Welcome to the 2019 CPHA Annual Meeting and Conference, Innovative Solutions to Public Health Challenges: Research, Programs and Policy!

       Thank you all for taking time out of your busy schedules to be here today! I have truly enjoyed my time as your President and first would like to thank my mentor, The UConn Public Health Program Director, Dr. David Gregorio, our former Associate Director Joan Segal, as well as the staff at the Department. They are knowledgeable and without them, I would not have reached my level of achievement, nor would I be standing before you today.

       It is an honor to be a part of the largest and broadest statewide professional association in Connecticut devoted to providing leadership, education and advocating for intervention and resolutions to priority public health issues affecting the people of Connecticut.  Unlike other professional organizations, CPHA’s diverse professional membership crosses all sectors of public health, which provides a unique organizational capacity to effectively address fundamental public health issues from different perspectives.  CPHA collaborates with its partner groups through surveys, conferences, internships, and its annual meeting to identify primary public health issues and develop a core agenda. CPHA responds to critical public health needs by being a leader in developing and advocating for legislative policies that promote key public health initiatives at the State and Federal levels.  Using scientific evidence-based public health information it provides high quality education to the community, its members, policy makers and legislators focusing on proactive measures to ensure the health of Connecticut’s citizens.

       Our role as public health professionals is becoming more essential each day. Climate change is the defining issue of our time and we are at a defining moment. Hurricanes Harvey, Irma and Maria combined with devastating Western wildfires and other natural catastrophes made 2017 the most expensive year on record for disasters in the United States, as reported by the National Oceanic and Atmospheric Administration. These horrific events caused $306 billion in total damage with 16 incidents that caused more than $1 billion in damage each. To put that figure in perspective, that's more than the interest on the US national debt and twice the federal budget for health, Medicare and education. The second most expensive disaster year was 2005, the year of Hurricane Katrina. That year’s total was $215 billion. Aside from costly natural disasters, 2017 was the third warmest year on record in the United States, following 2012 and 2016. Five states had their hottest year on record: Arizona, Georgia, North Carolina, South Carolina and New Mexico. Not surprisingly, 2017 was the most expensive disaster year on record for insurers. Much of these costs were fueled by the disasters in the United States, but the devastating flooding in Asia also added to the total.

       In 2018 the United States experienced 14 disasters that cost the economy as much or more than $1 billion dollars each. But the total cost of these hurricanes, wildfires, floods and other disasters that struck the U.S. last year is about $91 billion, according to the National Oceanic and Atmospheric Administration. US News and World reports that thousands of people around the world lost their lives to natural disasters in 2018, a tragic reminder of the devastation and costs we have absorbed. 2018 ended with a deadly tsunami in Indonesia, capping the country’s largest annual death toll in more than a decade from natural disasters.  2019 cannot be fully summarized at this juncture, although it has already included wildfires, flash floods, earthquakes, typhoons, and volcanic eruptions. 

        Closer to home, Connecticut has experienced both new and old public health crises that we continue our work to eliminate. Last week, The Connecticut Department of Public Health (DPH) reported six Connecticut residents who became ill with lung injuries possibly related to using e-cigarettes or vaping, bringing the total to 31 cases that have been reported to DPH. Three patients remain in the hospital. According to the Centers for Disease Control and Prevention (CDC), as of October 8, 2019, 1,299 cases of vaping-related lung injury had been reported from 49 states and 1 U.S. territory.  The CDC also reported 26 deaths had been confirmed in 21 states, including one fatality from Connecticut. Public health leadership in Connecticut continue their efforts to educate the public about the potential dangers of these substances.

I am very concerned that we continue to see new cases of vaping-related lung injury and this outbreak of illnesses and deaths appears to be far from over,” said DPH Commissioner Renée D. Coleman-Mitchell.  “I am asking Connecticut residents not to use e-cigarettes or vaping products that contain THC.”

            This has been an unprecedented year for Eastern Equine Encephalitis (EEE) in Connecticut.” said Dr. Matthew Carter, the DPH State Epidemiologist. Before 2019 Connecticut had only one human case of EEE and that was in 2013. Today we have four human cases, three of which were fatal.  The Commissioner has cautioned all residents to take serious precautions to avoid mosquito bites and works within DPH to continue to offer education around mosquito borne illnesses.

Connecticut has been deeply impacted by the opioid epidemic as have the rest of the country. One in ten Connecticut high school students reported taking prescription pain medications without a prescription or differently than prescribed (Youth Risk Behavior Survey, 2017). Over 30% of these students got the medications from their home, someone else’s home, or were given the medications. In 2018, there were 1,017 accidental intoxication deaths in the state (Office of the Chief Medical Examiner, 2019). Of these deaths, 948 involved some type of opioid. A total of 760 of these deaths involved fentanyl, while 407 deaths involved heroin, morphine and/or codeine.  The good news.  DPH and state partners including the Department of Consumer Protection, the Department of Mental Health and Addiction Services and the Department of Children and Families who work collaboratively on the State’s public awareness campaign to address the opioid crisis. Change the Script, as well as other treatment, recovery support and overdose prevention initiatives have been implemented. More good news; preliminary data from the latter part of 2018 indicates that Connecticut’s opioid epidemic may be stabilizing. This information is based on Edata from DPH’s EpiCenter syndromic surveillance system.

