Friday, July 11, 2014

Tick-borne diseases

Ticks are generally found in brushy or wooded areas, near the ground; they cannot jump or fly. Ticks are attracted to a variety of host factors, including body heat and carbon dioxide. They will transfer to a potential host when one brushes directly against them and then seek a site for attachment.
Ticks cause a variety of diseases in Maine, including Lyme disease, Anaplasmosis, Babesiosis, and Powassan. 

More than 1,375 cases of Lyme disease were reported statewide in 2013, a record high for Maine. So far in 2014, there have been 202 reported cases of Lyme disease. 

In 2013, providers reported 94 cases of Anaplasmosis, 36 cases of Babesiosis, and 1 case of Powassan. So far in 2014, there have been 52 cases of Anaplasmosis and four cases of  Babesiosis reported. 

  For more information:
 The winners of Maine CDC's annual Lyme Disease Awareness Poster Contest have been announced. The press release is available at http://go.usa.gov/XPHB 

Thursday, July 10, 2014

Mosquito-borne diseases

EEE and WNV
 
Arboviral diseases, including Eastern equine encephalitis (EEE) and West Nile virus (WNV), are very serious infections that are transmitted by the bite of an infected mosquito. Although rare, these diseases have potentially severe and even fatal consequences for those who contract them.  Vermont has already detected EEE.  
 
Clinicians should be aware of the potential for human disease activity in Maine, and to consider testing for arboviral disease in patients presenting with unexplained encephalitis, meningitis or fever ≥100.4°F or 38°C during the summer and early fall.
 
For more information, see the Health Alert from July 2: http://go.usa.gov/X9MV 


Chikungunya

Chikungunya virus is also transmitted to people by mosquitoes. Outbreaks have occurred in countries in Africa, Asia, Europe, and the Indian and Pacific Oceans. In late 2013, chikungunya virus was found for the first time in the Americas on islands in the Caribbean. This week, New Hampshire reported two cases of chikungunya in people who traveled to the Caribbean.

The most common symptoms of chikungunya virus infection are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. There is no vaccine to prevent or medicine to treat chikungunya virus infection.

Travelers can protect themselves by preventing mosquito bites. When traveling to countries with chikungunya virus, use insect repellent, wear long sleeves and pants, and stay in places with air conditioning or that use window and door screens.

For more information, visit http://www.cdc.gov/chikungunya/ 

Tuesday, July 8, 2014

Cyclosporiasis

Cyclosporiasis is an intestinal infection caused by a microscopic parasite. Cases are usually reported from May to August. Four cases have been reported in Maine between June 24 and July 7.

Maine CDC issued a Health Alert on July 8 to increase awareness among clinicians about cyclosporiasis and the need to specifically request testing for Cyclospora in patients with prolonged diarrheal illness. The Health Alert is available at http://go.usa.gov/XXDR 

Cyclosporiasis is not a reportable condition in Maine due to the low number of cases in previous years (last known case in Maine resident in 2010). However, due to large numbers of cases in the United States in 2013, Maine CDC is requesting providers report cyclosporiasis cases as an unusual condition, 
since it is not commonly seen in Maine residents.  
  
For more information, visit http://go.usa.gov/X9tF

Tuesday, July 1, 2014

July is National Cleft & Craniofacial Awareness & Prevention Month

Cleft lip and/or palate is the second most common birth defect in the United States with between 20 and 30 infants born in Maine each year. The Maine Cleft Lip & Palate Program provides hospital and home visits to families who have infants born with the birth defect of a cleft lip and/or cleft palate. The program completes feeding assessments and supplies special bottle systems. The program provides information and referrals for services and medical/dental treatment until the age of 21. Care coordination, clinical team care through two monthly clinics at Eastern Maine Medical Center and Maine Medical Center, parent to parent support and outreach education are included in the program’s services.

For more information: http://www.maine.gov/dhhs/mecdc/population-health/cshn/cleftlip-palate/index.html

Friday, June 13, 2014

Alzheimer's disease and other dementias

June is Alzheimer's & Brain Awareness Month - an opportunity to hold a global conversation about the brain, Alzheimer's disease and other dementias. Everyone is at risk to develop Alzheimer's, the only leading cause of death that cannot be prevented, cured or even slowed. During the month of June, the Alzheimer's Association® asks people around the world to wear purple and join in the fight to end Alzheimer's disease.

