Anxiety

Feeling worried or nervous is a normal part of everyday life. Everyone frets or feels anxious from time to time. Mild to moderate anxiety can help you focus your attention, energy, and motivation. If anxiety is severe, you may have feelings of helplessness, confusion, and extreme worry that are out of proportion with the actual seriousness or likelihood of the feared event. Overwhelming anxiety that interferes with daily life is not normal. This type of anxiety may be a symptom of another problem, such as depression.

Anxiety can cause physical and emotional symptoms. A specific situation or fear can cause some or all of these symptoms for a short time. When the situation passes, the symptoms usually go away.

Physical symptoms of anxiety include:

- Trembling, twitching, or shaking.
- Feeling of fullness in the throat or chest.
- Breathlessness or rapid heartbeat.
- Lightheadedness or dizziness.
- Sweating or cold, clammy hands.
- Feeling jumpy.
- Muscle tension, aches, or soreness (myalgias).
- Extreme tiredness.
- Sleep problems, such as the inability to fall asleep or stay asleep, early waking, or restlessness (not feeling rested when you wake up).

Anxiety affects the part of the brain that helps control how you communicate. This makes it more difficult to express yourself creatively or function effectively in relationships. Emotional symptoms of anxiety include:

- Restlessness, irritability, or feeling on edge or keyed up.
- Worrying too much.
- Fearing that something bad is going to happen; feeling doomed.
- Inability to concentrate; feeling like your mind goes blank.

Panic attacks

A panic attack is a sudden feeling of extreme anxiety or intense fear without a clear cause or when there is no danger. Panic attacks are common. They sometimes occur in otherwise normal, healthy people and will usually last for several minutes.

Symptoms include feelings of dying or losing control of yourself, rapid breathing (hyperventilation), and a racing heart. You may feel dizzy, sweaty, or shaky. Other symptoms include trouble breathing, chest pain or tightness, and an irregular heartbeat. These symptoms come on suddenly and without warning.

Sometimes symptoms of a panic attack are so intense that the person fears he or she is having a heart attack. Many of the symptoms of a panic attack can occur with other illnesses, such as hyperthyroidism, coronary artery disease, or chronic obstructive pulmonary disease (COPD). A complete medical examination may be needed before an anxiety disorder can be diagnosed.

People who have repeated unexpected panic attacks and worry about the attacks are said to have a panic disorder.

Phobias

Phobias are extreme and irrational fears that interfere with daily life. People with phobias have fears that are out of proportion to real danger. And although these people are aware that their fears are not rational, they are not able to control them.

Phobias are common and are sometimes present with other conditions, such as panic disorder or Tourette’s disorder. Most people deal with phobias by avoiding the situation or object that causes them to feel panic (avoidance behavior).

A phobic disorder occurs when the avoidance behavior becomes so extreme that it interferes with your ability to participate in your daily activities. There are three main types of phobic disorders:

- Fear of being alone or in public places where help might not be available or escape is impossible (agoraphobia)
- Fear of situations where the individual might be exposed to criticism by others (social phobia)
- Fear of specific things (specific phobia)

Use the Check Your Symptoms section to decide if and when you should see a doctor.

Menthol cigarettes now account for more than one-quarter of all cigarettes sold in the U.S. In fact, menthols—often described as “cooling,” “soothing,” and “smooth”—make up a growing share of the shrinking cigarette market. Between 2004 and 2008, the percentage of adult smokers who smoked them increased from 30% to 34%.

Experts say that menthol cigarettes’ minty flavor makes them more appealing to young people, more addictive, and harder to quit than regular cigarettes. Menthol is the “ultimate candy flavoring,” says Phillip Gardiner, a researcher at the University of California’s Tobacco-Related Disease Research Program, in Oakland.

The Food and Drug Administration hasn’t yet decided on whether it agrees. When the FDA was given the authority to regulate tobacco products in 2009, the agency banned cigarettes with flavors such as chocolate and fruit, because candy-like cigarettes are more attractive to kids. But menthol escaped the cut.

Since then, tobacco and public health experts have said that menthols should be banned, too—or at least regulated more strictly. The FDA’s new tobacco advisory committee is currently sifting through the evidence.

Short of an outright ban on menthol cigarettes, the FDA may decide to regulate their marketing and even the menthol content. The FDA committee has scheduled a second meeting on the matter in mid-July, although the committee’s final recommendation isn’t due until March 2011.