Connecticut faces a new public health issue, PFAS, a class of widely used chemicals called PER and polyflorintated alkyl. PFAS nonstick qualities make it useful in products as diverse as food wrappers, umbrellas, tents, and firefighting foam. The chemicals are also used in the manufacture of plastic and rubber and in insulation for wiring. These chemicals are all around us. They have been found in some regions and in drinking water.  That is because PFAS doesn’t break down easily.  They have come to be referred to as the “forever chemicals." Some varieties have been found to stick around in the human body for decades. Others accumulate in soil or water, creating a continuous source of exposure. Unfortunately, scientists know little about the health effects of most types of PFAS.

`           The last Connecticut public health issue I would like to mention is childhood vaccinations. When school started this fall DPH sent letters to parents to make sure their child’s immunizations are up to date.  The DPH reports that while the MMR immunization rate for Connecticut’s kindergarten students remains high, that rate declined from 96.5% for the 2017-2018 school year to a figure of 95.9% for the 2018-2019 school year that concluded this past June, according to data reported to DPH as of August 13, 2019, a decrease of 0.6%.  DPH is continuing its efforts to make sure all children have the appropriate vaccinations.

In 2019, the United States has seen the largest increase in the number of measles cases in the last 25 years.  According to the Centers for Disease Control and Prevention, more than 1,215 people in 30 states had contracted measles between January 1 and August 22, 2019, including three cases in Connecticut and more than 1,000 in Brooklyn and Rockland County, NY.  The resurgence of measles is very concerning.  CPHA would like to offer any assistance to the Commissioner and her staff around this very important issue.

            We are genuinely pleased to have the Commissioner of the Department of Public Health Renee Coleman-Michell with us this morning. Governor Lamont appointed The Commissioner on April 1st.  If you are a public health professional in the state of Connecticut, you know how capable Renee is.  Governor Lamont is quoted. “Renée knows Connecticut’s public health community well and has the right experience and leadership skills to help achieve our goal of making our state even healthier. I look forward to having her on our team and am confident that, along with the capable staff at the agency, we will be ready to face these important challenges.” Renee – There is not a person in this room that isn’t thrilled about your appointment.

              This is a very special year for CPHA, as we are honored to welcome Dr. Pamela Aaltonen, the APHA President, as our keynote speaker. Dr. Aaltonen worked for decades with the Purdue University School of Nursing in the College of Health and Human sciences.  For the past ten years, she has made major contributions to public health through her research, teaching and engagement efforts. Focusing on cutting edge topics like e-government in public health, Dr. Aaltonen is one of the pioneers of the application of technology in health. In addition, she worked closely with Purdue’s Homeland security institute to address issues related to public health systems and preparedness, which are central to major public health issues in the United States today. She is beyond accomplished in the Public Health field and we are privileged to have her join us for this event. Pam received her baccalaureate degree in nursing from St. Olaf College, her master’s in public health nursing & public health science from the University of Illinois Chicago and received a PhD from Purdue University.  Prior to joining Purdue’s faculty, Pam was a public health nurse and nursing administrator in local health departments in Minnesota, Oklahoma and Illinois.  Dr. Aaltonen has been active in several local, state, and national health organizations and her leadership has had a major impact on public health in those states. 

           We have two more special guests, the first is Dr. Glenn Flores, this year’s recipient of the 2019 American Public Health Association's David P. Rall Award for Advocacy in Public Health. This Award is given "to an individual who has made an outstanding contribution to public health through science-based advocacy." The APHA leadership specifically noted: "APHA joins your colleagues in recognizing your contributions to the health of America’s children through science-based advocacy. We are specifically impressed by your active involvement with policy leaders to produce effective public health policies and your research focusing on the unmet needs for translation and interpretation services for families with limited English proficiency as well as the impact of community health workers on the health care of underserved communities." Dr. Flores is Chief Research Officer and Director of the Health Services Research Institute at Connecticut Children's Medical Center and the Associate Chair of Research and a Professor of Pediatrics at UConn School of Medicine.  Congratulations Dr. Flores and thank you for representing Connecticut! 

           I would like to give a special thank you to Dr. Karl Minges, the Director of the MPH Program at the University of New Haven for his very generous Gold Sponsorship.  I would also like to thank our Bronze Sponsors; New England Public Health Training, Data Haven, CT Hospital Association, Connecticut Children’s Medical Center, Sacred Heart and InCHIP (Institute for Collaboration on Health, Intervention and Policy) at UConn. Thank you to our exhibitors and advertisers as well.  All such support is crucial to our ability to provide an exceptional and informative conference.