Often thought of as minor memory loss, Alzheimer's is a fatal disease that kills nerve cells and tissue in the brain, affecting an individual's ability to remember, think and plan. As the disease advances, the brain shrinks dramatically due to cell death. Individuals lose their ability to communicate, recognize family and friends and care for themselves. There are 10 warning signs and symptoms. Every individual may experience one or more of these signs in different degrees. If you notice any of them, please see a doctor.

For more information visit http://alz.org/maine/

The Alzheimer's Association, Maine Chapter offers a 24/7 Helpline that provides reliable information and support to all those who need assistance. Call toll-free anytime day or night at 800-272-3900. 

For more information about Alzheimer's & Public Health:

Thursday, June 12, 2014

Go local, get seasonal with new public health data

The Maine Tracking Network recently released a suite of local data related to private well water quality and testing. 

Now, anyone can query summary measures for arsenic, uranium, fluoride, and other chemicals commonly found in excess of public health standards in Maine private wells.
  
These data are the first on the Maine Tracking Network to be presented for Healthy Maine Partnership service areas and towns, making it easy to identify areas at high-risk for private well water concerns and focus local interventions.
  
And, in time for summer, the Maine Tracking Network has data about heat illness and Lyme disease-data that help describe who may be at-risk for these seasonal conditions.
  
Go to https://data.mainepublichealth.gov/tracking/  to create your own customized maps, tables, and charts for these topics and many more, such as asthma, childhood lead poisoning, cancer, and birth outcomes.

Thursday, May 29, 2014

Public health accreditation

Maine CDC submitted an application to become accredited by the Public Health Accreditation Board (PHAB) on May 28. Several Maine CDC staff were present to celebrate this milestone. The application for Public Health Accreditation is the formal notification to PHAB of a health department's official commitment to initiate the accreditation process.

Public Health Accreditation is the measurement of Maine CDC's performance against a set of nationally recognized, practice-focused and evidence-based standards. These standards emphasize process improvements, quality assurance, and effective stewardship of public health resources. Currently, two state health departments and 29 local health departments have achieved accreditation.

Throughout the summer, Maine CDC staff will continue preparations, and will receive training from PHAB. This fall, the Maine CDC will begin to finalize the documents that will serve as evidence to the Accreditation Board that the agency is meeting the national standards. Stay tuned for more updates as we continue to move through this process!


Dr. Sheila Pinette, surrounded by some Accreditation champions and staff, electronically submitted the Maine CDC's application for Public Health Accreditation

Wednesday, May 28, 2014

Know your numbers: Blood pressure

About 1 in 3 Mainers are told they have high blood pressure, also called hypertension.  Many people do not know they have it because there are usually no symptoms.  High blood pressure is like having high pressure in a pipe.  It damages the pipe, but you often don't see a problem until it bursts.

What is a normal blood pressure?

A normal blood pressure is less than 120 (top number) over 80 (bottom number).  After that, the higher the numbers, the more at risk you are for health problems.

Blood Pressure Category
Top Number
(Systolic)
Bottom Number
(Diastolic)

Normal

Less than 120

and

Less than 80

Prehypertension

120-139

or

80-89

Hypertension

140 or higher

or

90 or higher


What can you do to prevent high blood pressure?

There are risk factors that you cannot change like age and family history.  Below are risk factors that you can control:
  • Have your blood pressure checked.  It should be checked at least every two years since there are often no symptoms. Talk with your health care provider to see if you need to have it checked more often. 
  • Prevent and manage diabetes.  60% of people with diabetes also have high blood pressure.
  • Eat a healthy diet.  Add lots of fruits and vegetables.  Limit foods high in saturated fat and cholesterol.
  • Avoid sodium (salt).  Limit the amount of salt you add to your food.  Many processed foods/restaurant meals are high in sodium.
  • Maintain a healthy weight.  Being overweight can raise your blood pressure.
  • Be physically active.  Exercise for 30 minutes each day.
  • Do not use tobacco products.  It injures blood vessels and speeds up hardening of the arteries.
  • Limit alcohol use.  If you drink alcohol, try to consume less.
  • If you have high blood pressure, treat it.  Your healthcare provider can make a plan that is right for you.