But are menthols really worse than non-menthol cigarettes? The committee’s task won’t be an easy one. The opinions that physicians, public health experts, and tobacco executives have regarding menthol cigarettes seem to be stronger than the research supporting them.

Menthol ads target black community

Tobacco company representatives have maintained that menthol cigarettes are no more or less addictive and harmful than other brands on the market—although they are quick to acknowledge that all cigarettes are addictive and potentially deadly.

“The clear, science-based judgment must be that menthol cigarettes are not more harmful than non-menthol cigarettes,” William True, PhD, the senior vice president of research at the Lorillard Tobacco Company, told the FDA committee in March. “A menthol cigarette is, well, just another cigarette, and should be treated no different.” (Lorillard is the maker of Newport cigarettes, the most popular menthol brand in the U.S.)

The debate over whether menthols are more addictive and harmful than regular cigarettes is complicated by cultural and racial factors. Since the 1960s and 1970s, tobacco companies have largely marketed menthols to younger people and blacks, who now smoke the cigarettes at higher rates than other groups. Roughly 70% of blacks smoke menthols, compared to just over 20% of whites and 26% of Hispanics, according to the latest government data.

“Menthol cigarettes are marketed to the most vulnerable sectors of our society, particularly starting in the 1960s,” Gardiner says. “It’s essentially predatory marketing.”

As a result, the health effects of menthols can be difficult to untangle from broader factors that influence smoking. Although blacks tend to smoke less than whites, they “get lung cancer more often and die more often than non-African Americans,” says William Hicks, MD, professor of clinical medicine at the Ohio State University Comprehensive Cancer Center, in Columbus, who co-authored a recent report on lung cancer in African Americans for the American Lung Association.

Research suggests that blacks and other minorities have a harder time quitting menthol cigarettes than white smokers. One study, published in 2009 in the journal Preventive Medicine, found that among nearly 8,000 current and former menthol smokers, blacks and Hispanics were 45% less likely to quit smoking than white smokers.

It’s unclear what accounts for this disparity. It may be due to unidentified cultural and economic factors, or even physiological factors. A nicotine by-product known as cotinine “stays in the body twice as long in African Americans, and this may be a marker of greater addictiveness,” says Gardiner.

The research has some weaknesses, however. As True pointed out at the FDA committee meeting, it is very difficult to separate out the effects of menthol from other cultural and racial factors that may influence smoking habits and dependence.

What is menthol anyway?

Menthol is a type of alcohol found in oils extracted from mint plants (such as peppermint). Although some tobacco products are flavored with natural menthol, most menthol cigarettes—and cough drops and candies—use a synthetic version. About 90% of all cigarettes contain trace amounts of menthol, but only mentholated varieties contain enough of the flavor for it to be noticeable.

Tobacco companies have touted the “cooling” and “soothing” properties of menthol cigarettes since the 1920s—and that’s true, in a sense. Menthol is a mild anesthetic that excites cold receptors in the mouth, throat and airways, causing a slight numbing sensation that can make tobacco smoke seem less harsh. (This may be why menthol is added to regular cigarettes.)

“Mentholated products of all types, whether taken orally or inhaled, are better tolerated,” says Dr. Hicks. “There’s less irritation and, over the short term, some soothing effect.”

Researchers have long suspected that the cooling sensation might make menthols more harmful by masking the harshness of tobacco and allowing smokers to inhale more deeply (or more often), but they haven’t yet been able to prove it. Some studies show that menthol smokers actually inhale less smoke or take fewer puffs compared to people who smoke regular cigarettes.

Experts have also argued that the menthol sensation may contribute to nicotine addiction by making the cigarettes more palatable to young people. And there is some evidence that menthols are a “starter” cigarette.

National surveys have shown that teenagers are more likely to smoke menthols if they’ve been smoking for less than a year, and the percentage of white and Hispanic kids who smoke menthols is higher in middle school than in high school.

These figures suggest that inexperienced smokers are more likely to smoke menthols, but they don’t necessarily show that smoking menthols (rather than regular cigarettes) is more likely to lead to addiction.

Menthols may be harder to kick

Still, one of the main arguments made by people who support a menthols ban has been that the flavoring seems to make the cigarettes more addictive and harder to quit.

“Some studies have shown that menthol smokers have had less successful rates of quitting smoking than non-menthol smokers, feel less confident in their ability to quit, and have more relapses and quit attempts than non-menthol smokers,” says Olivia Wackowski, MPH, a tobacco specialist at the University of Medicine and Dentistry of New Jersey School of Public Health, in New Brunswick.

