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The U.S. Census Bureau predicts that the Asian-American population will total 40 million people by 2050. While as a whole this group is characterized by very dark hair and dark eyes, there is much diversity in Asian skin tones – from very light, pale skin to light or dark brown skin. One common thread is the pigmentation issues that Asian Americans often face as after-effects of other dermatologic problems that can be as troublesome as the original condition itself.

At the American Academy of Dermatology’s Summer Academy Meeting 2010 in Chicago, dermatologist Roopal V. Kundu, MD, FAAD, assistant professor and director of the Center for Ethnic Skin in the department of dermatology at Northwestern University Feinberg School of Medicine in Chicago, discussed two of the most common skin conditions in Asians and how treatment also involves addressing the ensuing pigmentation problems.

“The standards of beauty for Asian skin differ by region, but smooth skin and a flawless complexion are highly desired for most Asians,” said Dr. Kundu. “That is why treating the initial concern as well as any pigmentation problems that may occur as the result of the treatment are so important.”

Clearing Acne Step by Step
Acne is one of the most common skin conditions that affects Asians, and Dr. Kundu explained that this population tends to experience inflammatory acne. By its very nature, Asian skin has an increased amount of melanin (the pigment in skin), and the cells that make melanin tend to be more sensitive to any type of inflammation or injury. Because Asian skin becomes more inflamed with deeper acne pustules and papules, patients are often left with post-inflammatory hyperpigmentation (PIH), which refers to increased pigmentation or dark spots at the sites of inflammation.

“In my practice, Asian acne patients often are much more concerned with the after-effects of acne and how their skin may be affected by the resulting discoloration or scarring rather than the acne itself,” said Dr. Kundu. “However, the first goal of any successful treatment regimen is to control the acne with topical and/or systemic medications depending on the severity of the acne.”

In conjunction with medications she prescribes to clear acne, Dr. Kundu also recommends medications or over-the-counter products to even out the tone of Asian skin – which can help reduce the incidence of PIH. One such product that Dr. Kundu finds very effective in protecting Asian skin from uneven skin tone is sunscreen.

“Many of my Asian patients do not realize how important regular sun protection is to prevent the signs of aging skin, including preserving skin tone and helping minimize pigmentation problems from acne,” said Dr. Kundu. “Minimizing intense sun exposure, wearing sun protective clothing and wide-brimmed hats, along with applying a broad-spectrum sunscreen with an SPF 30 is a must for treating Asian skin for this reason.”

Another important component of treating acne in this population is exfoliation. Dr. Kundu often recommends glycolic acid, salicylic acid or topical retinoids to her patients to remove the surface skin cells and improve both acne and hyperpigmentation. Once acne is under control, the second goal is to address the resulting pigmentation problems. Dr. Kundu typically recommends bleaching agents, such as hydroquinone (considered the gold standard for bleaching), as well as chemical peels and cosmeceuticals. However, she cautioned that patients should be careful about where they purchase bleaching creams. Some establishments have been cited for selling products that contain too high levels of hydroquinone and even tested positive for toxic levels of mercury.

“It is very important for all patients to talk to their dermatologist before trying any at-home treatments designed to improve their skin tone, as some products can do more harm than good,” advised Dr. Kundu. “Your dermatologist can recommend proven therapies and preventive care to keep your skin healthy and looking its best, even when you are experiencing a skin condition like acne.”

Hot summer weather can pose special health risks to older adults. The National Institute on Aging (NIA), part of the National Institutes of Health, has some advice for helping older people avoid heat-related illnesses, known as hyperthermia.

Hyperthermia is an abnormally high body temperature caused by a failure of the heat-regulating mechanisms of the body to deal with the heat coming from the environment. Heat fatigue, heat syncope (sudden dizziness after prolonged exposure to the heat), heat cramps, heat exhaustion and heat stroke are commonly known forms of hyperthermia. Risk for these conditions can increase with the combination of outside temperature, general health and individual lifestyle.

Lifestyle factors can include not drinking enough fluids, living in housing without air conditioning, lack of mobility and access to transportation, overdressing, visiting overcrowded places and not understanding how to respond to hot weather conditions. Older people, particularly those with chronic medical conditions, should stay indoors on hot and humid days, especially when an air pollution alert is in effect. People without air conditioners should go to places such as senior centers, shopping malls, movie theaters or libraries. Cooling centers, which may be set up by local public health agencies, religious groups and social service organizations in many communities, are another option.

