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Am Fam Physician. 2018;98(3):140

Study Finds Disturbing Trends in Vaccination Exemptions

A study recently published in PLOS Medicine shows that numerous states and large metropolitan centers have seen an uptick in the number of nonmedical exemptions granted for childhood vaccinations. In the past decade, the number of philosophical exemptions to vaccination has increased in two-thirds of the states that allow such exemptions. Although school immunization laws in every state grant vaccination exemptions for medical reasons, states may also grant nonmedical exemptions for other reasons. According to the National Conference of State Legislatures, 47 states have provisions that allow parents to exempt their children from receiving a vaccine if it contradicts their religious beliefs, and 18 states permit philosophical exemptions based on moral, personal, or other beliefs. Using data collected for school years 2009–2010 to 2016–2017, researchers found an overall upward trend in the number of kindergarteners with nonmedical exemptions in 12 states that offer philosophical exemptions. To address these issues, the study authors suggested that legislation prohibiting philosophical nonmedical exemptions or requiring parents to watch an educational module before obtaining a nonmedical exemption may serve as an effective intervention. For more information, go to

Obesity Higher in Rural vs. Urban Counties

The prevalence of obesity is higher among U.S. adults living in rural counties than among those living in metropolitan counties (34.2% vs. 28.7%, respectively), according to a report from the Centers for Disease Control and Prevention (CDC). Self-reported weight and height from approximately 438,500 adults were used to calculate body mass index, with obesity defined as a body mass index of at least 30 kg per m2. In 2016, the overall obesity prevalence was 29.6%, with the highest figures among residents in the South (32%) and Midwest (31.4%) regions and the East South Central (35.3%) and West South Central (33.9%) divisions. Compared with metropolitan residents, rural residents had a higher prevalence of obesity-associated chronic diseases, such as diabetes mellitus, coronary heart disease, and arthritis. In a statement accompanying its report, the CDC said that understanding regional variations in obesity prevalence can help inform interventions and targeting of obesity prevention resources. For more information, go to

AMA House Backs AAFP's Call for Accurate 2020 Census

To properly allocate $675 billion in annual federal funding, the U.S. government depends on census respondents to provide complete and honest answers to the survey's questions. However, a potential hurdle exists in the 2020 census: the U.S. Census Bureau plans to gather most of its responses online rather than on paper. That plan has concerned some consumer watchdog agencies and other organizations, including the American Academy of Family Physicians (AAFP). Specifically, the Census Bureau's 2020 operational overview lists data quality among the project's risk factors. With this in mind, the AAFP introduced a resolution during the annual meeting of the American Medical Association (AMA) House of Delegates calling for the AMA to support adequate funding for the U.S. Census to ensure that accurate and relevant data are collected and disseminated. AMA delegates adopted the census measure unchanged. For more information, go to

AAFP Voices Support for Tobacco Regulation

The AAFP recently sent the U.S. Food and Drug Administration (FDA) letters stating the Academy's position on three separate tobacco-related issues: the use of flavors in tobacco products, premium cigars, and nicotine levels in cigarettes. In the first letter, the AAFP said regulating flavors in all tobacco products could potentially decrease youth tobacco initiation rates while improving health outcomes among vulnerable populations, preventing long-term addiction to tobacco products, reducing spending on tobacco-related illnesses, and reducing the number of long-term tobacco users. The letter also urged the FDA to regulate flavored tobacco products. In the second letter, the AAFP strongly urged the FDA to not revise the 2016 rule that gave the agency authority to regulate cigars, which are popular among young smokers. In the third letter, the AAFP applauded the FDA for investigating how to best implement regulations to reduce nicotine levels in cigarettes, then followed up by calling on the FDA to create a nonaddictive nicotine level standard for all tobacco products, not just cigarettes. For more information, go to


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