In a 2009 report to the FDA, Gardiner and a co-author indicated that this could be because menthol may increase nicotine absorption and has stimulating effects on the central nervous system.

“When you reach for menthol cigarettes, not only are you getting nicotine, which activates certain sensory properties in the brain, but also menthol, which activates certain sensory activities,” Gardiner explains. “That’s why it’s harder to quit. There’s an interaction between menthol and nicotine. It’s received more readily in the brain.”

Whether menthol actually enhances the addictiveness of cigarettes remains open to debate, however. Several studies have found that quitting is very difficult regardless of what kind of cigarette a person smokes, and researchers haven’t been able to confirm that menthols have a different effect on the nervous system than non-menthol cigarettes.

However, some research has found that people who smoke menthols are more dependent on nicotine. Studies have shown that, compared to people who smoke regular cigarettes, menthol smokers light up nearly twice as quickly after waking up in the morning and are also more likely to wake up at night to smoke. (Both are common measures of nicotine dependence.)

Still, the evidence isn’t strong enough to prove definitively that menthols are more addictive than regular cigarettes, says Wackowski.

“We can’t say that menthol is more addictive,” Gardiner agrees. “The problem is that cigarettes kill you anyway, so trying to prove that one substance is doing more harm than another has proved to be not fruitful.”

Is time running out for menthols?

Danny McGoldrick, vice president for research for the Campaign for Tobacco-Free Kids, an antismoking advocacy group based in Washington, D.C., feels that addictiveness should be only one of the measures used by the FDA in deciding whether to ban or regulate menthols.

“The FDA should look at menthol based on a broad public health standard, taking into account not only addictiveness but also increased toxicity, harm, or disease risk,” he says. “The FDA needs to look at all the evidence. We could learn a lot by requiring industry to turn over all their documents and also take into account how menthol is marketed and targeted.”

If you love salty snacks and reach for the saltshaker like clockwork at every meal, you might think you have dull or underpowered taste buds that need a boost to get excited.

In fact, just the opposite may be true: A new study suggests that you may love salt because you’re a “supertaster”—a person who experiences tastes such as saltiness and bitterness more intensely than other people do.

“We’ve known for a long time that people don’t all live in the same taste world,” says the study’s lead author, John Hayes, PhD, an assistant professor of food science at the Penn State College of Agricultural Sciences, in University Park.

“There are supertasters and non-tasters,” Hayes adds. “Supertasters live in a neon taste world—everything is bright and vibrant. For non-tasters, everything is pastel. Nothing is ever really intense.”

Previous research has suggested that supertasters need less fat and sugar to satisfy their taste buds (and food cravings), and Hayes and his colleagues suspected that the same would hold true for salt as well.

To confirm their suspicion, they taste-tested various off-the-shelf foods on 87 people, roughly a third of whom were supertasters. The others were a mix of non-tasters and “medium” tasters.

The participants tried samples of Campbell’s chicken broth with varying amounts of salt added, pretzel sticks, and shots of soy sauce. They were also asked to compare Lay’s potato chips and Cracker Barrel cheddar cheese with equivalent low-sodium store brands.

Hayes and his colleagues were surprised to discover that the supertasters liked more salt rather than less, even though they were more sensitive to it. But after the researchers analyzed the data in more detail, they realized that salt plays a role in tastes besides saltiness.

For instance, salt helps cancel out bitterness, one of the sensations that supertasters experience in Technicolor. This may explain why the supertasters in the study perceived the low-sodium cheddar cheese to be twice as bitter as the Cracker Barrel, and liked it far less than the other study participants did.

“They needed the salt to block the bitterness of the cheese,” Hayes explains.

What makes a supertaster?

Experts aren’t sure what makes some people supertasters. Taste sensitivity is believed to be genetic, and it may partly depend on the number of tiny bumps on your tongue (known as papilla) that house taste buds. “When you have more of these, you have more taste nerves that send a stronger signal to the brain,” Hayes explains.

The study findings, which were published today in the journal Physiology & Behavior, aren’t just an interesting tidbit for dinner-table conversation. They could have implications for the highly publicized efforts to cut the nation’s salt intake.