           Thank you to our old and new partner schools for their collaboration efforts and for providing funding so their students can attend today.  We have students from Yale, Southern Connecticut State University, Western Connecticut State University, Eastern Connecticut University, UConn, Sacred Heart and the University of New Haven.  

            A lot of time and effort goes into planning this conference so I would like to give a special thank you to the program committee. Thank you all for your endless efforts!  The committee thinks of everything from today’s menu to how far attendees have to walk to get to breakout rooms. We had more abstract submission this year than we have had in a decade, adding to their already heavy work load. This event is the product of your effort and I ask that you accept my gratitude

            Lastly, I would like to thank our members for their dedication to the organization and the field of public health. Your efforts will help make each generation of Connecticut residents healthier than the last.

               Before I turn it over to our APHA President, I would like to ask all Board Members to stand and be recognized.  Your passion and commitment are admirable and valued.  It is my privilege to have you serving the state of Connecticut along with me. 

Thanks for your support!

Morgan Spencer, MPA, MPH, CPH

CPHA hosted a successful public health advocacy training for over 40 public health students and professionals on April 7, 2018.  The Southern Connecticut State University (SCSU) School of Health and Human Services co-sponsored the event and generously hosted us on the SCSU campus.  The half-day training was kicked off by Shelley Geballe, JD, MPH, Assistant Clinical Professor at the Yale School of Public Health, and a Clinical Lecturer in Law at the Yale Law School, who made the complicated, sometimes mysterious Connecticut legislative structure and process seem simple and straightforward. She explained how bills become law, and how to keep up to date on what’s happening in the CT General Assembly. 

Shelley was followed by Ellen Andrews, PhD, Executive Director of the Connecticut Health Policy Project and Adjunct Faculty at Southern, who gave good advice about the most effective ways to communicate with legislators, including giving oral and written testimony, and writing opinion pieces for local newspapers.

Senator Gary Winfield, Deputy Majority Leader, representing New Haven and West Haven (with his young son and one of his newborn twins in tow!), put the group at ease about meeting with legislators by talking about the do’s and don’ts, and what works for him when he meets with constituents and others about legislative issues.

Attendees were able to immediately put their newly learned skills into practice with small group breakout sessions where they planned their next steps for legislator engagement on key public health issues. Thank you to our student and alumni volunteers, who assisted with the training and group facilitation!  They were Amalia Mahon, Bianca Flowers, Chandra Kelsey, Ermonda Gjoni, Francesca Testa, Shamika Smith, Veronica Cortes, and Whitney Allen.

We thank our speakers, participants, and volunteers, for making the 2018 CPHA Public Health Advocacy Training such a success!

The Training Committee:

Ashley Andreou, MPH Student Volunteer, Yale School of Public Health

Roberta Friedman, Co-Chair, CPHA Advocacy Committee

Valen Grandelski, Assistant Professor, Department of Public Health, SCSU

PRESIDENT’S MESSAGE

Happy New Year CPHA!  As we enter CPHA’s 2^nd century, we are already preparing for an active and productive year.  But before getting into all the details, let’s first welcome our brand new section: the Community Health Workers Association of Connecticut!  We are excited to have CHWACT under the CPHA umbrella, and we look forward to everything they bring to the organization.

One of underlying themes in all of our activities this year will be to get you involved.  Not just in CPHA but in helping to improve the health of everyone in Connecticut.  You have already seen action alerts sent out from the Advocacy Committee, and there will be plenty more.  When you see them, spread the message.  Call or email your legislators about the topic.  Forward the email to your friends and colleagues.  Show up at rallies.  Share our posts on Facebook.  Re-tweet them on Twitter.  Post your own message and tag CPHA.  Ultimately, the strength of our advocacy efforts is you, and even a small amount of effort can have tremendous impact.

In addition to impacting Connecticut’s health, help us honor those who have made a real difference in our lives.  Nominate a colleague, an organization, or a student for one of the CPHA Awards.  Show your support for all of their late nights and weekends of work by joining us at the CPHA Awards Breakfast, which will be held during National Public Health Week.

Last, but certainly not least, get involved directly with CPHA.  Encourage your co-workers to support CPHA’s Mission by becoming a member.  Submit an abstract to the 2017 CPHA Annual Conference and present your work during the largest public health conference in the state.  Encourage your organization to join the MOR and help mentor young students who are interested in public health.  Attend a Health Education Committee meeting and learn about the newest public health programs and research being conducted throughout the state.

Our success as an organization is reliant on your involvement.  Help us make CPHA the strongest public health organization in the state!

CPHA WELCOMES NEW EXECUTIVE COMMITTEE

Meet your new leadership team!  CPHA’s new Executive Committee began its term on January 1^st.  There are some familiar faces in new positions and some new faces entirely.  CPHA gives them and all of our new Board members the warmest welcome.  We look forward to all that can be accomplished over the next year.