Million Hearts Initiative

Million Hearts® is a national effort to prevent 1 million heart attacks and strokes by 2017. Million Hearts® brings together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to fight heart disease and stroke.  To learn more about the initiative or to make the commitment visit: www.millionhearts.hhs.gov.

For more information about heart disease visit:http://mainehearthealth.org/.

Monday, May 19, 2014

May is Asthma Awareness Month

Maine continues to have some of the highest asthma rates in the nation. Emergency departments deal with almost 8,500 visits a year for asthma, and there are more than 1,100 hospitalizations annually. These visits can be avoided, and while asthma cannot be cured, it can be managed. Proper medication, avoiding triggers, and seeing a medical provider on a routine basis, are simple steps that anyone can take to avoid costly visits to the ER or hospital.

Here at the Maine CDC, the Asthma Prevention and Control Program works to raise awareness about the dangers and costs associated with asthma, and also to provide resources that can help Maine people manage their condition and live happy and productive lives.

For more information on asthma and the Maine CDC Asthma Prevention and Control Program click here.

Friday, May 16, 2014

Hepatitis B

May is Hepatitis Awareness Month. One in in 12 Asian Americans and Pacific Islanders has Hepatitis B.

Hepatitis B is common worldwide, especially in many parts of Asia and the Pacific Islands. In the US, Hepatitis B disproportionately affects Asian Americans and Pacific Islanders (AAPIs). While AAPIs make up less than 5% of the U.S. population, they account for more than 50% of Americans living with Hepatitis B. 

Hepatitis B is serious, but treatments are available.

Left untreated, nearly 1 in 4 people living with hepatitis B develop serious liver problems, even liver cancer. In fact, Hepatitis B-related liver cancer is a leading cause of cancer deaths among Asian Americans. Getting tested for Hepatitis B can help many people access lifesaving treatments that can prevent serious liver damage.

Two in three Asian Americans with Hepatitis B don't know they are infected.

People can live with Hepatitis B for decades without having any symptoms or feeling sick. Hepatitis B is spread when blood or other body fluid infected with the Hepatitis B virus enters the body of a person who is not infected. This can happen through multiple ways, including getting Hepatitis B from an infected mother at birth or from a family member as a young child. Many AAPIs living with Hepatitis B got infected as infants or young children. Testing is the only way to know if someone has Hepatitis B.

Who should get tested for Hepatitis B?
  • Anyone born in Asia or the Pacific Islands (except New Zealand and Australia)
  • Anyone born in the United States, who was not vaccinated at birth, and has at least one parent born in East or Southeast Asia (except Japan) or the Pacific Islands (except New Zealand and Australia).
Hepatitis B testing identifies people living with Hepatitis B so they can get medical care to help prevent serious liver damage. Talk to a health care provider about getting tested for Hepatitis B. 

For more information, see:http://www.cdc.gov/knowhepatitisb/FAQs.htm or 

Thursday, May 15, 2014

American Stroke Month

A stroke happens when part of the brain cannot get the blood and oxygen it needs and starts to die.  This is due to a blocked or ruptured blood vessel leading to or in the brain.  Stroke is the 4th leading cause of death in Maine and is the leading cause of serious, long-term disability in Maine and the U.S. 

What can you do to prevent a stroke?

You cannot control risk factors like age and family history.  Here are steps you can take for the risk factors you can control:
  • Know Your ABCS:
    • Ask your doctor if you should take Aspirin every day.
    • Find out if you have high Blood Pressure or Cholesterol.  If you do, work with your doctor to treat it.
    • If you Smoke, get help to quit.  Call the Maine Tobacco Help Line at 1-800-207-1230.
  • Be physically active at least 30 minutes on most days
  • Eat more fruits and vegetables
  • Be sure other foods are low in sodium and trans fat
  • Take medication as prescribed by your doctor
What are the warning signs of stroke?

F.A.S.T. is an easy way to remember the sudden signs of stroke:

Face Drooping: Does one side of the face droop or is numb?  Ask the person to smile.  Is the smile uneven?
Arm Weakness: Is one arm weak or numb?  Ask the person to raise both arms.  Does one arm drift downward?
Speech Difficulty: Is speech slurred?  Is the person unable to speak or hard to understand?  Ask the person to repeat a simple sentence.  Is it repeated correctly?
Time to Call 9-1-1: If someone shows any of these signs, even if the signs go away, call 9-1-1.  Check the time so you will know when the first signs appeared.