Americans eat far more sodium per day than health guidelines recommend, which over time can cause high blood pressure, heart disease, and other health problems. In response, the Food and Drug Administration is considering limiting the amount of sodium in packaged foods, the main source of sodium in our diet. And some food companies—such as Kraft (maker of Cracker Barrel) and PepsiCo (the maker of Lay’s)—have pledged to voluntarily reduce the amount of sodium in their products.

Those reductions will happen gradually, however, because our palates have become so used to salt that many foods would taste unbearably bland if sodium levels were dropped abruptly.

Hayes’s study suggests that supertasters may have a harder time than most with a lower-sodium food supply. Supertasters tend to like salty foods better and consume more of them, the study found.

Keri Gans, RD, a spokesperson for the American Dietetic Association, suggests that supertasters try adding spices to their food instead of salt to compensate for reduced sodium.

“They could be using pepper, fresh garlic, basil, dill, oregano. Maybe they could add a few red pepper flakes,” Gans says. “If they’re taste sensitive, why not try to encourage people to enhance their food with natural herbs and spices as opposed to salt?”

Even with an overflowing spice rack, supertasters may find themselves yearning for their favorite salty foods.

“What we like to eat drives what we do eat,” Hayes says. “Some people might just find it a lot harder to successfully reduce salt intake.”

If you are struggling with a yeast infection, you’re not alone. About 75% of women develop at least one vaginal yeast infection during their lives, and almost half have two or more. This infection is also easily prevented and treated, but if you find you have more than four a year, you may want to contact your doctor.

Sexual pain problems tend to go on for a lot longer than necessary because they are so commonly misdiagnosed as vaginal infections. And some experts say the situation is made worse by a more general trend toward overdiagnosing yeast infections.

Doctors frequently diagnose yeast infections without using a microscope, but an infection that looks like yeast with the naked eye could be desquamative vaginitis (a severe and rare form of vaginitis) or trichomoniasis. And doctors aren’t the only ones to blame. “Seventy percent of women who treat themselves for yeast infections don’t have them,” says Marjorie Green, MD, director of the Mount Auburn Female Sexual Medicine Center in Cambridge, Mass., and a clinical instructor at Harvard Medical School.

Another theory holds that a major cause of vulvodynia is excessive and improper use of anti-yeast medications.

If you have sexual pain, it’s important to consult your primary care physician or gynecologist first; if that doesn’t get you anywhere after a few visits, ask for a referral to a sexual medicine specialist. Or find one yourself by contacting the National Vulvodynia Association or a university hospital in your area.

Sexual health problems can be difficult to diagnose—even for the experts. “If it was easy, I wouldn’t need to spend an hour and 15 minutes [with new patients],” says Andrew Goldstein, MD, an associate professor at George Washington University. “This stuff is hard!”

I worked hard to reach my Feel Great Weight so I don’t want to blow it on a couple of silly splurges—but I also don’t want to miss out on the fun at parties and family gatherings. Finding a happy medium has been the key to maintaining my weight loss. For that reason, when I know I have a few splurge-worthy occasions coming up, I make sure to save calories elsewhere in order to indulge myself without guilt.

Last weekend I had a couple of special occasions on my calendar: an early 30th birthday surprise (my husband only told me to keep Friday evening free), my sister’s housewarming party the following day, and Sunday brunch with friends. I knew I’d want to have a couple of cocktails and dessert, so I used a few tricks to “cheat” on my diet—and save room for the good stuff.

Friday Night: 30th birthday surprise party, 9:00 p.m.

Save: I ate a veggie burger and lentil salad, followed by peanut butter and banana soft serve for a snack.
Since I knew to expect something special that evening, I made sure to eat a healthy and satisfying lunch. My sweet tooth always kicks in during the afternoon. Hence, I satisfied my craving with a low-calorie snack made from one frozen banana, a spoonful of peanut butter, and a splash of soy milk, all blended together in my food processor. It tasted a lot like full-fat ice cream—but for a fraction of the calories.

Splurge: I savored a birthday cupcake with thick chocolate frosting.
My husband surprised me with a party full of family, friends, and plenty of indulgent treats. I love sweets, especially cupcakes, so I was excited to see that my husband had purchased 30 of them. I purposely saved calories throughout the day, allowing myself a dessert splurge: a German Chocolate Fudge cupcake. Each bite was heavenly and enjoyed without any guilt.

Celebrating my 30th birthday was the time to enjoy the foods that make me the happiest. Nothing was off-limits that night. But, of course, I didn’t let myself go too crazy either. I made sure to eat a filling lunch so that I wasn’t starving by the time I arrived. And while I may have wanted to eat three cupcakes, I kept my portions in check and woke up the next morning without a food hangover.