Health-related factors that may increase risk include:
Being dehydrated.
Age-related changes to the skin such as poor blood circulation and inefficient sweat glands.
Heart, lung and kidney diseases, as well as any illness that causes general weakness or fever.
High blood pressure or other conditions that require changes in diet. For example, people on salt-restricted diets may increase their risk. However, salt pills should not be used without first consulting a doctor.
Reduced perspiration, caused by medications such as diuretics, sedatives, tranquilizers and certain heart and blood pressure drugs.
Taking several drugs for various conditions. It is important, however, to continue to take prescribed medication and discuss possible problems with a physician.
Being substantially overweight or underweight.
Drinking alcoholic beverages.

Heat stroke is a life-threatening form of hyperthermia. It occurs when the body is overwhelmed by heat and unable to control its temperature. Someone with a body temperature above 104 degrees Fahrenheit is likely suffering from heat stroke and may have symptoms of confusion, combativeness, strong rapid pulse, lack of sweating, dry flushed skin, faintness, staggering, possible delirium or coma. Seek immediate emergency medical attention for a person with any of these symptoms, especially an older adult.

If you suspect that someone is suffering from a heat-related illness:
Get the person out of the sun and into a shady, air-conditioned or other cool place. Urge them to lie down.
If you suspect heat stroke, call 911.
Encourage the individual to shower, bathe or sponge off with cool water.
Apply a cold, wet cloth to the wrists, neck, armpits, and/or groin, places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.
Offer fluids such as water, fruit and vegetable juices, but avoid alcohol and caffeine.

For a free copy of the NIA’s AgePage on hyperthermia in English or in Spanish, contact the NIA Information Center at 1-800-222-2225 or go to http://www.niapublications.org/agepages/hyperther.asp or www.niapublications.org/agepages/hyperther-sp.asp for the Spanish-language version.

Radiation therapy that targets a specific area of the breast is as effective as whole-breast radiation in reducing breast cancer recurrence in some women and is far more convenient, a new study suggests.

Researchers led by Jayant S. Vaidya of University College London, and David Joseph of the University of Western Australia, examined the medical records of almost 1,000 breast cancer patients who received (targeted) intraoperative radiotherapy and a nearly equal number who underwent whole-breast external beam radiation.

A few received both treatments.

After four years, six women in the intraoperative radiotherapy group had a recurrence of breast cancer, compared to five in the external beam group.

The researchers caution that the patients in the study fit into a limited category: They were 45 years or older, had early invasive breast cancer and were considered appropriate candidates for breast-conserving surgery.

The study findings, published online before print publication in The Lancet, were to be released Saturday at the annual meeting of the American Society of Clinical Oncology in Chicago.

The targeted radiation requires just one session, making it less time consuming and less costly than whole-breast treatment, the researchers said.

For selected patients with early breast cancer, a single dose of radiotherapy delivered at the time of surgery by use of targeted intraoperative radiotherapy should be considered as an alternative to external beam radiotherapy delivered over several weeks, they said in a news release.

SOURCE: American Society of Clinical Oncology, press release.

People taking the prescription blood thinner warfarin (Coumadin) may up their risk for health complications if they also take herbal or non-herbal supplements, new research reveals.

In fact, eight out of the 10 most popular supplements in the United States could spark safety concerns with respect to warfarin, while also impacting the drug’s effectiveness.

“I specifically looked at warfarin use, but the real issue is that even though herbal supplements fall under the category of food, and they’re not regulated like prescription drugs, they still have the effects of a drug in the body,” cautioned study author Jennifer L. Strohecker, a clinical pharmacist at Intermountain Medical Center in Salt Lake City.

“Warfarin is a very high-risk medication, which can be associated with severe consequences when it’s not managed properly,” she added. “However, warfarin is derived from a plant, sweet clover. In fact, many of our prescription drugs came from plants. So, it’s very important for patients to recognize that just because an herb is marketed not like a prescription drug [that] doesn’t mean it doesn’t have similar effects in the body.”

Strohecker and her colleagues are slated to present their findings Thursday at the Heart Rhythm Society annual meeting in Denver.