Jonathan Noel, President

Jonathan Noel, PhD(c), MPH is currently a doctoral candidate in the public health program at the University of Connecticut, where he also earned his MPH.  His research consists of evaluating alcohol advertising published on social media, understanding how alcohol-related messages spread through social networks, and how social media influences alcohol behavior.  He has previously worked at the Harvard School of Public Health and Beth Israel Deaconess Medical Center in Boston, MA.  Jonathan has worked with CPHA since 2007.  He was the recipient of the CPHA Michael J. Perlin Award in 2015 and a CPHA President’s Award in 2010.  He is also an active member of the American Public Health Association and has served as APHA’s Student Liaison for the University of Connecticut.

Morgan Spencer, President-Elect

Morgan Spencer, MPA, MPH, CPH serves as the Program Coordinator for the Graduate Programs in Public Health at the University of Connecticut.  Morgan earned her Masters of Public Health (MPH) in applied public health practice in 2005 from the University of Connecticut.  In 2012, she completed her Masters of Public Administration (MPA) in public and financial management also from the University of Connecticut.  Morgan passed the Certification in Public Health (CPH) exam in 2008 and has maintained her public health certification since. Morgan is a proud member of both Delta Omega, Beta Rho, UConn’s Public Health Honor Society and Pi Alpha Alpha, the Global Honor Society for Public Affairs & Administration. Morgan has been a member of CPHA since 2005 and has served on the Board of Directors since 2013.

Heather Clinton, Secretary

Heather Clinton is a Research Assistant in the Injury Prevention Center at Connecticut Children's Medical Center. Heather has been assigned to work with the Office of Injury Prevention at the Connecticut Department of Public Health since March 2016. As a member of the Office of Injury Prevention, Heather engages in activities focused on surveillance of unintentional drug overdose fatalities, utilizing the Connecticut Violent Death Reporting System (e.g., abstracting data from select official reports, analyzing data results, and generating reports).  In addition, Heather holds a concurrent position with Reach Out and Read Connecticut. Heather is responsible for activities related to communications, programs evaluation and coordination, and data management. Heather received a BS in Mathematics from the University of Connecticut.

Elizabeth Schwartz

Be it at Pepe’s, Modern, Sally’s, or Zinc Kitchen, New Haven resident Elizabeth Schwartz is still enough of a native New Yorker to know how to fold a slice!  Elizabeth would prefer to live in a world scored by upbeat, ‘80s one-hit wonders, where all stall doors swing outward, and where everyone has access to adequate healthcare and outstanding, public education. Her public health passions are issues of health equity, neglected tropical diseases, and health engineering using low-cost, local products in the developing world.  Professionally, Elizabeth leads community health activities in five New England states for a major cancer-focused charitable organization. She is also a part-time professor of public health at Southern Connecticut State University, and a public health ghost writer. In 2016, she was the recipient of CPHA’s Michael J. Perlin Student Award, as well as SCSU’s A. Kay Keiser Valedictory Award.  When not knee-deep in the world of public health, Elizabeth is a passionate globe trekker, photographer, and connoisseur of treehouse living!

 SAVE THE DATE: Friday, April 7, 2017 – 2017 CPHA PUBLIC HEALTH AWARDS

Mark your calendars!  The 2017 CPHA Public Health Awards Event is scheduled for Friday, April 7, 2017. Like every year, we welcome you to join us in honoring our 2017 CPHA Award Recipients (to be selected) for their outstanding contributions to public health in Connecticut. This event will also be an opportunity for professional networking with public health colleagues and supporters from around the state! More details about the event to follow soon!

PROGRAM PLANNING COMMITTEE WELCOMES INPUT FOR CPHA ANNUAL MEETING

The 2017 Program Committee is in the beginning stage of organizing the annual conference. The 100th anniversary celebration exceeded expectations and attendance, and we are looking forward to the same enthusiasm and attendance this year.  If you want to participate in the planning committee, please send email to: program_committee@cpha.info.

2017 ADVOCACY UPDATE

The legislative session is in full swing, and the Advocacy Committee will be keeping you updated on ways to get involved. CPHA is committed to protecting and promoting public health efforts and investments, particularly in the areas of Prevention, Public Health Infrastructure, Health Equity, and Environmental Health. We need your voice- 2017 is shaping up to be a challenging year for the public health community.  We encourage you to speak up and help others to do the same.

HOW TO GET INVOLVED

1) GET TO KNOW YOUR LEGISLATORS. Follow your legislators on social media, save their numbers in your phones, bookmark their online contact info- however you want to get in touch, they NEED to hear from you!

Find your State Senator and Representative.