Making room for BBQ and brunch splurges

Saturday: Mexican-themed BBQ at my sister’s house, 1:00 p.m.

Save: I skipped the chips and dip.
Before I decided what to eat, I took note of the different food options at the BBQ. I ended up passing on the usual tortilla chips and salsa—things that are easy to mindlessly nibble on—and saved room for what I really wanted.

Splurge: I indulged in chili with all of the fixings.
I love my brother-in-law’s chili so when I realized that he made it for the party, I knew it was exactly what I wanted to splurge on. I made myself a bowl and loaded on all of the available toppings, including shredded cheddar, onions, scallions, sour cream, hot sauce, and pumpkin seeds. I enjoyed every single bite, guilt-free. It was very delicious, and I didn’t even miss the tortilla chips that I had passed on earlier!

Sunday: Brunch with friends at the Wheelhouse Diner, 10:30 a.m.

Save: I took a Body Pump class pre-brunch.
I like to exercise first thing in the morning (especially on weekends) because it prevents me from making excuses later in the day. Plus fitting in a sweaty a.m. workout helps me start my day off the healthy way—and leaves a little wiggle room for Sunday splurges.

Splurge: I had an egg-and-cheese sandwich with a side of home fries.
Even though I’m working to maintain my weight loss, I still occasionally enjoy greasy diner food on the weekends. I knew I wanted to indulge. Therefore, I needed to make a smart trade-off, which meant not hitting snooze when my alarm sounded. I worked up a serious appetite after burning many calories at Body Pump, so I didn’t feel bad about ordering a hefty breakfast. Plus I made sure the rest of my meals on Sunday included plenty of lean protein, fruits, and veggies.

The next time you order Chinese food or need a side dish to serve with dinner, you’re better off choosing brown rice instead of white. Eating more brown rice and cutting back on white rice may reduce your risk of diabetes, a new study reports.

“People at risk of diabetes should pay attention to carbohydrates in their diet and replace refined carbohydrates with whole grains,” says the lead author of the study, Qi Sun, MD, a nutrition researcher at the Harvard School of Public Health, in Boston.

If you eat a little more than two servings of white rice (about 12 ounces) per week, switching to brown rice will lower your risk of developing type 2 diabetes by 16%, Dr. Sun and his colleagues estimate. And if you replace those servings of white rice with whole grains in general, they estimate, your diabetes risk will decline even further, by 36%.

White rice is produced by removing the husk-like outer layers of brown rice. Those discarded layers contain nutrients (such as magnesium and insoluble fiber) that have been shown to guard against diabetes, which may in part explain the study’s findings, Dr. Sun says.

White rice may also contribute to diabetes risk because it causes blood-sugar levels to rise more rapidly than brown rice does. (This is known as having a higher glycemic index.)

Type 2 diabetes occurs when your body loses its sensitivity to insulin, a hormone that helps convert blood sugar (glucose) into energy. The result is that blood sugar, which is toxic at high levels, can creep into the danger zone. Eating lots of foods with a high glycemic index—such as refined carbohydrates—has been linked to diabetes risk in the past.

“White rice is digested much faster and converted into sugar in your blood much quicker, so your body puts out a lot more insulin in response to white rice,” says Alissa Rumsey, RD, a nutritionist at New York-Presbyterian Hospital, in New York City. “Whole grains like brown rice are broken down into glucose a lot slower.”

In the study, which is published in the Archives of Internal Medicine, Dr. Sun and his colleagues analyzed survey data from nearly 200,000 nurses and health professionals who participated in three long-running studies. Roughly 5% of the participants were diagnosed with type 2 diabetes during the studies, which lasted from 14 to 22 years.

Eating more white rice increased risk

People who ate five servings or more of white rice per week had a 17% increased risk of developing diabetes compared to those who ate little or no white rice, the researchers found. On the other hand, people who ate at least two servings of brown rice had an 11% lower risk of diabetes compared to those who ate barely any brown rice.

Although the researchers controlled for a number of diet and lifestyle factors (such as red meat intake, smoking, and physical activity), it’s possible that the findings partly reflect the type of people who tend to prefer white versus brown rice.

For instance, the researchers note that brown rice intake was associated with “a more health-conscious lifestyle” and diet. People who ate the most brown rice tended to be more physically active, were slimmer, and ate more whole grains, while they were less likely to smoke or have a family history of diabetes.