The authors note that almost 20 percent of Americans currently take some type of herbal or non-herbal supplement.

To gauge how these products might interact with warfarin, the researchers ranked the 20 most popular herbals and 20 most popular non-herbal supplements based on 2008 sales data, and then looked at how their use affected both clotting tendency and bleeding.

More than half of the herbal and non-herbal supplements were found to have either an indirect or direct impact on warfarin. Nearly two-thirds of all the supplements were found to raise the risk for bleeding among patients taking the blood thinner, while more than one-third hampered the effectiveness of the medication.

An increase in bleeding risk was specifically linked to the use of cranberry, garlic, ginkgo and saw palmetto supplements, the team said.

Glucosamine/chondroitin, essential fatty acids, multi-herb products, evening primrose oil, co-enzyme Q10, soy, melatonin, ginseng and St. John’s wort all affected warfarin’s effectiveness so much so that they prompted a need for adjustments in the drug’s prescribed dosage.

“I’m not against herbal supplement use at all,” Strohecker stressed. “But physicians need to proactively discuss this issue with their patients because of the consequences that can occur.”

Dr. Richard L. Page, a cardiologist and chair of medicine at University of Wisconsin, Madison, and president of the Heart Rhythm Society, believes the larger problem here is poor patient-doctor communication.

“Doctors don’t always know what their patients are taking,” he said. “Supplements may perform a very good service. Or they may not be providing the sort of care that patients are looking for when they’re essentially self-medicating. And where this becomes especially important is that these supplements can interact with the prescription drugs that your doctor may be giving you.”

“This report is important,” Page said, “because they look at a very common drug, warfarin, which has a narrow therapeutic window. Which means too much is bad cause you bleed, and too little is bad because it won’t do the job of thinning the blood that you want. So the bottom line is, be careful of adding new supplements if you are on existing prescription medications, and talk to your doctor if you do.”

A representative of the supplements industry took a slightly different view.

Duffy MacKay, vice president of scientific and regulatory affairs for the D.C.-based Council for Responsible Nutrition, the leading dietary supplement industry trade association, said that, “the issue here is really more with warfarin.”

“It’s just a very sensitive medication,” he said. “Warfarin itself has a huge list of drugs, foods and over-the-counters that it interacts with. If you take too much or too little, it can become dangerous.”

“So it’s sort of a form of sensationalism to suggest that here you have this situation with dietary supplements specifically,” MacKay added.

SOURCES: Jennifer L. Strohecker, Pharm.D., clinical pharmacist, Intermountain Medical Center, Salt Lake City, Utah; Richard L. Page, M.D., FHRS, cardiologist and chair, medicine, University of Wisconsin, Madison, and president of Heart Rhythm Society; Duffy MacKay, N.D., vice president, scientific and regulatory affairs, Council for Responsible Nutrition, Washington, D.C.;

A team from the U.S. Food and Drug Administration is investigating a farm in Arizona as a potential source of E. coli-tainted lettuce that has so far sickened 19 people nationwide, the Associated Press reported Friday.

Possible E. coli contamination prompted the recall of Freshway Foods’ romaine lettuce, which is sold in 23 states and the District of Columbia, the FDA announced Thursday.

The agency said the lettuce may be linked to cases of E. coli illness in Michigan, Ohio and New York that involved the hospitalization of 12 people, three with potentially life-threatening symptoms, the AP reported.

College students at the University of Michigan, Ann Arbor, Ohio State in Columbus and Daemen College in Amherst, N.Y., have been among those sickened in the outbreak, according to local state health departments.

The lettuce was sold to wholesalers, food service outlets, in-store salad bars and delis in Alabama, Connecticut, the District of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, West Virginia and Wisconsin, according to Ohio-based Freshway Foods.

The recall covers lettuce with a “best if used by” date of May 12 or earlier, as well as “grab and go” salads sold at Kroger, Giant Eagle, Ingles Markets and Marsh grocery stores, the AP reported.

The lettuce does not include any bulk or prepackaged romaine or bagged salad mixes in retail supermarkets, the company stressed.

“Freshway Foods does not produce bulk, prepackaged romaine or bagged salad mixes containing romaine for sale in supermarkets, and therefore these products are not included in this recall,” the company said in a news release.

