Latest / Morning Medical with Dr. Chow / US Death Rate Decline, Childhood Vaccinations, and Adolescent E-Cigarette Cessation Programs

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US Death Rate Decline, Childhood Vaccinations, and Adolescent E-Cigarette Cessation Programs · Morning Medical with Dr. Chow

• 0:00
  Good morning and welcome to another episode of Morning Medical with Dr.
• 0:03
  Chow.
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  I am your host, Dr.
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  Chi-Ming Chow.
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  On today's docket, we have some intriguing updates to share with you.
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  First up, a significant drop in the United States death rate for 2023, as reported by the
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  Centers for Disease Control and Prevention.
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  Let's dive into the details.
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  According to provisional data published on Thursday by the United States Centers for
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  Disease Control and Prevention, the overall death rate in the United States fell by six
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  percent in 2023.
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  This decline is largely attributed to a steep drop in Covid-19 deaths.
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  There were about 3.1 million deaths in the United States last year, with an age-adjusted
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  rate of 750 deaths for every 100,000 people.
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  In comparison, 2022 saw a rate of 799 deaths per 100,000 people.
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  The death rate has been on a decline since it reached a pandemic-high of approximately 880
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  deaths for every 100,000 people in 2021.
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  However, the current provisional data suggests that the death rate is still higher than the
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  pre-pandemic years.
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  For instance, in 2019, there were 715 deaths per 100,000 people.
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  Heart disease, cancer, and unintentional injury—which includes drug overdoses—remained
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  the leading causes of death, accounting for about half of all deaths in 2023.
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  Interestingly, while cancer deaths saw an uptick, deaths from heart disease actually
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  declined.
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  Covid-19, which was the fourth leading cause of death in 2022, fell to the tenth position in
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  2023.
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  The virus was associated with about 76,000 deaths last year, a significant drop of 69%
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  from the more than 245,000 deaths recorded in 2022.
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  This decline allowed stroke to move up to the fourth leading cause of death, followed by
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  chronic lower respiratory diseases, Alzheimer’s disease, diabetes, kidney disease, and liver
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  disease.
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  Overall death rates fell across all age groups, but the decrease was less significant among
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  children younger than five years old.
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  When looking at racial and ethnic groups, death rates decreased for all, but remained highest
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  among the Black population.
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  The age-adjusted rate of 924 deaths per 100,000 people in this group was 23% higher than the
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  overall rate.
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  White people were more likely than any other group to die from Covid-19 in 2023.
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  As in previous years, the death rate was higher among men than women, but the gap narrowed
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  slightly in 2023.
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  The provisional age-adjusted data shows there were approximately 884 deaths for every 100,000
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  men and 633 for every 100,000 women.
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  Provisional death estimates provide an early indication of shifts in mortality trends and
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  can guide public health policies and interventions aimed at reducing mortality among
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  populations experiencing higher death rates.
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  CDC researchers emphasized that this early data is subject to change as it may take longer to
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  finalize data from death certificates for certain causes of death or from specific
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  regions in the United States.
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  Moving on to some more encouraging news, let's talk about the impact of childhood vaccinations
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  in the United States.
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  According to a new report published by the Centers for Disease Control and Prevention,
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  routine childhood vaccinations will have prevented more than 500 million illnesses and
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  over 1 million deaths among people born between 1994 and 2023.
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  The report, released on Thursday, analyzed the benefits of routine childhood immunizations
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  through the CDC’s Vaccines for Children Program, which was launched in 1994.
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  The findings are remarkable: these vaccinations have saved the country billions of dollars in
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  healthcare costs and societal costs, such as parents missing work to care for sick children.
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  The researchers from the National Center for Immunization and Respiratory Diseases examined
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  the health benefits and economic impact of routine immunizations among children born
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  between 1994 and last year.
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  They included nine vaccines in their analysis: diphtheria, tetanus, and pertussis (DTaP);
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  Haemophilus influenzae type b (Hib); poliovirus; measles, mumps, and rubella (MMR);
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  hepatitis B; varicella; hepatitis A; pneumococcal conjugate; and rotavirus.
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  Interestingly, some other common vaccines like flu, Covid-19, and Respiratory Syncytial Virus
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  were not included in the analysis.
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  Using data from National Immunization Surveys and school vaccination surveys, the researchers
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  estimated the number of children vaccinated.
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  They also used data from the National Notifiable Diseases Surveillance System to
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  estimate disease cases and deaths.
