HHS WEEKLY REPORT
January 12 - 19, 2004

THIS ISSUE AVAILABLE ONLINE WITH EXPANDED INFORMATION AND PHOTOS AT:
http://www.hhs.gov/news/newsletter/weekly

IN THIS ISSUE:
1) U.S. Surgeon General to Release 40th Anniversary of Smoking Report
2) New Guide Offers African American Families Help to Cope with Crises
3) What is lactose intolerance?
4) Taking Aspirin to Lower Your Risk of Heart Attack
5) Secretary Thompson's Public Schedule:

U.S. Surgeon General to Release 40th Anniversary of Smoking Report

U.S. Surgeon General Richard Carmona announced that there will be a comprehensive smoking report and new web site that will aid smokers who are trying to quit with educational materials on proven approaches for helping people avoid tobacco use. This is the 28th report released by the Office of the Surgeon General since smoking was linked to lung cancer in the first report in 1964. The report will focus on the health effects of tobacco on every organ of the body.

STATEMENT BY HHS SECRETARY TOMMY G. THOMPSON:

"I urge each and every American who smokes to quit. Make it a New Year's resolution and a daily commitment to live a longer, healthier life- without cigarettes. If you won't do it for yourself, do it for your family and for your loved ones.

"Forty years after the first Surgeon General's report on smoking, the fact remains the same: Smoking remains the single leading preventable cause of death in this country, costing us too many lives, too many dollars, and too many tears. Every day more than 4,000 children smoke their first cigarette and every year more than 440,000 moms, dads, sons and daughters die because of their lifelong decision to smoke. The science is clear that by quitting smoking, a person becomes healthier within just a matter of hours as the carbon monoxide level in the blood drops to normal, and after a year excess risk of heart disease is cut in half.

"I look forward to the next Surgeon General's report on smoking coming out later this year, which will continue to outline the health effects of smoking and further educate the American people about the dangers of this lethal habit.

STATEMENT BY SURGEON GENERAL RICHARD H. CARMONA:

"Luther Terry's watershed report released on January 11, 1964, declared that smoking causes lung cancer and began to dispel the myth that smoking is cool, but instead exposed it as a killer. At that time, the scientific body of knowledge about tobacco use was limited, but today we know that tobacco use has a devastating health impact on the body.

"Smoking kills 440,000 Americans every year, costing each of them more than a decade of their lives. In addition, more than 8.6 million Americans currently suffer from one or more serious illness attributable to cigarette smoking, with direct health care costs reaching a staggering $75 billion a year. And sadly, every day more than 4,000 kids smoke their first cigarette, taking their first deadly puff.

"As Surgeon General, my job is to present the best available science to the American people. Since 1965 Surgeons General have been warning Americans about the dangers of smoking on every single cigarette pack sold in the United States.

"In addition, within the next few months I will be releasing the 28th Surgeon General's report on the health consequences of smoking, which will provide new information about the impact that smoking has on health. With it, I will also release the first-ever database of scientific research on the hazards of smoking, which can be instantly updated as new science becomes available. Using this technology, once a threshold of danger is met, we can immediately alert the American people of new or more serious hazards of smoking.

"In short, smoking remains the most preventable cause of death and disease in the nation. Those who smoke need to quit, and we need to work together to get kids to stop starting.

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New Guide Offers African American Families Help to Cope with Crises

African American parents now have an important new resource to help them support their children in times of stress or crisis. The National Institute of Child Health and Human Development (NICHD) and the National Black Child Development Institute (NBCDI) have developed an Activity Book for African American Families: Helping Children Cope with Crisis.

The Activity Book for African American Families was developed by the African American Parents' Project, a collaboration between families, professional organizations, and leaders of national African American organizations, to provide African American families and communities with activities and resources to comfort their children in times of crisis. The project, begun shortly after the September 11th terrorist attacks, is designed to help African American families console their children who may become frightened by repeated media coverage of terrorism, war, and violence, and instill in them a sense of safety.

"Parents have the most important job in the world - one that is even more challenging and more difficult when children try to make sense of reports of violence and heightened threat alerts in the media," said Duane Alexander, M.D., director of the NICHD. "This activity book is designed to empower families to address everyday hardships and also to strengthen families for times of major crisis."

In developing this booklet, the NICHD and the NBCDI listened to parents' concerns and suggestions about what they needed to help their children cope with crisis situations. A number of African American organizations provided their expertise and assistance in developing the workbook and are committed to helping promote it.

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Personal Health
What is lactose intolerance?

Lactose intolerance is the inability to digest significant amounts of lactose, the predominant sugar of milk. This inability results from a shortage of the enzyme lactase, which is normally produced by the cells that line the small intestine. Lactase breaks down milk sugar into simpler forms that can then be absorbed into the bloodstream. When there is not enough lactase to digest the amount of lactose consumed, the results, although not usually dangerous, may be very distressing. While not all persons deficient in lactase have symptoms, those who do are considered to be lactose intolerant.

Common symptoms include nausea, cramps, bloating, gas, and diarrhea, which begin about 30 minutes to 2 hours after eating or drinking foods containing lactose. The severity of symptoms varies depending on the amount of lactose each individual can tolerate.

Some causes of lactose intolerance are well known. For instance, certain digestive diseases and injuries to the small intestine can reduce the amount of enzymes produced. In rare cases, children are born without the ability to produce lactase. For most people, though, lactase deficiency is a condition that develops naturally over time. After about the age of 2 years, the body begins to produce less lactase. However, many people may not experience symptoms until they are much older.