According to the AP, Freshway Vice President Devon Beer, said the company has been working with FDA to trace the contaminated lettuce back to the (as yet unidentified) grower in Yuma, Ariz.

The health effects of E. coli infection can range from mild diarrhea to more severe illness, including kidney damage. According to the AP, the three patients with life-threatening illness have developed a condition called hemolytic uremic syndrome, which can trigger hemorrhage in the brain or kidneys.

Complicating matters is the fact that the strain identified in the lettuce is E.coli 0145, not the much more common and more easily identified and reported E.coli 0157, the AP said.

In the meantime, restaurants across the nation are rushing to assure customers that their salads are safe to eat. According to CNN, Yum! Brands — which owns chains such as KFC, Pizza Hut, Taco Bell and Long John Silver’s — has said that Freshway Foods does not supply lettuce to any of its restaurants.

SOURCES: 2010, news release, Freshway Foods;

If losing weight feels like a never-ending battle, new research may explain why: Diets that restrict calories can actually make it harder to lose weight and keep it off.

Cutting calories increases production of cortisol, the stress hormone, which is linked to added belly fat, a new study finds.

“For the first time in humans, we are finding out that cutting your calories increases cortisol,” said lead researcher A. Janet Tomiyama, a Robert Wood Johnson Foundation Health & Society Scholar at the University of California, San Francisco.

“We think this may be one reason dieters tend to have a hard time keeping weight off in the long-term,” she said.

People who count calories feel stressed, she said, but it’s the reduction in calories that increases cortisol, which, in turn, stresses the body and leads to weight retention.

“No matter how you cut calories, whether that’s doing it on your own, or doing something like Nutrisystem or Jenny Craig, it doesn’t matter, it’s still going to increase your cortisol level,” she said.

At any given time, 47 percent of U.S. adults are dieting, but up to 64 percent gain back more weight than they lost, according to background information in the report published online April 6 in Psychosomatic Medicine.

For the study, Tomiyama’s team randomly assigned 121 women to one of four diets. One group tracked their calories, keeping them to 1,200 a day; another group ate normally but recorded the number of calories they consumed; a third group ate 1,200 calories a day, but did not have to record them, and the fourth group ate normally without any calorie-tracking.

At the start and end of the three-week trial, the researchers measured each woman’s cortisol and stress levels. When calories were restricted, cortisol levels increased. In addition, calorie-counting also increased the women’s perceived stress, the researchers found.

“The term ‘dieting’ brings to mind deprivation, starvation, being miserable and uncomfortable and ultimately failing in weight loss efforts,” Samantha Heller, a dietitian, nutritionist and exercise physiologist who is familiar with the study, said.

Burning more calories than you consume is how your body loses weight, she said. “However, severe calorie restriction, diet fads, pills and potions, detox cleanses and other quacky approaches to weight loss only contribute to people’s diet failures and, in fact, may increase the likelihood of regaining even more weight than what was lost — if any,” Heller added.

The best way to drop unwanted pounds is to adopt healthy lifestyle behaviors that include eating a variety of healthy foods, physical activity, patience and a game plan, she said.

“Many people want to lose weight and do not know how to begin. Creating a step-by-step plan is one piece of the puzzle a lot of people forgo,” Heller said.

Starting a weight-loss program takes discipline, motivation and a desire to make behavioral changes and finding support can be very helpful, Heller added.

Another expert, Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine in New Haven, Conn., said while dieting isn’t easy, certain strategies can help reduce stress and achieve a healthier lifestyle.

“Food itself, a reliable source of immediate gratification, may be used to relieve stress,” Katz said. “When food intake is restricted, something else should replace it.”

In general, dieting alone is not all that useful, Katz added. “Eating well and being active for life is the way to go,” he said.

“By eating foods of higher overall nutritional quality, fullness can generally be achieved on fewer calories, eliminating the need for deprivation,” Katz said. “In addition, physical activity can accelerate weight loss, promote health and alleviate stress in the bargain.”

SOURCES: A. Janet Tomiyama, Ph.D., Robert Wood Johnson Foundation Health & Society Scholar, University of California, San Francisco; David L. Katz, M.D., M.P.H., director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Samantha Heller, M.S., R.D., dietitian, nutritionist, exercise physiologist, Fairfield, Conn;

Researchers have identified two gene variants that increase the risk of both the most common chronic liver disease in the United States as well as type 2 diabetes.