Find your U.S. Senator and Representative. Already know? Find their contact info below:

Senator Richard Blumenthal (202) 224-2823

Online: www.blumenthal.senate.gov/contact Twitter @SenBlumenthal

Senator Chris Murphy (202) 224-4041

Online: www.murphy.senate.gov/contact Twitter @ChrisMurphyCT

Rep. John Larson (1st District) (202) 225-2265

Online: larson.house.gov/contact Twitter @RepJohnLarson

Rep. Joe Courtney (2nd District) (202) 225-2076

Online: courtney.house.gov/contact Twitter @RepJoeCourtney

Rep. Rose DeLauro (3rd District) (202) 225-3661

Online: delauro.house.gov/contact Twitter @rosadelauro

Rep. Jim Himes (4th District) (202) 225-5541

Online: himes.house.gov/contact Twitter @jahimes

Rep. Elizabeth Esty (5th District) (202) 225-4476

Online: esty.house.gov/contact Twitter @RepEsty

2) ACT ON STATE LEGISLATION. We will provide updates on bills we are watching with calls to action. The list of bills we are tracking will be updated regularly and can be found here. If there are bills you are watching that you feel should be brought to the attention of the CPHA Board, please let us know. The Public Health Committee page can be a helpful resource to identify bills of interest, but keep in mind there may be bills in other Committees as well. You can make your own bill tracking list by creating an account, which will provide you with text and email alerts.

3)  ACT ON FEDERAL LEGISLATION. We will also provide updates on federal legislation and calls to action.

4) ATTEND EVENTS. We will share information about educational sessions, community conversations, and rallies related to public health legislation or public health issues relevant to our priority areas. We encourage you to share opportunities with us.

5) FOLLOW CPHA ON FACEBOOK. In addition to email alerts, we will be sharing opportunities to get involved through Facebook. Follow us here!

ISSUES TO WATCH

CPHA has taken a special interest, based on the bills currently under consideration, in the following topics:

· Opioid Addiction Treatment and Opioid Control

· Substance Abuse Treatment

· Tobacco Control

· Pay Equity and Paid Family Medical Leave

· Community Health Worker Integration

· Protecting and Enhancing Access to Reproductive Healthcare

· Promoting Affordable Housing

· Reducing Consumption of Sugar Sweetened Beverages

· Protecting Provisions of the Affordable Care Act

· Protecting and Enhancing the Water Supply

· Funding Lead Abatement Activities

To date CPHA has provided testimony on the following bills and issues:

H.B. 5210: An Act Concerning Various Pay Equity and Fairness Matters 

H.B. 5384: An Act Raising the Legal Age for Purchase and Use of Tobacco Products

S.B. 35: An Act Concerning Beverages with Added Sugars, Sweeteners, and Artificial Sweeteners and Obesity

S.B. 126: An Act Concerning Community Health Workers

Submitted by Community Health Workers Association of CT

S.B. 126: An Act Concerning Community Health Workers

Submitted by CPHA

Proposed Changes to the Affordable Housing Land Use Appeals Statute 8-30G

In addition to providing testimony, we will be sharing fact sheets with our members to accompany action alerts on the above topics. If you have special knowledge on any of the above and are willing to help in the development of fact sheets, please let us know.

In addition, the 2017 SHIP Policy Agenda is the first ever, collaboratively developed listing of priority policy issues for the Healthy CT 2020: State Health Improvement Coalition (SHIP Coalition).  The 2017 SHIP Policy Agenda is a consolidated list of input from Action Team members and SHIP Action Summit participants to align with policies and priorities developed through SHIP Action Teams. For more information about SHIP priorities, visit the SHIP Coalition webpage:  www.ct.gov/dph/SHIPCoalition

If you are interested in supporting the Advocacy Committee, please contact Jenna Lupi, jenna.lupi@gmail.com.

MEMBERSHIP COMMITTEE UPDATE

New and Existing Members – Get your CPHA Member pin!

This year, as part of our National Public Health Week (April 6th – 12th) activities, CPHA is asking all CPHA members to ask one or more colleagues and/or friends to join CPHA.  Membership is the backbone of the Association and we need you, your colleagues, and your friends to amplify your public health voice.  We know that our current membership reflects only a fraction of those involved in public health in the State.  Who works in public health?  Our friends at APHA have developed a fairly full roster including: first responders; restaurant inspectors; health educators; scientists and researchers; nutritionists; community planners; social workers; epidemiologists; public health physicians; public health nurses; occupational health and safety professionals; public policymakers; and, sanitarians.

If you know anyone who has a career listed above, ask them, “do you belong to CPHA?”  If they don't, ask them to join.  CPHA’s online membership form is the easiest way to do this.  During this membership drive every new member who signs up from March 1st to April 30th will receive a “CPHA Member” lapel pin (a new member agency will receive 3 pins).  As a thank you to existing members, if the new member (student, individual, agency, retiree, lifetime, or community health worker) lists the name of a CPHA member on their application as the person who referred them, the existing CPHA member will also receive a “CPHA Member” lapel pin.