Between 30 and 50 million Americans are lactose intolerant. Certain ethnic and racial populations are more widely affected than others. As many as 75 percent of all African Americans and American Indians and 90 percent of Asian Americans are lactose intolerant. The condition is least common among persons of northern European descent.

Researchers have identified a genetic variation associated with lactose intolerance; this discovery may be useful in developing a diagnostic test to identify people with this condition.

How is lactose intolerance diagnosed?

The most common tests used to measure the absorption of lactose in the digestive system are the lactose tolerance test, the hydrogen breath test, and the stool acidity test. These tests are performed on an outpatient basis at a hospital, clinic, or doctor's office. The lactose tolerance test begins with the individual fasting (not eating) before the test and then drinking a liquid that contains lactose. Several blood samples are taken over a 2-hour period to measure the person's blood glucose (blood sugar) level, which indicates how well the body is able to digest lactose.

Normally, when lactose reaches the digestive system, the lactase enzyme breaks it down into glucose and galactose. The liver then changes the galactose into glucose, which enters the bloodstream and raises the person's blood glucose level. If lactose is incompletely broken down, the blood glucose level does not rise and a diagnosis of lactose intolerance is confirmed.

The hydrogen breath test measures the amount of hydrogen in a person's breath. Normally, very little hydrogen is detectable. However, undigested lactose in the colon is fermented by bacteria, and various gases, including hydrogen, are produced. The hydrogen is absorbed from the intestines, carried through the bloodstream to the lungs, and exhaled. In the test, the patient drinks a lactose-loaded beverage, and the breath is analyzed at regular intervals. Raised levels of hydrogen in the breath indicate improper digestion of lactose. Certain foods, medications, and cigarettes can affect the accuracy of the test and should be avoided before taking it. This test is available for children and adults.

The lactose tolerance and hydrogen breath tests are not given to infants and very young children who are suspected of having lactose intolerance. A large lactose load may be dangerous for the very young because they are more prone to the dehydration that can result from diarrhea caused by the lactose. If a baby or young child is experiencing symptoms of lactose intolerance, many pediatricians simply recommend changing from cow's milk to soy formula and waiting for symptoms to abate.

If necessary, a stool acidity test, which measures the amount of acid in the stool, may be given to infants and young children. Undigested lactose fermented by bacteria in the colon creates lactic acid and other short-chain fatty acids that can be detected in a stool sample. In addition, glucose may be present in the sample as a result of unabsorbed lactose in the colon.

How is lactose intolerance treated?

Fortunately, lactose intolerance is relatively easy to treat. No treatment can improve the body's ability to produce lactase, but symptoms can be controlled through diet.

Young children with lactase deficiency should not eat any foods containing lactose. Most older children and adults need not avoid lactose completely, but people differ in the amounts and types of foods they can handle. For example, one person may have symptoms after drinking a small glass of milk, while another can drink one glass but not two. Others may be able to manage ice cream and aged cheeses, such as cheddar and Swiss, but not other dairy products. Dietary control of lactose intolerance depends on people learning through trial and error how much lactose they can handle.

For those who react to very small amounts of lactose or have trouble limiting their intake of foods that contain it, lactase enzymes are available without a prescription to help people digest foods that contain lactose. The tablets are taken with the first bite of dairy food. Lactase enzyme is also available as a liquid. Adding a few drops of the enzyme will convert the lactose in milk or cream, making it more digestible for people with lactose intolerance.

Lactose-reduced milk and other products are available at most supermarkets. The milk contains all of the nutrients found in regular milk and remains fresh for about the same length of time, or longer if it is super-pasteurized.

For more information on lactose intolerance, go to:
http://digestive.niddk.nih.gov/ddiseases/pubs/
lactoseintolerance/index.htm

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What You Need To Know

Taking Aspirin to Lower Your Risk of Heart Attack

If you are at risk for a heart attack, taking aspirin every day or every other day can lower your risk.

How Do I Know if I Am At Higher Risk for A Heart Attack?

You may be at higher risk for a heart attack if you can say yes to any of the following:

If you answered "Yes" to any of these, talk to your doctor or nurse about whether taking aspirin is right for you.

Is Aspirin Safe?

For most people, taking aspirin is safe. But for some people, aspirin can increase the chance of bleeding in the stomach or intestines and may cause a small increase in some kinds of stroke.

For that reason, taking aspirin is not the right choice for everyone. The higher your risk of heart disease, the more you have to gain by taking aspirin.

What Should I Do?

Ask your doctor or nurse about taking aspirin. They can help you decide:

Background

The What You Need To Know series provides recommendations for the public on staying healthy from AHRQ. The recommendations are based on the work of the U.S. Preventive Services Task Force (USPSTF), sponsored by AHRQ.

The USPSTF is an independent panel of experts in the fields of family medicine, obstetrics-gynecology, pediatrics, nursing, prevention research, and psychology. The Task Force reviews research on a wide range of preventive services, including screening, counseling, and using medications to prevent disease, then makes recommendations for the public.

This fact sheet is part of Put Prevention Into Practice (PPIP), a national program sponsored by AHRQ to increase the delivery of USPSTF-recommended clinical preventive services in the primary care setting. Select for more information about PPIP and PPIP tools.

For More Information

To order more copies of this fact sheet or other PPIP material for patients, clinicians, or office systems, call the AHRQ Publications Clearinghouse:

Phone: 1-800-358-9295

Outside the United States: (410) 381-3150

Toll-free TDD service; hearing impaired only: 888-586-6340

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Secretary Tommy G. Thompson's public schedule:

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Last updated: January 12, 2004
United States Department of Health and Human Services
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