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For most people, thinking about health and health care is a very personal issue. Assuring the health of the public, however, goes beyond focusing on the health status of individuals; it requires a population health approach. As noted in Chapter 1, America's health status does not match the nation's substantial health investments. The work of assuring the nation's health also faces dramatic change, systemic problems, and challenging societal norms and influences. Given these issues, the committee believes that it is necessary to transform national health policy, which traditionally has been grounded in a concern for personal health services and biomedical research that benefits the individual. Such repositioning will affirm and expand existing commitments to reflect a broader perspective. Approaching health from a population perspective commits the nation to understanding and acting on the full array of factors that affect health.
To best address the social, economic, and cultural environments at national, state, and local levels, the nation's efforts must involve more than just the traditional sectors—the governmental public health agencies and the health care delivery system. As has been outlined in the preceding pages, what is needed is the creation of an effective intersectoral public health system. Furthermore, the efforts of the public health system must be supported by political will—which comes from elected officials who commit resources and influence based on evidence—and by "healthy" public policy—which comes from governmental agencies that consider health effects in developing agriculture, education, commerce, labor, transportation, and foreign policy.
This chapter describes the rationale behind a transformed approach to
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The Future of the Public's Health in the 21st Century
Understanding Population Health and Its Determinants
For most people, thinking about health and health care is a very personal issue. Assuring the health of the public, however, goes beyond focusing on the health status of individuals; it requires a population health approach. As noted in Chapter 1, America's health status does not match the nation's substantial health investments. The work of assuring the nation's health also faces dramatic change, systemic problems, and challenging societal norms and influences. Given these issues, the committee believes that it is necessary to transform national health policy, which traditionally has been grounded in a concern for personal health services and biomedical research that benefits the individual. Such repositioning will affirm and expand existing commitments to reflect a broader perspective. Approaching health from a population perspective commits the nation to understanding and acting on the full array of factors that affect health.
To best address the social, economic, and cultural environments at national, state, and local levels, the nation's efforts must involve more than just the traditional sectors—the governmental public health agencies and the health care delivery system. As has been outlined in the preceding pages, what is needed is the creation of an effective intersectoral public health system. Furthermore, the efforts of the public health system must be supported by political will—which comes from elected officials who commit resources and influence based on evidence—and by "healthy" public policy—which comes from governmental agencies that consider health effects in developing agriculture, education, commerce, labor, transportation, and foreign policy.
This chapter describes the rationale behind a transformed approach to
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addressing population health problems. This approach identifies key determinants of the nation's health and presents evidence for their consideration in developing effective national strategies to assure population health and support the development of a public health system that blends the strengths and resources of diverse sectors and partners (IOM, 1997).
For nations to improve the health of their populations, some have cogently argued, they need to move beyond clinical interventions with high-risk groups. This concept was best articulated by Rose (1992), who noted that "medical thinking has been largely concerned with the needs of sick individuals." Although this reflects an important mission for medicine and health care, it is a limited one that does little to prevent people from becoming sick in the first place, and it typically has disregarded issues related to disparities in access to and quality of preventive and treatment services. Personal health care is only one, and perhaps the least powerful, of several types of determinants of health, among which are also included genetic, behavioral, social, and environmental factors (IOM, 2000; McGinnis et al., 2002). To modify these, the nation and the intersectoral public health system must identify and exploit the full potential of new options and strategies for health policy and action.
Three realities are central to the development of effective population-based prevention strategies. First, disease risk is currently conceived of as a continuum rather than a dichotomy. There is no clear division between risk for disease and no risk for disease with regard to levels of blood pressure, cholesterol, alcohol consumption, tobacco consumption, physical activity, diet and weight, lead exposure, and other risk factors. In fact, recommended cutoff points for management or treatment of many of these risk factors have changed dramatically and in a downward direction over time (e.g., guidelines for control of "hypertension" and cholesterol), in acknowledgment of the increased risk associated with common moderately elevated levels of a given risk factor. This continuum of risk is also apparent for many social and environmental conditions as well (e.g., socioeconomic status, social isolation, work stress, and environmental exposures). Any population model of prevention should be built on the recognition that there are degrees of risk rather than just two extremes of exposure (i.e., risk and no risk).
The second reality is that most often only a small percentage of any population is at the extremes of high or low risk. The majority of people fall in the middle of the distribution of risk. Rose (1981, 1992) observed that exposure of a large number of people to a small risk can yield a more absolute number of cases of a condition than exposure of a small number of people to a high risk. This relationship argues for the development of
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strategies that focus on the modification of risk for the entire population rather than for specific high-risk individuals. Rose (1981) termed the preventive approach the "prevention paradox" because it brings large benefits to the community but offers little to each participating individual. In other words, such strategies would move the entire distribution of risk to lower levels to achieve maximal population gains.