CPHA MENTORS ON REQUEST UPDATE

This National Public Health Week the CPHA MOR is trying to Make CT the Healthiest State by April 8 by engaging them in the CPHA 30-30 Step Challenge. Please read the letter below which we sent to our 45 MOR members to get them involved in helping APHA reach its goal of 1 billion steps by April 9th.  We encourage you to join this effort by signing up as an individual member on the CPHA 30-30 Team, or as a team leader with one or more members at http://www.cpha.info/?page=MORNPHW.

Thank you from the NPHW MOR team:

Joan Lane Naugatuck Valley Health District, Co-chair NPHW

Cyndi Billian Stern, CPHA MOR Chair 

Pamela Kilbey-Fox, UConn MPH Adjunct Faculty

Susan Troupe, HOSA Chair

N. Chi Anako, Health Equity Program Coordinator for Trinity Health Care Systems

Jane Donn, Health Science Curriculum Specialist, Ed Advance

Michelle Pomerantz, Student Organization UConn MPH Program

On January 21st some 3 million people walked... rather marched... for women’s health. Now the American Public Health Association (APHA) has challenged Americans to collectively walk 1 billion steps by the close of National Public Health Week (April 3-9, 2017). With a population of just over 3.5 million, Connecticut’s fair share is 10 million steps of APHA’s goal of 1 billion. But CPHA believes we can do much better and is raising the bar to 30 million steps to Make CT the Healthiest State by April 8.

Whether we are walking for our heart or better health policies. Here’s how we will get there:

 Goals:

· Reach 30 million steps between March 11 and April 8 (3 times our share by our portion of the population) by forming small walking teams of co-workers and community members.

· Mentor students from undergraduate programs or courses in public health as you walk.

· Develop long-term relationships with schools, private businesses and foundations to increase support for, contribute to and participate in public health activities.

· Educate individuals and organizations across the state about the benefits of walking. Regular physical activity like walking reduces the risk of conditions such as diabetes, obesity, heart disease and cancer. Walking can be relaxing, spiritual, and when we do it together, it decreases loneliness, one common risk factor for depression.

Our Strategy:

· Recruit CPHA MOR leaders from at least 20 of our 45 member organizations.

· Each MOR leader recruits 2 or more walkers (staff, colleagues, students, friends, family).

· Each MOR leader will also recruit a partner organization(s) in the community, which will also recruit walkers. Non-public health community organizations (businesses, schools, hospitals, foundations) that form teams will need to have one member join CPHA as an individual, or have the organization become a member.

· Walkers will count their own steps (via Fitbit, phone apps, pedometers) and report their results to their team leader.

· Team leaders will report steps on the CPHA website each Saturday from March 11th-April 8th.

· Watch our progress on APHA’s 1 Billion Steps Campaign website (look for the CPHA 30-30 team).

· Teams will be recognized at the CPHA Annual Awards Event in April.

· Encourage team members to join CPHA!

 We Can’t Do This Without You. Email or call us to get involved. We will send you what you need to make this easy: From letters to community partners to how to submit team information and number of steps. Watch for updates at http://www.cpha.info/page/MORNPHW.

COMMUNITY HEALTH WORKERS ASSOCIATION OF CONNECTICUT (CHWACT)

What is the Community Health Workers Association of Connecticut (CHWACT)?

CHWACT is an organization for Community Health Workers.  A Community Health Worker (CHW) serves as a liaison-link-intermediary among the community, health and, social services to facilitate access to resources and improve the quality and cultural competency of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.         

CHWACT is a section of the CPHA.

CHWACT’s mission is: To advance the CHW workforce through policy, education, research and leadership.

CHWACT’s Core Values:

CHANGE:  We believe in the effectiveness of CHWs empowerment to transform individuals and communities.

JUSTICE:  We protect the capacity of CHWs to function ethically and with care. We accomplish this with integrity and courage.

LEADERSHIP:  We take steps to advance the CHW workforce and inspire others to join us.

Activities performed by CHWACT:

• Provide information, education and capacity-building for CHWs, CHW employers, CHW champions and community members

• Offer networking and professional development opportunities for CHWs

• Influence CHW-related policymaking and advocate for a strong, sustainable CHW workforce in Connecticut

• Collect and share current data impacting the CHW workforce in Connecticut, New England, and the U.S.

For more information on CHWACT visit:  http://www.cpha.info/?page=CHWACT

Or contact: chwassociation@cpha.info

SAVE THE DATE: CPHA ANNUAL CONFERENCE OCTOBER 30, 2017

Following an amazing 2016 Conference event, the 2017 CPHA Program Committee is hard at work preparing for this year's Annual Conference. The conference will be held on October 30, 2017 at the Aqua Turf in Southington, CT.

If you are interested in participating in the planning of this year's conference, please email program_committee@cpha.info

Interested in sponsoring, exhibiting or advertising at the CPHA conference? Take advantage of the opportunity and gain exposure to hundreds of public health professionals and advocates from around the state. Click here for more information!