Other warning signs of stroke include blurred vision, dizziness or loss of balance, and severe headache.

Million Hearts Initiative

Million Hearts® is a national effort to prevent 1 million heart attacks and strokes by 2017. Million Hearts® brings together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to fight heart disease and stroke.  To learn more about the initiative or to make the commitment visit:www.millionhearts.hhs.gov
  
For more information about heart disease visit:http://mainehearthealth.org/

Thursday, May 1, 2014

Lyme Disease Awareness Month

May is Lyme Disease Awareness Month. Lyme disease is the most common vectorborne disease in Maine. Cases have already been reported in 2014, and the number will rise as the weather continues to get warmer.

Lyme disease is a bacterial infection carried by the deer tick. Cases have been increasing each year in Maine, and occur in all 16 counties. More than 1,375 cases of Lyme disease were reported statewide in 2013, a record high for Maine. Lyme disease is most common among school age children and adults older than 65. Most infections occur during the summer months.

The most common early symptom of Lyme disease is an expanding red rash that occurs 3-30 days after being bitten. Fever, headache, joint and muscle pains, and fatigue are also common during the first several weeks. Later features of Lyme disease can include arthritis in one or more joints (often the knee), Bell's palsy and other cranial nerve palsies, meningitis, and carditis (AV block). Lyme disease is treatable, and the majority of patients recover after receiving appropriate therapy.

What to do after a tick bite:
  • Remove the tick properly, ideally using tweezers or a tick spoon. 
  • Clean the area around the bite, and watch for signs and symptoms for 30 days. 
  • Testing of the tick is not routinely recommended. 
  • Prophylactic treatment after a tick bite is not routinely recommended, but can be considered under specific circumstances including. 
  • If you suspect Lyme disease, contact your health care provider for laboratory testing. The IDSA guidelines for assessment, treatment, and prevention of Lyme disease are available at http://cid.oxfordjournals.org/content/43/9/1089.full

Other tickborne diseases:
Other diseases that are carried by ticks in Maine include Anaplasmosis, Babesiosis and Powassan. Symptoms of Anaplasma include: fever, headache, malaise, and body aches. Symptoms of Babesia include: extreme fatigue, aches, fever, chills, sweating, dark urine, and possibly anemia. Symptoms of Powassan include: fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties, seizures, and encephalitis and meningitis.

In 2013, providers reported 94 cases of Anaplasmosis, 36 cases of Babesiosis, and 1 case of Powassan. Five anaplasmosis cases and two babesiosis cases have already been reported in 2014.

For more information:

Tuesday, April 22, 2014

State Health Improvement Plan (SHIP)

The 2013-2017 State Health Improvement Plan (SHIP) has been finalized, and implementation will begin soon.

Implementation teams for each of the six priorities will be recruited in the next two months. Partners who were identified in the planning process will receive an invitation to join the implementation teams, but we are also welcoming other interested parties.

The six priorities in the 2013-2017 SHIP are:
  • Immunization 
  • Obesity 
  • Substance Abuse and Mental Health 
  • Tobacco Use 
  • Educate, Inform and Empower the Public 
  • Mobilize Community Partnerships 
The implementation teams will be asked to focus on one or more of the objectives, and strategies in the plan, and may choose to work on all or part of those strategies.

Team members will help develop a work plan, identify commitments that they or their organization can make towards implementation, and then meet quarterly to provide progress updates and suggest new partnerships and or revisions to the work plan.

The plan can be found at: http://www.maine.gov/dhhs/mecdc/ship/index.shtml. If you are interested in participating in an implementation team, please contact Nancy Birkhimer at nancy.birkhimer@maine.govor 287-5716.

Monday, April 7, 2014

Viral hepatitis plan

On April 3, the U.S. Departments of Health and Human Services (HHS), Housing and Urban Development (HUD), Justice (DOJ), and Veterans Affairs (VA) released a 3-year update of Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care, & Treatment of Viral Hepatitis, which builds on the success of the nation's first comprehensive cross-agency action plan, released in 2011.   The updated Viral Hepatitis Action Plan builds on the foundation of and momentum generated by the original action plan and seeks to harness:
  • New recommendations for health care providers regarding screening for hepatitis C;
  • Promising new developments in treatments for hepatitis C;
  • Mounting public awareness of and concern about hepatitis B and hepatitis C; and
  • The expansion of access to viral hepatitis prevention, diagnosis, care, and treatment offered by the Affordable Care Act.