The third reality, provided by Rose's (1992) population perspective, is that an individual's risk of illness cannot be considered in isolation from the disease risk for the population to which he or she belongs. Thus, someone in the United States is more likely to die prematurely from a heart attack than someone living in Japan, because the population distribution of high cholesterol in the United States as a whole is higher than the distribution in Japan (i.e., on a graph of the distribution of cholesterol levels in a population, the U.S. mean is shifted to the right of the Japanese mean). Applying the population perspective to a health measure means asking why a population has the existing distribution of a particular risk, in addition to asking why a particular individual got sick (Rose, 1992). This is critical, because the greatest improvements in a population's health are likely to derive from interventions based on the first question. Because the majority of cases of illness arise within the bulk of the population outside the extremes of risk, prevention strategies must be applicable to a broad base of the population. American society experienced this approach to disease prevention and health promotion in the early twentieth century, when measures were taken to promote sanitation and food and water safety (CDC, 1999b), and in more recent policies on seat belt use, unleaded gasoline, vaccination, and water fluoridation, some of which are discussed later in this chapter.
The committee recognizes that achieving the goal of improving population health requires balancing of the strategies aimed at shifting the distribution of risk with other approaches. The committee does, however, endorse a much wider examination, and ultimately the development, of new population-based strategies. Three graphs illustrate different models for risk reduction (see Figure 2–1).
These hypothetical models assume etiological links exist among all exposures and disease outcomes. Figure 2–1a shows the effects of an intervention aimed at reducing the risk of those in the highest-risk category. In this example, people with the highest body mass index (BMI)1 are at in
Body mass index is a measure of body fat based on height and weight (kilograms divided by meters squared, kg/m2). A person with a BMI of between 18.5 and 24.9 would be considered of normal weight, whereas a person with a BMI of between 25 and 29.9 would be considered overweight, and someone with a BMI of 30 or greater would be classified as obese. BMIs above normal are associated with an increased risk of morbidity and mortality. A person's BMI is influenced by genes, behavior, the environment, and interactions among these factors.
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FIGURE 2–1 Models for risk reduction.
SOURCE: Data for current distribution from Schwartz and Woloshin, 1999.
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creased risk for cardiovascular heart disease and a plethora of chronic illnesses. Intervening medically, for example, to decrease risk (by lowering levels of obesity, as measured by BMI) ultimately decreases the proportion of the population with the highest BMIs. Such measures among very high-risk individuals may even be endorsed in cases where the "intervention" itself carries a substantial risk of poor outcome or side effects. However, use of such an intervention would be acceptable only in those whose medical risk was very high. Moreover, interventions in high-risk groups may have a limited effect on population outcomes because the greater proportion of those with moderate risk levels may ultimately translate into more chronic disease or other poor health outcomes.
Figure 2–1b illustrates Rose's classic model whereby the greatest benefit is achieved by shifting the entire distribution of risk to a lower level of risk. Because most people are in categories of moderately elevated risk as opposed to very high risk, this strategy offers the greatest benefit in terms of population-attributable risk, assuming that the intervention itself carries little or no risk. The hypothetical example shows what might occur if social policies or other population-wide measures were adopted to promote small decreases in weight in the general population. The committee embraces this kind of model of disease prevention in the case of policies such as seat belt regulation and the reduction of lead levels in gasoline.
The final hypothetical model (Figure 2–1c), although not discussed by Rose explicitly, illustrates a reduction in the distributions of those at highest and lowest risk with no change in the distribution of those with a mean level of risk. This model is appropriate for illustrating phenomena relating to inequality, where redistribution of some good (e.g., income, education, housing, or health care) reduces inequality without necessarily changing the mean of the distribution of that good. One hypothetical example is the association between low income and poor health. In many cases, there is a curvilinear association between these goods and health outcomes, with decreased health gains experienced by those at the upper bounds of the distribution. For example, data on income suggest that there are large differences in the health gains achieved per dollar earned for those at the lower end of the income distribution and fewer differences in the health gains achieved per dollar earned for those at the upper end. Thus, the curvilinear association, if it were a causal one, would suggest that substantial gains in population-level health outcomes may be achieved by a redistribution of some resources without actual changes in the means.
These graphs help to illustrate three different strategies for improving the health of the population. The nation has often endorsed the first strategy without a critical examination of the other two, especially the second one. The American public has grown accustomed to seeing differences in exposures to risk, both environmental and behavioral, and disparities in
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health outcomes. Acknowledging these gradients fully will help develop true population-based intervention strategies and help the partners who collaborate to assure the public's health move to take effective actions and make effective policies.