People who carry the variants of a gene for apolipoprotein C3 (APOC3), which produces an enzyme important in fat metabolism, have a higher incidence of nonalcoholic fatty liver disease and also insulin resistance, according to a report in the March 25 issue of the New England Journal of Medicine. The research group was led by Dr. Gerald I. Shulman, a professor of physiological chemistry, medicine and cellular and molecular physiology at Yale University.

Identification of the gene variants “might make it possible to screen individuals to see if they have a higher risk of fatty liver disease,” Shulman said. “It also can provide an ideal drug target to prevent development of fatty liver disease and insulin resistance.”

Fatty liver disease can be caused by excessive alcoholic consumption and obesity. Its incidence has increased in the United States, and more than 30 percent of Americans are estimated to have it, Shulman said.

In many cases, excess buildup of fat in the liver causes only minor problems. But it can progress to cause major, life-threatening deterioration of liver function. In the same way, insulin resistance can lead to type 2 diabetes, a major risk factor for heart attack, stroke and other cardiovascular problems.

Shulman and his colleagues first looked for the APOC3 gene variants in 95 lean Asian Indian men, an ethnic group in which the incidence of fatty liver disease is high, for unknown reasons. “Carriers of these gene variants had 5.5 percent fat in their liver, and were also markedly insulin-resistant,” Shulman said.

The variants cause higher levels of APO3C, which inhibits an enzyme that breaks down fats, Shulman said. The excess fats are deposited in the liver. Thirty-eight percent of the men with the gene variants had fatty liver disease.

The Yale group then did the same genetic study in a mixed ethnic group of 163 men and found a similar incidence of fatty liver disease and insulin resistance among those with the gene variants.

The next step in the Yale program will be an effort to learn why the condition is more common in East Asian men, Shulman said. But a longer-term goal is to put the finding to use to detect high-risk individuals, he noted.

“If you have a test, you can make them careful about their weight,” he said. “The good news is that we have shown that even modest weight reduction can reduce the risk. Dropping 15 pounds reverses fatty liver disease and insulin resistance.”

Beyond that would be a treatment aimed at the gene variants, Shulman said. “It’s even better if you have something you can do about it,” he said. “You could screen people, test for fatty liver and insulin resistance and treat that with agents.”

A screening test could help single out people whose fatty livers were not dangerous, said Dr. Anna Mae Diehl, chief of gastroenterology at Duke University, who wrote an accompanying editorial in the journal.

“Simply having extra fat in the liver is of unknown significance,” Diehl said. “Many people who have it are fine. Some get more advanced forms of liver disease. We want to know if this polymorphism is associated not only with fat, but also with damage.”

Such a determination now requires a biopsy to remove a segment of the liver for examination, Diehl said. “We still don’t have a noninvasive blood test,” she said. “That might help sort out who has more serious damage. We are hoping that in the next few years better tests become available.”

SOURCES: Gerald I. Shulman, M.D., Ph.D, professor, physiological chemistry, medicine, cellular and molecular physiology, Yale University, New Haven, Conn.; Anna Mae Diehl, M.D., professor, medicine, and chief, gastroenterology, Duke University, Durham, N.C.; New England Journal of Medicine

Brown rice is better than white rice at reducing the risk of type 2 diabetes, but whole grains are the most effective at lowering the risk, study findings show.

U.S. researchers analyzed data from 39,765 men in the Health Professionals Follow-up Study and 157,463 women in the Nurses’ Health Study I and II. None of the participants had diabetes, heart disease or cancer at the start of the studies. Their consumption of brown and white rice, as well as other foods, was assessed every two to four years.

During 3.3 million person-years of follow-up, there were 10,507 incidents of type 2 diabetes. After adjusting for a number of dietary and lifestyle risk factors, the researchers found that people who ate five or more servings per week of white rice were 17 percent more likely to develop type 2 diabetes than those who ate less than one serving of white rice per month.

In contrast, people who ate two or more servings of brown rice per week were 11 percent less likely to develop type 2 diabetes than those who ate less than one serving of brown rice per month, the study authors reported.