Thursday, March 20, 2014

Water Fluoridation Map

US CDC has recognized community water fluoridation as one of the 10 public health achievements of the 20th century.  Fluoridation is a cost effective community heath measure for all regardless of education, socioeconomic status, or access to dental care.

The Pew Charitable Trust Foundation has developed an interactive map to show the percentage of residents served by public water systems in each state who are receiving fluoridated water.  

Saturday, March 15, 2014

National Nutrition Month

The Nutrition Month 2014 theme is Enjoy the Taste of Eating Right. Consumer research suggests that people tend to purchase and eat more of the foods that taste great to them. The trick lies in convincing people that foods low in saturated fats, sodium, and added sugars and rich in color, fiber, and poly- and monounsaturated fats are tasty.

The 2012 Behavioral Risk Factor Surveillance System data and the 2011 Maine Integrated Youth Health Survey data tell us that 28% of Maine's adult and 13% of Maine's youth population are obese. These data also show that only one third of Maine's adult and youth population meet the fruit and vegetable recommendations.  Many of the most common chronic diseases that cut Maine residents' lives short are influenced by food intake, activity level, and weight status, so it's important that Maine focuses on strategies to aid people in enjoying the taste of eating right.

Here are a few suggestions from the US CDC Division of Physical Activity, Nutrition, and Obesity Prevention:
  • Increase access to healthy foods
    • o   Consider which foods are readily available at work, school, and the childcare center. Aim to make the environment support the words "making the easy choice the healthy choice."
    • o   Is there a grocery store with affordable and varied produce within 10 miles of residents in rural areas? Or 1 mile in urban areas? If not, what could be done?
    • o   Is there a farmers' market in those areas that live greater than the 10 or 1 mile from a grocery store? If not what can be done about it?
    • Support farm to school and farm to institution.
      • o   Farm to School programs introduce youth to healthy foods in their natural state and often include taste testing. This has been shown to increase youth's likelihood of eating foods like fruits and vegetables.
      • o   Does your child's school have a garden? Growing a vegetable garden is another great way to create interest in eating fruits and vegetables.

Saturday, March 1, 2014

Colorectal Cancer Awareness Month

March is Colorectal Cancer Awareness Month, and Maine CDC encourages Mainers to talk with a health care provider about when and how to be tested for colorectal cancer.

The number of deaths from colorectal cancer and the number of new colorectal cancer cases diagnosed in Maine has been decreasing over the last decade due to screening and improvements in treatment. However, colorectal cancer still remains the third-leading cause of Maine cancer cases and deaths.

While many people know that early detection of cancer is important to a positive long-term outcome, some cancers such as colorectal cancer (also referred to as colon cancer) can be prevented. Colorectal cancer starts as a polyp, which is a small collection of abnormal cells in the colon or rectum. Polyps tend to grow slowly and can take many years before they become cancerous.

The recommended age to start screening is 50. There are three types of tests recommended for colorectal screening: the high-sensitivity fecal occult blood test (FOBT) or fecal immunochemical test (FIT) (annually); flexible sigmoidoscopy (every five years); and colonoscopy (every 10 years). For those younger than age 50 who have a family history of colorectal cancer, screening may start earlier.

It is important for people to talk with their health care provider about their risk for all cancers.  For additional information and resources: www.screenmaine.org/colon-cancer

Monday, February 10, 2014

Stay healthy when traveling abroad

Travel-Related Disease Conditions – 2014

Background: Maine Center for Disease Control and Prevention (Maine CDC) investigated multiple cases of travel-related illness in 2013. Cases of chikungunya, dengue fever, and malaria have been reported to Maine CDC in persons who have recently traveled or have moved to Maine from another country. Maine residents frequently travel outside of the United States during school vacation weeks in February and April, often to warmer climates, putting them at risk for vector- and food-borne diseases.

Recommendations: Many travel-related illnesses can be prevented by vaccinations, good hand hygiene, and knowledge of high-risk conditions in other countries. Maine CDC recommends that clinicians counsel patients who plan to travel, on precautions they can take to prevent travel-related illness. The federal CDC recommends vaccines based on travel destination, available at www.cdc.gov/travel. Clinicians are reminded to obtain recent travel history, especially travel outside of the US, for symptomatic patients.