Understanding and ultimately improving a population's health rest not only on understanding this population perspective but also on understanding the ecology of health and the interconnectedness of the biological, behavioral, physical, and socioenvironmental domains. In some ways, conventional public health models (e.g., the agent–host–environment triad) have long emphasized an ecological understanding of disease prevention. Enormous gains in the control and eradication of infectious diseases rested upon a deep understanding of the ecology of specific agents and the power of environmental interventions rather than individual or behavioral interventions to control disease. For example, in areas where sanitation and water purification are poor, individual behaviors, such as hand washing and boiling of water, are emphasized to reduce the spread of disease. However, when environmental controls become feasible, it is easy to move to a more "upstream"2 intervention (like municipal water purification) to improve health. The last several decades of research have resulted in a deeper understanding not only of the physical dimensions of the environment that are toxic but also of a broad range of related conditions in the social environment that are factors in creating poor health. These social determinants challenge the discipline of public health to more fully incorporate them.
Over the past decade, several models have been developed to illustrate the determinants of health and the ecological nature of health (e.g., see Dahlgren and Whitehead [1991], Evans and Stoddart [1990], and Appendix A). Many of these models have been developed in the United Kingdom, Canada, and Scandinavia, where population approaches have started to shape governmental and public health policies. The committee has built on the Dahlgren-Whitehead model—which also guided the Independent Inquiry into Inequalities in Health in the United Kingdom—modifying it to reflect special issues of relevance in the United States (see Figure 2–2). This figure serves as a useful heuristic to help us think about the multiple determinants of population health. It may, for instance, help to illustrate how the health sector, which includes governmental public health agencies and the health care delivery system, must work with other sectors of government such as education, labor, economic development, and agriculture to
Upstream refers to determinants of health that are somewhat removed from the more "downstream" biological and behavioral bases for disease. Such upstream determinants include "social relations, neighborhoods and communities, institutions, and social and economic policies" (IOM, 2000).
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FIGURE 2–2 A guide to thinking about the determinants of population health.
NOTES: Adapted from Dahlgren and Whitehead, 1991. The dotted lines between levels of the model denote interaction effects between and among the various levels of health determinants (Worthman, 1999).
aSocial conditions include, but are not limited to: economic inequality, urbanization, mobility, cultural values, attitudes and policies related to discrimination and intolerance on the basis of race, gender, and other differences.
bOther conditions at the national level might include major sociopolitical shifts, such as recession, war, and governmental collapse.
cThe built environment includes transportation, water and sanitation, housing, and other dimensions of urban planning.
create "healthy" public policy. Furthermore, the governmental sector needs to work in partnership with nongovernmental sectors such as academia, the media, business, community-based organizations and communities themselves to create the intersectoral model of the public health system first alluded to in the 1988 Institute of Medicine (IOM) report and established in this report as critical to effective health action.
Most models of health determinants identify macro-level conditions
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and policies (social, economic, cultural, and environmental) as potent forces in shaping midlevel (working conditions, housing) and proximate (behavioral, biological) determinants of health. Macro-level or upstream determinants (such as policies and societal norms) and micro-level determinants (such as sex or the virulence of a disease agent) interact along complex and dynamic pathways to produce health at a population level. As mentioned above, exposures at the environmental level may have a greater influence on population health than individual vulnerabilities, although at an individual level, personal characteristics including genetic predispositions interact with the environment to produce disease. For instance, smoking is a complex biobehavioral activity with both significant genetic heritability and nongenetic, environmental influences, and many studies have shown an interaction between smoking and specific genes in determining the risk of developing cardiovascular disease and cancers. It is also important to note that developmental and historical conditions change over time at both a societal level (e.g., demographic changes) and an individual level (e.g., life course issues) and that disease itself evolves as agents change in virulence.
In the pages that follow, the committee provides a concise discussion of the key determinants that constitute the ecology of health, including environmental and social determinants, and elaborates in more detail on the social influences on health. This decision was made in recognition of a longer history in studying the ways in which environment shapes population health.
At least since the time of Hippocrates' essay "Air, Water and Places," written in 400 B.C.E., humans have been aware of the many connections between health and the environment. Improved water, food, and milk sanitation, reduced physical crowding, improved nutrition, and central heating with cleaner fuels were the developments most responsible for the great advances in public health achieved during the twentieth century. These advantages of a developed nation are taken for granted, but in fact, they could deteriorate without adequate support of the governmental public health infrastructure.
Environmental health problems, historically local in their effects and short in duration, have changed dramatically within the last 25 years. Today's problems are also persistent and global. Together, global warming, population growth, habitat destruction, loss of green space, and resource depletion have produced a widely acknowledged environmental crisis (NRC, 1999). These long-term environmental problems are not amenable to quick technical fixes, and their resolution will require community and
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societal engagement. At the local and community levels, environmental issues are equally complex and are also related to a range of socioeconomic factors. A brief look at some of the evidence on environmental determinants of health may help shed some light on why health is not equally shared.