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  Their analysis revealed that among about 117 million children born from 1994 through 2023,
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  routine childhood vaccinations will have prevented some 508 million cases of illness, 32
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  million hospitalizations, and about 1.13 million deaths over the children’s lifetimes.
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  The cumulative number of illnesses prevented ranged from about 5,000 cases for tetanus to
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  around 100 million for measles and varicella.
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  The greatest estimated cumulative number of hospitalizations and deaths prevented was about
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  13.2 million hospitalizations for measles and about 752,800 deaths for diphtheria.
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  The financial benefits are also noteworthy.
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  The analysis found that routine childhood vaccinations among children born between 1994
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  and 2023 yielded a net savings of 540 billion dollars in direct costs, such as medical care
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  costs of treating an infection, and 2.7 trillion dollars in societal costs.
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  Dr.
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  Sara Siddiqui, a pediatrician at Hassenfeld Children’s Hospital at New York University
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  Langone in New York, emphasized the importance of these findings.
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  In an email, she said, 'These are vaccinations that are currently recommended in the childhood
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  vaccination series and also are provided at reduced cost as part of the Vaccines For
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  Children Program.
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  I am very pleased and grateful to see this study being performed to report the health
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  benefits of vaccinations as a way to prevent disease.'
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  Dr.
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  Siddiqui added, 'My job as a pediatrician is to keep children healthy and out of the hospital.
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  Vaccinations are a way to keep children healthy and prevent the severity of disease.
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  I encourage all parents to continually have a conversation and discussion with their
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  pediatrician about each vaccine that their child is due for as well as the specific
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  disease that it would help in preventing.'
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  The CDC’s Vaccines for Children program was established after a measles epidemic from 1989
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  through 1991, which resulted in tens of thousands of infections and hundreds of deaths.
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  The CDC found that more than half of the children who had measles during that outbreak
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  had not been vaccinated.
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  The program was launched in 1994 to provide vaccines at no cost to eligible people 18 and
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  younger.
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  Last year, more than half—about 54 percent—of children in the United States were eligible to
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  receive vaccines through the program.
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  The program plays an important role in maintaining high childhood vaccination coverage
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  by reducing barriers to access, especially in areas and among populations that have
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  historically had lower vaccination coverage, such as children living in rural areas.
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  The researchers also suggested expanding the provider network by using nontraditional
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  vaccine providers, such as pharmacies, in areas where access is inadequate.
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  They highlighted the importance of provider reminders, provider assessment and feedback,
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  and client reminder-recall systems to reduce missed opportunities for vaccination.
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  However, routine childhood vaccination coverage did decline during the Covid-19 pandemic,
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  partly due to reduced access to primary care services and increased spread of
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  misinformation, leading to vaccine hesitancy.
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  Data from the World Health Organization and the United Nations International Children’s
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  Emergency Fund shows that the world has yet to recover from this decline.
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  For instance, worldwide coverage of the diphtheria, tetanus and pertussis vaccine was
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  84 percent in 2023, the same as in 2022 but below the 86 percent recorded in 2019.
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  The pandemic marked a 'historic backslide,' according to Dr.
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  Katherine O’Brien, director of the Department of Immunization, Vaccines and Biologicals at
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  the World Health Organization.
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  The race is now on to reach children who missed their shots during the pandemic and to restore
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  and strengthen immunization services beyond pre-pandemic levels.
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  It is crucial to overcome the challenges posed by disruptions in healthcare services,
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  logistical difficulties, vaccine hesitancy, and inequities in access to services.
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  In a groundbreaking study, adolescent e-cigarette users enrolled in a free
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  text-message-based vaping cessation program were 35% more likely to quit seven months
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  later.
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  This double-blind randomized trial involved more than 1,500 teens, and the results are
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  promising.
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  Thirty-eight percent of the participants assigned to the "This Is Quitting" program
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  reported abstinence at their seven-month follow-up, compared to 28% of those in a
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  control group.
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  The relative risk was 1.35, with a 95% confidence interval of 1.17 to 1.57, and the
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  findings were statistically significant with a P-value of less than 0.001.
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  Led by Amanda Graham, Ph.D., of the Innovations Center at the Truth Initiative in Washington,
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  D.C., this is the first randomized trial to demonstrate an effective intervention for
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  helping adolescents quit e-cigarettes.
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  The authors detailed their findings in the Journal of the American Medical Association.