Table 1: Regions for Increased Attention, Select Diseases
Caribbean
Latin America
Africa
Indian Sub-Cont.
SE Asia
W Pacific
Chikungunya is a mosquito-borne viral disease. In December 2013, local transmission was found for the first time in the Caribbean/ Americas. The best prevention is to avoid being bitten by infected mosquitoes, including wearing repellant while indoors or out.


Dengue Fever is a mosquito-borne viral illness occurring in many tropical and subtropical countries world-wide.  The best prevention for dengue is to avoid being bitten by infected mosquitoes, including wearing repellant while indoors or out.

Malaria is a mosquito-borne parasitic disease, preventable by taking medication before and during travel (chemoprophylaxis). It occurs in more than 100 tropical and subtropical countries.
*Haiti

Hepatitis A is one of the most common vaccine-preventable infections acquired during travel. Transmitted through the fecal-oral route by ingesting contaminated food or water, and close personal contact, it is best prevented by vaccination and good hand hygiene.



Shigellosis is a bacterial infection of the intestine transmitted through the fecal-oral route by ingesting contaminated food or water, and close personal contact. Like other enteric diseases, including salmonella and campylobacter, good hand hygiene is the best prevention.




All suspected cases of travel-related illnesses that are notifiable conditions should be reported to the Maine CDC at 1-800-821-5821. If patients present with unusual symptoms, providers are encouraged to call Maine CDC for a consultation. A list of notifiable conditions is available at www.maine.gov/idepi.  


For More Information: Please contact the Maine CDC by calling the disease reporting and consultation line at 1-800-821-5821, e-mailing disease.reporting@maine.gov, or visiting the Maine CDC website at www.maine.gov/idepi. A list of travel medicine clinics in Maine can be found at www.maine.gov/dhhs/mecdc/infectious-disease/immunization/international-travel.shtml.

Thursday, February 6, 2014

American Heart Month

Heart disease is the second leading cause of death in Maine and describes a variety of conditions that affect your heart and/or blood vessels including coronary artery disease, heart attack, and congestive heart failure.

You can help protect yourself and your loved ones from heart disease by understanding associated risks and taking these steps:
  • Know Your ABCS:
    • Do you take Aspirin?  If your healthcare provider has said you are at risk for a heart attack, ask them about taking aspirin.
    • Do you know your Blood Pressure?  A normal blood pressure level is below 120/80.  Talk with your healthcare provider to find out your blood pressure numbers and get in control.
    • Do you know your Cholesterol Level?  A normal cholesterol level is below 200.  Talk with your healthcare provider to find out your cholesterol number and get in control.
    • Do you Smoke?  If you do, get help to quit. Smoking can raise your chances of having a heart attack or stroke.  To help you quit call the Maine Tobacco Help Line at 1-800-207-1230.
  • Be physically active at least 30 minutes on most days
  • Eat more fruits, vegetables, and other foods low in sodium and trans fat
  • Take medication as prescribed by your doctor
Million Hearts Initiative

Million Hearts® is a national effort to prevent 1 million heart attacks and strokes by 2017. Million Hearts® brings together communities, health systems, nonprofit organizations, federal agencies, and private-sector partners from across the country to fight heart disease and stroke. 

To learn more about the initiative or to make the commitment visit: www.millionhearts.hhs.gov.

For more information about heart disease visit: http://mainehearthealth.org/.

Wednesday, February 5, 2014

CVS Tobacco Announcement

Maine CDC and the US Department of Health and Human Services applaud CVS Caremark Corp. for their leadership in helping to make the next generation tobacco-free.

The company's announcement that CVS/pharmacy stores will no longer sell cigarettes and other tobacco products is an unprecedented step in the retail industry. We look forward to seeing other stores and chains follow suit.
  
To see the related article in the Journal of the American Medical Association, visit http://jama.jamanetwork.com/article.aspx?articleid=1828530 

To see the statement by HHS Secretary Sebelius, visit: http://go.usa.gov/BkDH 
  
For support and resources related to tobacco cessation, visit http://tobaccofreemaine.org/ or call 1-800-207-1230