Indeed, though brown rice is more nutritious than white rice, the study doesn’t necessarily prove that white rice will contribute to diabetes, says Loren Wissner Greene, MD, a clinical associate professor of medicine at New York University’s Langone Medical Center, in New York City.

“More brown rice is helpful because it is higher in fiber and that may protect against diabetes, but white rice may not increase the risk,” Dr. Greene says.

At least half of your daily grain intake should be whole grains, Rumsey says.

“Look for brown foods such as whole-wheat bread, whole-wheat wraps, or whole-grain or blended pastas,” she suggests. “There are a lot of whole grains—such as barley, bulgur, oatmeal, and quinoa—that are easy to cook with.”

Check ingredients and nutrition labels when food shopping, Rumsey says. The first ingredient should say “whole grain” or “whole wheat,” and the foods should have at least 3 grams of fiber per serving.

“Whole grains have so much more fiber, vitamins, minerals, and protein, so you get a lot more nutritional bang for your buck than with refined carbohydrates like white rice or white bread,” she says.

Amid the highest unemployment rate in recent decades and massive job losses around the country, most workers feel happy to at least be employed. What they aren’t feeling, however, is healthy.

One in three workers has at least one symptom of clinical depression; 41% say they feel stressed sometimes, often, or very often; and one in five has trouble falling asleep often or very often. In all, 14% are being treated for high cholesterol and one in five is taking blood-pressure-lowering medication.

In fact, the percentage of workers who say they’re in excellent health has dropped from 34% in 2002 to 28% in 2008, according to a report recently released by the Families and Work Institute (FWI), a nonprofit research company.

“When we try to explain what happened [since 2002], it wasn’t what we thought was the simple answer—that the population is getting older and younger people simply have better health,” says Ellen Galinsky, the FWI’s president and cofounder. “It was a change among men and higher income employees [due to] the uncertainty around the economy and the greater pressure that people are feeling to manage their work and family life.”

Some workplaces are healthier than others

Not all workplaces are created equal when it comes to health. In fact, 38% of workers at certain jobs—called “effective” workplaces in the report—were much more likely to say they were in excellent health. Conversely, only 19% of employees in workplaces with a low effectiveness rating reported being in excellent health.

So what makes an effective workplace? Six factors make a difference, Galinsky says. Workers may feel healthier if they have “learning opportunities and challenge, a good fit between work and personal life, autonomy, having a supervisor who supports job success, economic security—no surprise in this economy—and a work climate of respect and trust,” she says.

Eric Endlich, PhD, a Massachusetts-based clinical psychologist who specializes in workplace health, says these factors can make people feel in control of their destiny, challenged but not stressed, and appreciated.

“If someone is stressed at work from [feeling like they lack in] any of these factors, they could have a higher pulse, hypertension, [and] higher blood pressure, and if these things happen chronically they can worsen as well as worsen an existing condition,” he says.

Feeling a lack of control in the workplace or not enough support from a supervisor may lead to feelings of helplessness, says Endlich, which in turn can spiral into depression, “which is associated with lots of poor health outcomes [and] increases mortality rates from all causes,” he says.

According to the report, one of the biggest predictors of feeling healthy is a balance between work and personal life. “If someone has difficulty with this balance,” says Endlich, “then they’re going to be cutting back wherever they can,” including on important components of a healthy lifestyle, like getting enough sleep, shopping for and preparing healthy food, and exercising.

What employers—and employees—can do

It’s a tough economy, and many employers may feel that they have no choice but to cut corners. For example, the researchers found that employees with paid sick days and more paid vacation days reported better health. Although these options may cost employers, there are other things employers can do—such as promoting a respectful work environment—to become more effective workplaces. “It’s important to know that having an effective workplace doesn’t [have to] cost employers any money,” says Galinsky. “It’s as simple as how people treat each other.”

Galinsky suggests that bosses who can’t afford to offer extra vacation days should put themselves in their workers’ shoes and imagine how employees would want to be treated. She encourages managers to talk calmly and respectfully to workers and implement greater flexibility in hours to help them manage their personal lives.

Allowing employees to work earlier or later could even benefit the company, for example, by extending hours of business or productivity each day. It can also help to survey employees and listen to their suggestions, which can bolster employees’ feelings of control, says Endlich.