The importance of "place" to health status became increasingly clear in the last decades of the twentieth century. The places in which people work and live have an enormous impact on their health. The characteristics of place include the social and economic environments, as well as the natural environment (e.g., air, water) and the built environment, which may include transportation, buildings, green spaces, roads, and other infrastructure (IOM, 2001b). Environmental hazards in workplaces and communities may range from tobacco smoke to pesticides to toxic housing. Rural areas may present increased health risks from pesticides and other environmental exposures, whereas some environmental threats to health can occur because of urban living conditions.
More than three-quarters of Americans live in urban areas (Bureau of the Census, 1993). Although rural Americans experience certain health-related disadvantages (e.g., health care access issues due to transportation and availability) (Slifkin et al., 2000; NCHS, 2001), some of the health effects of the inner city (i.e., decay and crime) are often dramatic and may be related to broader social issues. The "urban health penalty"—the "greater prevalence of a large number of health problems and risk factors in cities than in suburbs and rural areas" (Leviton et al., 2000:863)—has been frequently discussed and studied (Lawrence, 1999; Freudenberg, 2000; Geronimus, 2000). A variety of political, socioeconomic, and environmental factors shape the health status of cities and their residents by influencing "health behaviors such as exercise, diet, sexual behavior, alcohol and substance use" (Freudenberg, 2000:837). The negative environmental aspects of urban living—toxic buildings, proximity to industrial parks, and a lack of parks or green spaces, among others—likely affect those who are already at an economic and social disadvantage because of the concentration of such negative aspects in specific pockets of poverty and deprivation (Lawrence, 1999; Maantay, 2001; Williams and Collins, 2001). Urban dwellers may experience higher levels of air pollution, which is associated with higher levels of cardiovascular and respiratory disease (Hoek et al., 2001; Ibald-Mulli et al., 2001; Peters et al., 2001). People who live in aging buildings and in crowded and unsanitary conditions may also experience increased levels of lead in their blood, as well as asthma and allergies (Pertowski, 1994; Pew Environmental Health Commission, 2000; CDC, 2001a). These examples illustrate some of the profound effects of the physical environment on health. The places where people live may expose them to harmful factors.
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Methylmercury: A Case Study
The case of methylmercury as an environmental pollutant illustrates the potentially dramatic effects of the physical environment on health. Environmental toxins are a specific form of environmental hazard, caused in most cases by industrial enterprises, and the adverse effects of such toxins on the nervous system have been well documented. High levels of exposure to certain environmental pollutants are known to cause acute effects including convulsions, paralysis, coma, and death. The effects of lead on health and development have been documented for decades, and policy action regarding leaded gasoline and lead-based paints has been taken, with positive effects on child health. However, there is growing concern about emerging evidence that other ubiquitous pollutants such as polychlorinated biphenyls (PCBs) and mercury may cause behavioral problems and affect mood and social adjustment. The adverse impacts of exposure to these pollutants may be most profound during fetal development and early childhood. Amidst growing national concern about developmental disabilities, exposure to mercury in the environment represents an emerging and preventable environmental health threat.
The National Research Council (NRC) report Toxicological Effects of Methylmercury (NRC, 2000) examined the evidence of adverse health impacts resulting from exposure to mercury, focusing on consumption of seafood contaminated by releases to the environment. Fossil fuel combustion represents the major source of mercury released to the environment. The deposition of mercury on the land and in surface waters results in conversion to forms that accumulate in the food chain. This bioaccumulation can result in very high concentrations of mercury in some fish, which are the main source of exposure for the population. The developing brain is particularly sensitive to the adverse effects of mercury exposure. Prenatal exposures may interfere with the growth and development of neurons and cause irreversible damage to the nervous system. Infants whose mothers were exposed to high levels in poisoning episodes in Minamata, Japan, and in Iraq were born with severe disabilities, including mental retardation, cerebral palsy, blindness, and deafness (EPA, 1997; NRC, 2000). More recently, epidemiological studies of lower-level exposure from maternal fish consumption have raised concerns about subtle neurodevelopmental deficits.
The NRC report concluded that the evidence of developmental neurotoxic effects from mercury exposure is strong and called for revision of the Environmental Protection Agency (EPA) reference dose that provides public health guidance on acceptable population exposure levels. This conclusion was based on epidemiological studies of low-level chronic exposure from seafood consumption. The population at risk consists of women of childbearing age and their children. Frequent consumers, par-
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ticularly of fish that tend to accumulate high levels of mercury, may be exposing their unborn children to levels of mercury in the range that has been shown to be associated with developmental deficits. Based upon the available data on fish consumption, the NRC committee estimated that as many as 60,000 newborns may be at risk for adverse neurodevelopmental effects from in utero exposure to mercury. Recently, the Centers for Disease Control and Prevention (CDC) released the first National Exposure Report, which provided dramatic confirmation of the emerging threat of mercury. Ten percent of a national sample of women of childbearing age had mercury levels in their blood within 1/10 of potentially hazardous levels, indicating a narrow margin of safety for many women (CDC, 2001c).