CURRENT JOB OPENINGS

Today, we are highlighting the value of using the Healthy CT 2020 Performance Dashboard—which displays how Connecticut residents are faring in health improvement target areas in a simple and visual format—with our partners. Below, we have asked Marianne Buchelli to share how the HIV Prevention Program has incorporated the Dashboard into their daily work.

Q:   How has your program used the Dashboard?

A:     We use it to monitor ourselves regularly and also as tool to share with our funders on our progress in meeting our goals and objectives.  One of the ways it has been helpful has been in presenting our data to the layperson in the community, which is part of our effort to be transparent and engage our patients/clients in understanding performance measures in general. We have used the Dashboards at a variety of task force meetings, such as Center for Interdisciplinary Research on AIDS (CIRA) community core meeting, Connecticut HIV/AIDS Identification and Referral (CHAIR) Task Force, and the statewide Connecticut HIV Planning Consortia (CHPC). The Dashboard has helped demonstrate how “numbers are people” to further engage the community in performance improvement.  The picture to the right is of our very own Ramon presenting to community stakeholders at Yale University.

Q:  What are the benefits of using the Dashboard? 

A:   The Dashboard offers a way for our program to show stakeholders in the community how well our programs meet our annual goals and objectives.  It provides an easy way to show the data in a manner that is user-friendly to community members and also engages them in discussing the data rather than just talking at them with data sets. 

In 2015, the HIV Prevention Program presented our Dashboard at the Connecticut HIV Planning Consortia (CHPC) meeting.  It was a great way to highlight our successes and have a dialogue with community members about areas for improvement, specifically around health inequities.  Further information about how the community responded to the Dashboard can be found in the attached CHPC meeting minutes and CT Integrated HIV Prevention and Care Plan 2017-2021 on page 12.

Q:  What improvements have you seen since you started using the Dashboard and what do you attribute  them to? 

A:   The main improvement is in communicating performance improvement with our stakeholders.  Another of the major outcomes was identifying Plan, Do Study, Act (PDSA) projects for our funded contractors to implement based on the health disparities data among gay men and women of color living HIV/AIDS.  This has sparked a statewide initiative for Connecticut to develop a plan to end HIV/AIDS in CT.  The HIV Prevention Program is supporting this initiative to “get to zero” by laying the ground work for a community level plan that will work towards achieving zero infections, zero deaths, and zero stigma.  

Use of the Dashboard with partners helps with a common understanding of health issues, DPH’s role and partners roles, identification of policies, and system changes needed to improve health and health equity

If you have any questions about the Dashboard, want to learn more about it, or have a story to share about how you have used the dashboard,  please contact Etienne Holder (ex: 7781) at Etienne.holder@ct.gov or Joan Ascheim (ex: 7626) at Joan.ascheim@ct.gov.

Debbie L. Humphries, PhD, MPH, Yale School of Public Health

C.E.A. Winslow Award

Dr. Humphries is a clinical instructor in Epidemiology (microbial diseases) at the Yale School of Public Health and teaches the renowned Practice Based Community Health Research course, which places student groups with agencies around Connecticut.  The benefits for community-based public health in CT are twofold: students develop skills in planning and designing practice-based community health research projects while precepting organizations employ the results and pilot data to develop strategic plans and apply for grants and consultation services they could not otherwise afford. Last year participating agencies included the New London Homeless Hospitality Center, Yale New Haven Health System, Common Ground High School’s Urban Farm and Environmental Education Center, and the City of Norwalk.  Dr. Humphries also serves on the leadership committees for AIDS Project New Haven and the CT Public Health Practice Based Research Network (CT PBRN).  She is a key figure in the CT PBRN, serving as a principal investigator on several studies that were developed in collaboration with the CT Association of Directors of Health and focus on local health department organizational structure, financing, and service delivery. Her CT PBRN research includes studying the effects of cross-jurisdictional resource sharing on the implementation, scope and quality of public health services in CT.  Dr. Humphries is also a co-author of the Community Research Assessment Tool (CREAT), a framework for characterizing the research capacity and value of research conducted by public health and community organizations that was conceived by the Yale Center for Interdisciplinary Research on AIDS (CIRA). Dr. Humphries is a CIRA affiliated scientist and has collaborated with numerous community based HIV prevention and care providers in CT.   

The Witness Project of Connecticut, Bridgeport, CT

Ira V. Hiscock Award

The Witness Project of Connecticut is a non-profit organization founded in 2002 with the mission to reduce the number of African American women diagnosed with late stage breast cancer in Connecticut by increasing early detection and treatment rates through education and empowerment. The Witness Project serves under-served women in Bridgeport, Norwalk and Stamford by providing culturally sensitive breast health education, patient navigation services for uninsured women and sponsor mammography screening days in the community. All of these efforts combined help facilitate detection, which is key to surviving breast cancer.