Employees can take matters into their own hands too. Half of the workers in the survey didn’t exercise regularly, and 25% smoked. In 2002, 21% were obese, but by 2008, that number had jumped to 26%. So taking charge of your health outside of the workplace is a good place to start.

You can also gauge your workplace’s effectiveness (and make suggestions for improvement) by taking the FWI’s quiz. Galinsky suggests focusing on one factor of an effective workplace at a time instead of trying to change everything at once.

“We have this image of work as a marathon; you’re always running a race and can never stop,” Galinsky says. This marathon, just like running, takes a physical toll, leading to the health problems prevalent among American workers.

“The image of work as weight lifting is better,” she says. “Having some time for rest and relaxation is important.”

The survey, which is updated every five years, focused on about 2,800 workers who were salaried or paid on an hourly wage basis.

Heart attacks dropped by 24% in a large cross section of Northern Californians over the past decade, most likely due to less smoking, better blood pressure control, and lower cholesterol, a new study reports.

What’s more, rates of the most severe type of heart attack dropped by 62%, according to the study, published this week in the New England Journal of Medicine.

“We believe improvements in targeting risk factors are in part responsible,” says the study’s senior author, Alan Go, MD, the assistant director for clinical research at Kaiser Permanente, in Oakland. “We’ve observed in our population that fewer people are smoking, and there’s better control of blood pressure and cholesterol.”

All of the 46,086 heart attack patients in the study were insured by Kaiser Permanente Northern California, a private not-for-profit health plan that serves more than 3 million people.

The plunge in heart attack rates may not reflect trends elsewhere in the country, or even in other Northern Californians, however. Although the study patients were ethnically diverse and ranged in age from 30 to 90-plus, they all had one thing in common: They were insured and received quality preventive care.

“The Kaiser Permanente people, almost by definition, are employed,” says Thomas Pearson, MD, the director of the Prevention Research Center at the University of Rochester Medical Center, in Rochester, N.Y. “They are on a health-care plan, one which has paid attention to making sure people get guidelines.”

The study included “haves” but no “have-nots,” Dr. Pearson adds. Still, he says, the findings “provide a pretty good map” for how to prevent heart disease and reduce heart attacks.

Dr. Go and his colleagues looked at the 10 years spanning 1999 and 2008. During that period, the percentage of Kaiser Permanente Northern California members meeting recommended blood pressure levels doubled (from 40% to 80%), while the percentage of those with healthy levels of LDL (or bad cholesterol, a primary culprit in heart disease) rose from 67% to 73%.

The use of heart medications—including beta-blockers, cholesterol-lowering statins, and aspirin—increased during those years as well.

Prevention pays off

These prevention efforts appear to have paid off. Over the study period, the heart attack rate declined from 274 to 208 cases per 100,000 people, a decrease of 24%. The percentage of people who died within 30 days of a heart attack also declined by 24%.

Meanwhile, the rates of a severe and often deadly form of heart attack in which a coronary artery is fully blocked—known as an ST-segment elevation heart attack—also decreased, from 133 to just 50 cases per 100,000 people.

“Differences in the patients themselves did not explain what we were finding, so the remaining explanations could be differences in types of care,” says Dr. Go, referring largely to preventive care.

That’s great news for the members of Kaiser Permanente Northern California. What about for the rest of us?

The outlook isn’t nearly as positive in some other regions and populations, says Jeremiah Brown, PhD, an instructor at the Dartmouth Institute for Health Policy and Clinical Practice, in Lebanon, N.H., and the co-author of an article on heart disease trends accompanying Dr. Go’s study.

While heart attack rates were falling among the people in the study, Brown points out, rates of diabetes and obesity continued to climb across the nation as a whole. “We are still facing an epidemic that is causing a gradual-to-rapid increase in heart disease-related deaths,” he says.

And heart disease is not equally distributed across the U.S., Dr. Pearson notes. Southeastern states, and especially the regions lining the Mississippi and Ohio River Valleys—a swath collectively known as “Coronary Valley”—are among the hardest hit, he says.

Though the population in the study isn’t representative of the nation as a whole, the findings do highlight the changes that need to be made to heart disease care, Brown says.

Right now the American health-care system is largely “reactionary,” he says. “We do an excellent job of treating heart attacks and a relatively poor job of prevention.”

If the health-care system can transition from “dealing with problems” to “creating sustainable lifestyle changes in our communities,” Brown adds, “we can prevent the onset of chronic illness in our country beyond that of heart disease alone.”