Currently, 40 states have issued fish consumption advisories to reduce exposure to mercury. EPA and the Food and Drug Administration (FDA) have also recently revised their guidance concerning consumption of fish species that have been shown to have high levels of mercury. Ultimately, the threat of mercury can be most effectively reduced through control of the sources of pollution. However, control of sources from the burning of fossil fuels may be decades away. In the meantime, prevention of adverse public health impacts from mercury will require a partnership among health care providers, public health agencies, and others.
The example of methylmercury clearly illustrates the serious impact of just one environmental risk factor. The influences of many other environmental risk factors on health have not been fully documented, and evidence of the influence of environmental factors for some health conditions like asthma is rapidly accumulating (Trust for America's Health, 2001). The association between certain chronic diseases and environmental causes is devastatingly clear, yet knowledge about the scope of environmental health risks and their impact on the public's health is limited. Most states do not track environmental risk factors like pesticides and other hazards or most chronic diseases (such as asthma) and birth defects (Pew Environmental Health Commission, 2001). Certainly, a significant amount of work remains to be done to address the physical environment's powerful influence on health status. A great deal about health determinants in the built and natural environments has been learned in recent decades, but much more is yet to be examined.
Most recently, social epidemiologists and other researchers have focused on identifying the social equivalents of leaded gasoline and environmental tobacco smoke. Among the greatest advances in understanding the factors that shape population health over the last two decades, and clearly
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text:
Due to inclement weather and road conditions, DBU is cancelling all Saturday classes at all locations.
Beginning at 12 noon today, all classes at all DBU campuses are canceled. No determination has been made about Saturday classes.
Student Email
Schedule Of Classes
DBU Board of Trustees Elects Dr. Gary[…]
DBU Receives Reaccreditation from National Association of[…]
Inclement weather forces game to be pushed[…]
Johnson leads DBU with 16 points.

subset: commoncrawl


text:
Catch them with their pants down! Betty and Norm are taking a gardening break, but their drawers can't take a break from gravity…throw stuff in their butts for Mother's Day!
Throw stuff at the traditional Plumber Crack under the kitchen sink. Or, go for the second most popular crack sighting: the IT Technician under your office desk. Plus we're adding new scenes all the time for you to hone your "crack" throwing skills.
• Pick your plumber: Norm or Betty
• Toss things in their butts in the kitchen, the office and on the beach
• Choose from more than 15 items to throw in their butts
• Collect coins and earn Bucks to buy costumes, tattoos and throw items
• Complete collections over and over again to earn buckets stuffed with Bucks
• Arcade, Sharpshooter and Time Challenge modes
• Leaderboards and 55+ achievements – impress your friends and family with your crack throwing skills
Everybody's been there: you try to look away, but you can't stop staring! And now, more than ever, you just want to drop something in there and see what happens…whether it's an Ice Cube, Peanut, Quarter or Bouncy Ball (to name a few).
Take it further, and dress up your Plumber or IT Tech. Toss Norm into a French maid outfit, or put Betty in her snorkeling gear. Are you an Elvis, superhero or sports fan? There's something for everyone!
Add the finishing touch and ink your Plumber or IT Tech with Tattoos. From "Daddy's Girl" to "Born To Ride" – Red Roses to Bullseyes: pick the tattoo you think will look best, and slap it on your favorite backside!
You've dreamed of dressing up, abusing and inking your local Plumber or IT Tech, and now you can!
Hours of plain, silly fun from the folks that brought you Office Jerk. Play Plumber Crack today and throw stuff in their butts: in the kitchen, in the office and on the beach!
More than 18 million people in 145 countries enjoy throwing stuff in the Plumber's butt!
"The first time I played my ribs hurt from laughing so hard. What a fun game! Thanks for a good laugh and a good time."
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Play Plumber Crack today!
"Like" Plumber Crack on Facebook – https://www.facebook.com/PlumberCrackGame
Plumber Crack is brought to you by Fluik Entertainment, makers of wicked-fun mobile games such as Office Jerk, Grumpy Bears and Streaker Run. Search the App Store for "Fluik" to browse all our games.
Follow @FluikGames on Twitter for awesome game announcements and other updates.