“We estimated that replacing 50 grams/day intake of white rice with the same amount of brown rice was associated with a 16 percent lower risk of type 2 diabetes, whereas the same replacement with whole grains as a group was associated with a 36 percent lower diabetes risk,” wrote Dr. Qi Sun, of Harvard School of Public Health in Boston, and colleagues.

The study was to be presented Wednesday at the American Heart Association’s Nutrition, Physical Activity and Metabolism Conference in San Francisco.

SOURCE: American Heart Association

Americans eat way too much salt and cutting down on that consumption should be a cornerstone of new public health efforts to curb hypertension.

That’s one of the key messages of an Institute of Medicine (IOM) report, commissioned by the U.S. Centers for Disease Control and Prevention and released Monday, that calls hypertension — or high blood pressure — a “neglected disease,” one that has fallen off the public health radar and needs to be put back on.

“High blood pressure and its consequences are too important to remain a neglected disease,” Dr. David Fleming, chairman of the committee that produced the report, said during a morning news conference. “It’s time to give our complete attention to take full advantage of known and promising interventions, and take concerted actions necessary to achieve prevention and control of hypertension.”

The public-health initiatives described by the report would refocus efforts from individual actions to so-called environmental considerations, such as stocking fresh produce in urban grocery stores, making streets safe to walk on, and enlisting the help of industry in manufacturing foods with lower salt content.

“Congress must give priority to adequate resources to implement a broad sweep of policy-based approaches at the state, local and federal levels,” said Fleming, who is director of public health for Seattle/King County, Washington.

According to the report, nearly one-third of U.S. adults have high blood pressure, and it accounts for about one in six adult deaths annually, a 25 percent increase from 1995 to 2005. High blood pressure usually has no symptoms: You can have it for years without knowing it, even though it can damage the heart, blood vessels, kidneys and other parts of the body, according to the U.S. National Institutes of Health.

“If you live long enough, you are almost guaranteed to get hypertension,” said Dr. Corinne Husten, a committee member who, at the time the report was being prepared, was executive vice president for program and policy at the Partnership for Prevention. She is now senior medical advisor at the U.S. Food and Drug Administration’s Center for Tobacco Products.

The report outlines several priorities.

The first would be to cut Americans’ salt intake — 80 percent of Americans currently eat more than the recommended amount and that number is growing. But given that 70 percent of Americans’ sodium comes from packaged foods and restaurants — not from the family salt shaker — the food industry needs to play a role here, Fleming said. “These efforts should be focused on making it easier for people to eat less salt,” he said.

Experts also need to better understand why many health-care providers fail to adhere to current treatment guidelines, despite knowing what the stakes are. Some people don’t even know they have high blood pressure, likely a failure of their doctor or other provider. “We are alarmed at the extent to which Americans have undiagnosed hypertension, equally the millions who have been diagnosed and are under the care of a provider but whose hypertension isn’t controlled,” Fleming said. Only one-third of people with the diagnosis have it under control.

The third area involves breaking down economic barriers that prevent patients from taking their medication. The committee recommended that the CDC work with the Centers for Medicare & Medicaid Services, pharmaceutical companies and businesses to help get medication to those who need it.

The committee also recommended that procedures be set up to measure performance in controlling hypertension and how much salt is actually being consumed. “There is really inadequate national data on trends,” said Dr. Walter Willett, chairman of nutrition and epidemiology at the Harvard School of Public Health.

American Heart Association President Dr. Clyde Yancy said in a prepared statement: “This Institute of Medicine report on hypertension now reinforces the need for a broad-based initiative in the science and public health spectrums to help individuals manage hypertension and perhaps even prevent the onset of hypertension.”

Yancy stated, “We support the IOM’s recommendations to make drug therapy more affordable for Medicaid and Medicare beneficiaries and boost funding for prevention programs that provide smoking-cessation counseling and screenings for high blood pressure and cholesterol for underserved populations.”

SOURCES: news release, American Heart Association; teleconference with David W. Fleming, M.D., director, public health, Seattle/King County, Wash.; Corinne Husten, M.D., former executive vice president for program and policy, Partnership for Prevention, and currently senior medical advisor, Center for Tobacco Products, U.S. Food and Drug Administration; Walter Willett, M.D., Dr.P.H., Fredrick John Stare Professor of Epidemiology and Nutrition, and chair, department of nutrition and epidemiology, Harvard School of Public Health, Boston; A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension