associated. Much of our current evidence regarding comorbid conditions comes from clinical studies rather than population-based studies.

· Explore mechanisms to append economic and social burden studies on other ongoing or completed studies in order to quantify the burden of ADHD.

· Foster collaborations across Federal agencies in order to include information on ADHD in data collection efforts.

· Establish a resource for both professionals and the public regarding what is known about the impact of ADHD.

Epidemiologic Issues in ADHD

Although investigation of ADHD has been quite extensive over the past 30 years, the scientific process has been significantly slowed by the lack of a single, consistent, and standard research protocol for case identification. Variable and disparate findings have been noted throughout the literature even on basic issues such as prevalence. As a consequence, speculation regarding possible increases in ADHD prevalence cannot currently be evaluated.

Additionally, we do not have demographic and descriptive statistics for children and adults with the disorder; therefore, there are disparities in identification, access to treatment, and reports of the manifestation of ADHD and its comorbidities. Risk factors for ADHD have not been thoroughly investigated although some clinical samples have identified possible factors that may contribute to ADHD. Some of these related factors are prenatal alcohol use, prenatal smoking, and low birth weight. Genetic predisposition or family history of ADHD has been noted consistently among clinical samples as a risk factor for the development of ADHD.
Unfortunately, many fundamental etiologic questions remain for ADHD. Identifying and understanding etiologic factors will enhance prevention efforts and treatment for both children and adults with ADHD.

Action to Address Public Health Needs

· Develop standard case identification protocols for use in research projects.

· Conduct etiologic studies of ADHD using population-based approaches to identify important risk factors and opportunities for prevention activities and research.

· Use observational epidemiologic methods to describe the impact of ADHD, its impact, and its intervention patterns at the population level.

· Utilize scientific findings to develop, design, and implement ADHD prevention efforts where possible.

· Identify current national or regional surveys where adding ADHD questions would provide particularly useful information regarding the magnitude of the disorder, the nature of common comorbidity and/or secondary conditions, as well as data on health risk behaviors and long-term outcomes for those with ADHD.

· Establish a Federal interagency workgroup to pool research expertise and resources in order to launch epidemiologic research efforts that address the public health research needs in ADHD. Such collaborations should be multi-disciplinary and include professionals in epidemiology, mental/physical health, risk behavior prevention, and health communication for example.

· Establish a resource for both professionals and the public regarding what is known about the epidemiology of ADHD.

Interventions for ADHD

ADHD is a chronic condition of high prevalence that requires long-term intervention. Because ADHD is an impairing condition and can have lifelong consequences, interventions designed to reduce negative outcomes and increase capacities should be carefully considered at the national level. One key public health concern is the safety of pharmacological interventions. A second key concern is the effectiveness of current interventions to reduce the impairment associated with ADHD thereby improving health and functioning for ADHD individuals over time. A third public health concern is access to appropriate interventions for individuals and families affected by the disorder.

There are several public health concerns relative to pharmacotherapy. Pharmacologic treatment is extremely prevalent. Assessing the health risks and benefits to young children, particularly preschoolers, is a high priority. Children who begin medication therapies very early and receive treatment on a long-term basis may have unknown risks associated with current treatments. Additionally, pharmacologic interventions often do not normalize behavior. Research, albeit limited, suggests that even with long-term treatment, children and adults with ADHD experience substantial problems in the school, home, workplace, and community settings. This raises questions about the effectiveness of pharmacologic interventions as a long-term approach.
Another intervention option to treat ADHD is behavior modification. It is clear that behavior modification therapies, for youth in particular, have been tested and shown beneficial for the treatment of behavioral disorders including ADHD. However, the majority of youth receiving psychological interventions for ADHD are probably receiving treatments that have not been shown to be effective, such as individual therapy and/or play therapy. The effectiveness of behavioral interventions must be further studied in the treatment of ADHD, to better understand their potential to normalize the behavior and functioning of those with the disorder, especially when combined with pharmacotherapy.

Access to interventions is a critical public health concern. ADHD affects a person=s ability to learn and be socialized to his/her potential; therefore access to diagnosis and intervention is a necessity. Common barriers to services include lack of insurance coverage for mental health problems, exclusion of behavior disorders, including ADHD, from mental health coverage, and under-identification or mis-identification. Community practice with respect to the diagnosis of ADHD fails to uniformly employ accepted methods for establishing cross-situational symptomatology, measurement of functional impairment, and diagnosis of comorbid conditions. Nationally, we must begin to look at a wide variety of intervention issues surrounding ADHD, including how current interventions impact individuals and systems over time, as well as problems with access to appropriate services.

Action to Address Public Health Needs

· Disseminate educational materials relating to the diagnosis of and intervention opportunities for ADHD. Recipients should include but would not be limited to primary care physicians, physician extenders (NP=s and PA=s), mental health professionals, and educators.

· Promote the necessity of careful case identification using standardized instruments and the employment of the most effective interventions in common practice by disseminating useful information to professionals and the public related evidence-based interventions for ADHD.

· Conduct population-based studies of ADHD intervention practices to examine such variables as age of initiation of treatment, type(s) of treatment, duration of treatment, and barriers to receipt of services.

· Establish a mechanism (possibly a registry) of treated individuals to monitor the health effects and potential benefits of long-term treatment for ADHD, particularly among pre-school age children. Additionally collect other related outcomes such as school attainment, interface with judicial system, work performance, and other pertinent variables.

· Collaborate with other organizations to educate and promote what is known about ADHD interventions, appropriate standards of practice, their effectiveness, and their safety.

· Establish a resource to the public for accurate and valid information about ADHD and evidence-based interventions.

Footnote

1 Although the DSM-IV (1994) cites a prevalence rate of 3-5% of school age children, methodological issues in epidemiological research and the evolving dynamics of the disorder have led to wide variations of reported prevalence estimates that range from approximately one percent to nearly 20 percent of school age children.

Article from: http://www.cdc.gov/ncbddd/adhd/