To help keep Plumber Crack awesome, please send any bug reports or complaints directly to us, instead of posting them in your app reviews. We can't respond directly to app reviews, so it's hard for us to help you with your problem or issue. You can post all your bugs or suggestions on the Facebook fan page, http://www.facebook.com/PlumberCrackGame, or email them to us at email@example.com


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Adv. Purchase:
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Flight from Chicago to Hudson Valley
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- Date of Flight:
- February 2011
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Genuine Whirlpool part. Whirlpool brands include Whirlpool, Maytag, KitchenAid, Jenn-Air, Amana, Magic Chef, Admiral, Norge, Roper, and others. See all items in Refrigerator Door. Whirlpool also makes various appliance models for Sears / Kenmore.
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Chocolate Cookarolis (Fried Ravioli Cookies)
Total Time
20 minsCook
5 minsYou make these chocolate treats like ravioli. While this recipe requires a bit of work, the results will astound you.
- 16 ounces refrigerated sugar cookie dough (Pillsbury refrigerated log style)
- 1⁄2 cup bittersweet chocolate chips
- 2 cups all-purpose flour
- 2 teaspoons baking powder
- 3⁄4 teaspoon kosher salt
- 6 tablespoons shortening
- 3⁄4 cup milk
Other Ingredients Needed
- 1 egg, beaten with
- 2 teaspoons water
- vegetable oil, for frying
- confectioners' sugar, for dusting
- MAKE THE COOKAROLIS: Cut cookie dough in half lengthwise and place onto a long sheet of plastic wrap (about 2 feet). Place one half of the dough into the center, then place another sheet of plastic wrap loosely over top. Roll out cookie dough into a 4" wide strip 1/4" thick. Lift off top sheet of plastic wrap and discard. Place 3-4 chocolate morsels in a group onto the bottom of cookie strip 1/2" apart.
- Using the top part of the plastic wrap, fold top half of cookie strip over filling. Using your finger, gently press between and bottom the cookaiolis to seal. Holding the ends of the plastic wrap taut, place the strips onto a cookie sheet and freeze till needed. Repeat with the other half of cookie dough.
- MAKE THE PASTRY DOUGH: In the bowl of a food processor, combine the flour, baking powder and salt. Pulse for a few seconds and then pour into a large mixing bowl.
- Add the shortening and knead it into the flour with your hands until it is crumbly. Add the milk all at once and mix in with a spatula until it begins to come together.
- Lightly flour your hands and the countertop and turn the dough out onto the countertop. Knead the dough ball, folding over about 12 times. Divide dough in half. Roll each half out to 6" wide strips and about 1/8" thin.
- Remove cookarolis from the freezer and separate them into individual pieces using a knife or pizza pie cutter. Place cookarolis onto the dough 1/4" apart on the bottom half of the dough. Brush the edges of half of the dough lightly with the egg wash (remember egg wash sticks to dough, but not itself). Fold top part of dough over and separate (using a pizza cutter works well) and then gently seal the edges together with the tines of a fork, dipping the tines into some flour as needed. Repeat with second ball of dough. Place on cookie sheet and refridgerate for a minimum of 30 minutes. NOTE: at this point, they can be frozen on the cookie sheets, then placed into a ziploc bag and frozen for up to a year till needed.
- DEEP FRY: Heat oil in a deep fryer to 350°F Carefully fry in batches for about 3 minutes until just light brown. Drain on paper towels. When cooled (about 5 minutes), dust with powdered sugar. Serve immidiately but be careful, as filling may still be hot.
Nutrition Info
Serving Size: 1 (55 g)
Servings Per Recipe: 20
- Amount Per Serving
- % Daily Value
- Calories 204.7
- Calories from Fat 98
- 48%
- Total Fat 11 g
- 16%
- Saturated Fat 3.5 g
- 17%
- Cholesterol 17.2 mg
- 5%
- Sodium 228.5 mg
- 9%
- Total Carbohydrate 24.5 g
- 8%
- Dietary Fiber 1 g
- 4%
- Sugars 5 g
- 19%
- Protein 3.3 g
- 6%
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The top 25 places we think should be on every traveler's radar this year.
MoreBargains here are few; rooms generally start at $200 a night and can climb into the thousands. For groups of six or more planning an extended stay, condos or villas can be a convenient and economical option, though you should always book early.
Hotel rates in Baja California Sur are subject to a 10% value-added tax and a 2% hotel tax for tourism promotion. Service charges (at least 10%) and meals generally aren't included in hotel rates. Several of the high-end properties include a daily service charge in your bill; be sure you know the policy before tipping (though additional tips are always welcome). We always list the available facilities, but we don't specify extra costs; so always ask about what's included.