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  They noted that the interactive and youth-tailored program showed consistent
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  benefits across various subgroups, including teens with high levels of nicotine dependence
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  and those with mental health concerns.
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  Dr.
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  Graham emphasized the significance of this study, stating, 'Healthcare providers,
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  teachers, and parents have been asking how to help teens quit vaping.
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  This study is a critical breakthrough that demonstrates the power of a behavioral
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  intervention for vaping cessation.' She also highlighted that the program did not lead to
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  teens transitioning to smoking.
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  'The intervention was effective in reducing dual use—smoking and vaping—and keeping teens
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  in this study from starting to smoke,' she added.
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  Dual abstinence at seven months was reported by 53% of those in the intervention group,
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  compared to 35% of controls, with a P-value of less than 0.001.
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  The researchers suggested that changes in one form of tobacco use, such as vaping cessation,
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  positively affected other tobacco use behaviors, like the decision to reject or quit
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  combustible tobacco products.
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  Importantly, there was no evidence that adolescents who quit vaping transitioned to
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  combustible tobacco products.
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  The automated program sends users messages that focus on vaping risks and the benefits of
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  quitting, crafting messages based on a participant's age, planned quit date, and brand
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  of e-cigarette.
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  For example, it offers 'I do not JUUL at all anymore' as a potential response.
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  'This Is Quitting' also provides information on nicotine-replacement therapy and can offer
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  mental health support, among other features.
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  According to data from the 2023 National Youth Tobacco Survey, 10% of all high schoolers and
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  5% of middle schoolers in the United States reported using an e-cigarette in the past
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  month, making it the most common form of tobacco use in these age groups.
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  While e-cigarettes are viewed as less harmful than traditional cigarettes and can serve as a
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  potential cessation tool for adult smokers, they contain various toxic substances and high
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  levels of addictive nicotine.
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  Studies have linked them with various harms.
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  Many teens who vape are interested in quitting, primarily due to concerns about their health,
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  but they struggle to do so.
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  Bonnie Halpern-Felsher, Ph.D., of Stanford University, emphasized the importance of
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  tailored interventions for youth who vape.
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  She noted that no nicotine-replacement therapies are approved by the Food and Drug
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  Administration for people under 18, but providers often prescribe them off-label for
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  adolescents in line with recommendations from the American Academy of Pediatrics.
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  Dr.
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  Halpern-Felsher praised the study, saying, 'This Is Quitting uses key best practices when
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  it comes to adolescent intervention programs, including being free and available via cell
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  phone; evidence-informed; based in theory; tailored to meet the adolescent “where they
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  are” with respect to age, quit date, and type of e-cigarette used; and empowers the
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  adolescent to quit.'
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  Since its launch in 2019, over 750,000 young people have used 'This Is Quitting,' according
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  to a press release from the Truth Initiative, the nonprofit that developed the program.
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  The program has also shown benefits in a prior trial of young adults.
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  In the current study, Graham's group randomized 1,501 adolescents aged 13 to 17 years who were
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  recruited via social media to either the text messaging intervention or a control group,
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  where only participants' smoking habits were assessed over text.
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  To be eligible, individuals needed to report vaping in the past month, be interested in
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  quitting, and own a text-message-capable cellphone.
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  Regardless of study assignment, individuals received gift card incentives and could receive
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  up to 95 dollars in total for participating in the trial by responding at various points.
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  Response rates dropped from 83% at one month to 71% at seven months, with no difference between
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  groups.
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  The study's primary endpoint was self-reported 30-day vaping abstinence in the intent-to-treat
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  population, with missing responses marked down as continued vaping.
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  The average participant age was 16 years, with 51% identifying as female, 42% as male, and 7%
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  as nonbinary.
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  Additionally, 43% identified as LGBTQ+.
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  The study population was 63% white, 19% multiracial, and 10% Black, with 16% reporting
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  Hispanic ethnicity.
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  Teens enrolled were highly addicted, with three-fourths vaping within 30 minutes of
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  waking up, 94% feeling somewhat or very addicted, and 87% having tried to quit in the
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  year prior to enrollment.
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  The researchers noted some limitations, including the lack of biochemically verified
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  abstinence and the potential for social desirability bias in the intervention group.
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  They also did not assess changes in the use of cannabis or alcohol in this publication.
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  That wraps up today's episode of Morning Medical with Dr.
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  Chow.
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  Thank you for joining me to discuss these important updates in healthcare.
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  I hope you found the information valuable and insightful.
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  Until next time, stay healthy and take care.