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Valentine's Day is right around the corner, and as is customary, every year we try to add one more cute and creative hairstyle that you can wear for the occasion. {You can pick your favorite from our Valentine's Day Hairstyles playlist.}
Today's tutorial is absolutely adorable, and you can share/pin it <——- here!
A very good friend of mine, whose twin daughters we have used in some of our Disney hairstyles, texted me a photo of a heart bun that she created the other day and wanted me to see it! We loved it so much that we asked her if we could film a tutorial for it… he said that was her intention!
So today, we are going to show you how to create a Love Bun {heart-shaped sock bun}!
What I love about this hairstyle, is how simple it is to create the heart form out of a simple bun maker and a few hair elastics. I would never have thought of that!
So this Love Bun tutorial is dedicated to my friend Jill, one of my best friends and an even better vacationing buddy!
Feel free to tag your own photos of this hairstyle with: #CGHLoveBun
If you know how to make a sock bun, this hairstyle will be easy for you. You can use the bun alone, as I did in CGH#4, or in any number of combinations, including one I show you on CGH#3. You can also do two on top of the head, or incorporate a braid around the base, etc.
We've worn this around several times in the past two weeks and had people stopping us everywhere! If you want a comment-getter hairstyle for Valentine's Day, this is the one!
Items Needed: Brush, rat-tail comb, spray bottle, 1 bun maker {hair donut}, 4 small hair elastics, 2-3 hair bands, 6-8 bobby pins, hairspray and accessory {if desired}.
Time Requirement: 5-8 minutes
Skill Level: Medium
Step-by-Step Instructions:
I know some of you will ask, but yes, you could carefully wrap the head in an old towel and spray the heart red with temporary color {adding a spritz of glitter spray as an accent}.
Please feel free to leave me a comment below letting us know what you think of Valentine's Day Love Bun idea! Of the two ideas shown in the video, which was your favorite?
If you love the look of this hairstyle, please help us by sharing it on YouTube, Pinterest, Facebook, Twitter, Instagram, etc! I have a feeling that this video will go viral with your help if you send it to as many friends as you can! The Love Bun is simply too adorable to keep a secret!
You can also share the link by clicking any of the social share buttons in the floating sidebar to the left!
Happy early Valentine's Day!
A week ago, Brooklyn had her braces taken off and filmed it all for their BrooklyAndBailey YouTube channel. You can see the process, before and after, including her reaction by clicking below…
Before Disney's Frozen hit theaters in November, 2013, the team at DisneyStyle had already contacted us about filming three individual hairstyle tutorials from the styles worn by the movie's main characters. {We love that they trust us so much!}
That being said, it was a challenging task for us… especially since hairstyles worn by animated characters are more easily drawn, by hand or computer, than they are in being actually done in actual hair.
This particular updo hairstyle was worn by Anna {Elsa's little sister} at Elsa's coronation as queen. Of the three hairstyles, this one was definitely one of the most difficult we have ever done, but simply gorgeous!
After seeing the movie twice, and looking at still frames from the movie, my girls and I figure that we spent close to 20 hours trying to recreate this on our mannequin head. This is the closest we could get to the actual style that Anna wore in the movie.
When I was stumped on the finishing touches, we checked in on good friend Princess Hairstyles' tutorial of this hairstyle and saw that she had the same difficulty. {Be sure to click the previous link to see her fabulous tutorial.}
What was the challenging step? Bringing up the hair from the bottom up and tucking it into the center of the bun, under the center hair. Instead, we opted to pull it up first before creating the bun, which makes this hairstyle much easier to achieve. Don't you think it is simply beautiful?
The end result is a fabulous looking updo, something I have never seen before! We know you will love this hairstyle, and are happy to share it with you! {Be sure to watch until the very end, for a cute cameo by Sweet Pea singing, "Do you want to build a snowman?"
Items Needed: Brush, rat-tail comb, water bottle, 2 hair elastics, 1 braid headband {matching hair color}, 6-8 bobby pins, 1 small golden bow comb barret, green ribbon, hairspray and pomade {as desired}.
Time Requirement: 7-10 minutes
Skill Level: Medium
Step-by-Step Instructions:
Please feel free to leave me a comment below letting us know what you think of this updo hairstyle from Disney's Frozen! As always, if you loved this hairstyle, please feel free to share it!
Comment on this post »One of our favorite hairstyles of all time is the Lace Braid, not just because they are simple and elegant, but because they wear very well throughout the day.
The challenge is to try and find ways to create variations of if that are different, given that the Lace Braid is becoming very popular.
Today's tutorial looks very similar to a Lace Braid, only we used a separate thin-parted hair section for the crossover stranding which creates a very unique look to a simple Dutchback!
In this tutorial, we straightened my daughter's hair beforehand, but it would look just a cute with hair that has a little wave to it. {Using second-day hair after braids would be great idea.}
CGH#4 wore this Crossover Dutch Braid hairstyle to school about a month ago, and it wore very well for as active as she is!
She had lots of compliments on it, and we are sure you will as well!
Items Needed: Brush, rat-tail comb, spray bottle, 1 hair band, 1 small hair elastic, hairspray {if desired}.
Time Requirement: 3 minutes
Skill Level: Medium
Step-by-Step Instructions:
This hairstyle technique is another great one for your arsenal to be used in any number of hairstyle combinations {to accent a bun, high ponytail, etc}.
Please feel free to leave me a comment below letting us know what you think of this Crossover Dutch Braid! As always, if you loved this hairstyle, please feel free to share it!
Happy Hairdoing!
With the holiday week, my twins BrooklyAndBailey shared a Christmas Traditions video, showing you some of the things we do in the CGH home to celebrate this wonderful day!
We have had quite a few requests for formal updos lately, with all the formal dances going on and the upcoming Prom season.
Today we wanted to show you this variation of a twisted bun style that we first did over two years ago.
On Brooklyn, we used a curling wand to provide a base of soft curls before forming the undo. The purpose was to add a bit of texture to the hair, but this step is not necessary and can be eliminated to save time.
We think this hairstyle is very beautiful, and know that you will love it, too!
Items Needed: Brush, rat-tail comb, spray bottle, curling iron, heat protectant, 1 hair band, 10-12 bobby pins, 2+ Goody Spin Pins, hairspray {if desired}.
Time Requirement: 15-20 minutes
Skill Level: Medium
Step-by-Step Instructions:
Please feel free to leave me a comment below letting us know what you think of this updo! As always, if you loved this hairstyle, please feel free to share it!
Happy Hairdoing!
This past week my twins BrooklyAndBailey shared a Christmas fashion video, showing you some of their favorite season outfits! {Yes, that is me with the dancing cameo at the end of the video!}
Last week, our neighborhood went without electricity and heat for just over two days, after an awful ice storm here in Dallas, with temperatures below freezing! Yes, we were super cold, but did have a few fireplaces going to provide heat.
That being said, there wasn't any way to shower, or curl my hair without getting sick, so I instead exclusively relied on hair buns.
This bun style uses a French-Up technique, which is an upside down French braid, and it has been a very popular style during 2013. We had shown this style briefly in a video two years ago, but never filmed a full tutorial for it. It is basically an Upside-Down French Braid into a Bun!
I love this French-Up High Bun, and since it was the style I wore for those two freezing days with out electricity, we felt it appropriate to show you how to recreate it!
In the video, I am using a hair bun tool called the Wrap-Up that I have been carrying around in my purse for months. {You can find one at the the link above, and by using the coupon code of Merry1230, you will receive 20% off your purchase until Dec 30th, 2013.}
Also, if you are careful CHG tutorial viewers, you will notice that this is the exact same tool that Brooklyn used on me in the DisneySide video we posted a few months ago! You can see the video here.
Items Needed: Brush, rat-tail comb, spray bottle, 1 hair band, hairspray and bow accessory {if desired}.
Time Requirement: 5 minutes
Skill Level: Medium
Step-by-Step Instructions:
Please feel free to leave me a comment below letting us know what you think of this updo! As always, if you loved this hairstyle, please feel free to share it!
Happy Hairdoing!
Be sure to watch the BrooklyAndBailey's video below, where they show you how to make cute little {and inexpensive} Christmas gifts for friends!
What do you get when you cross 34 yrs of living, 14 yrs of marriage, one HOT husband, five adorable daughters, one handsome son, and tons of great family and friends? Pretty much the sum total of who I am!!


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A key style for work or school, this mary jane style ballerina has stitching detail and touch fastening. Interest is added with a printed floral sock. Read more ...


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Leaf Spring Perches, Steel, 3 in. Diameter Axle Housing, 2 1/2 in. Width, Universal, Pair
Estimated Ship Date: Monday 3/2/2015 Would you rather pick it up? Select Location
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Brand: Summit Racing
Manufacturer's Part Number: SUM-720025
Part Type: Leaf Spring Perches
Product Line: Summit Racing® Leaf Spring Perches
Summit Racing Part Number:
Axle Tube Diameter (in): 3.000 in.
Leaf Spring Perch Width (in): 2.500 in.
Leaf Spring Perch Material: Steel
U-Bolts Included: No
Quantity: Sold as a pair.
In-Store Pickup: Choose In-store pick-up (OH, GA, NV) on our web site.
Our Summit® stamped steel rear housing mounts are ideal for installing a new rear-end housing or relocating rear springs. They're made for use with any rear-end housing with 3 in. tubes, and welding is required.
Some parts are not legal for sale or use in California on any pollution-controlled motor vehicles
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