The Witness Project utilizes an evidence-based education model to provide women with breast health education and identify those who have not received a mammogram in the past 12 months. Women are reached in education sessions conducted for churches and the community service organizations that serve low income women. Group education sessions utilize lay health advisors and witness role models to educate and discuss breast health. Nearly 60% of the women reached are in group sessions and the Witness Project has consistently exceeded its annual education goals by 150%. The other 40% are reached in one to one education sessions during community mammography screenings.

Thomas P Meehan, MD, Harvard Pilgrim Health Care, Hartford, CT

Charles G. Huntington III Award

Dr. Meehan is a committed primary care provider, leader, researcher, and teacher dedicated to improving CT’s health care system and to supporting those working within it. Dr. Meehan began his career in primary care, working for seven years in the Waterbury area caring for patients of all socioeconomic backgrounds. Between 1998 and 2013, Dr. Meehan served in Yale-New Haven Hospital’s hypertension clinic, in which he cared for referred patients, many underinsured, with refractory hypertension. Throughout his entire 15 years working in Yale’s hypertension clinic, Dr. Meehan was a volunteer. Motivated by his passion for public health and quality improvement, Dr. Meehan earned his MPH degree and became involved in leadership, with noteworthy positions including Chief Medical Officer of Qualidigm (non-profit quality improvement organization) and more recently, Associate Medical Director of Harvard Pilgrim Health Care (not-for-profit health plan). As a leader, Dr. Meehan has sought opportunities to improve safety net programs (Medicare and Medicaid) and to eliminate health disparities across all settings of care.

 Dr. Meehan has taught at UConn, Yale, and Quinnipiac over the last 26 years, working with students in medicine, nursing, and public health. In addition, he has published 69 original research papers regarding quality improvement in health care. Dr. Meehan’s career objective is to make a meaningful contribution to society by facilitating improvements in healthcare quality, safety, and cost-effectiveness.

Randy Domina, MPH Candidate, Southern Connecticut State University

The Michael J. Perlin Student Award 

Randy Domina received a Bachelor of Arts in History and Sociology from Hope College and brings a diverse background to the field of public health. For over 10 years, Randy worked closely with children of varying ages, helping at-risk teenagers, teaching environmental education, directing operations of an environmental education center, and eventually teaching geography and history at a local middle school after receiving his Certification for Middle School Social Studies in the State of Connecticut. In addition, Randy’s carpentry skills allowed him to start and own his own remodeling business for many years. In 2015, Randy also participated in a New England Public Health Training Center Fellowship in addition to working towards his MPH from SCSU. 

Elizabeth Schwartz, MPH Candidate, Southern Connecticut State University

The Michael J. Perlin Student Award 

Elizabeth Schwartz graduated from Kenyon College with a degree in Cultural Anthropology before pursuing a Master of Public Health from Southern Connecticut State University. Elizabeth brings an array of experiences, from working in the New York State Assembly as a Legislative Aide to lead a team of experienced real estate professionals in management as an Assistant Director at Merlot Properties Group. Elizabeth worked with Susan G. Komen of Connecticut as a research assistant for the 2015 Community Profile of Breast Cancer in Connecticut Report and wrote the Executive Summary for the report. In 2015, Elizabeth also became a Fellow in Resident at the Connecticut Coalition on Aging. As of October 2016, Elizabeth also serves on the CPHA Board as our interim treasurer. 

PRESIDENT’S MESSAGE

Plans are well under way for CPHA’s 100^th anniversary conference. There is plenty of excitement with this conference, not only because we are celebrating a century of public health successes but also because our featured speaker is APHA President, Dr. Camara Jones. We expect this to be an excellent conference and I encourage members to register early.

As many of you may know, we have been working closely with Connecticut Community Health Workers to develop a CHW section for our chapter similar to the APHA’s section. Recently, we signed on as supporters of the New England CHW Coalition comments addressed to the U.S. Department of Labor on the Standard Occupational Classification (SOC) code for CHWs. Specifically, we are urging the DOL to adopt revisions to the definition of CHWs to better reflect the important work CHWs perform.

The CPHA Board has been working hard to implement our new strategic plan and is always happy to receive help and input from our members. If any members would like to become more involved with the Board or a specific committee, please reach out to myself or any of our committee chairs for more information.

Thank you and I look forward to seeing you in November!  

BACK TO THE FUTURE: 2016 CPHA CENTENNIAL CELEBRATION AND ANNUAL MEETING: NOVEMBER 10, 2016

Join us for our Centennial Celebration and Annual Meeting on November 10! Back to the Future: 100 years of Public Health in CT and Beyond will be held at Anthony's Ocean View in New Haven, CT beginning at 9 AM. We are excited this year to be including a Rapid Fire session, Roundtable, and Panel Discussion. We are very pleased to host our Keynote Speaker, Dr. Camara Jones, APHA President, as well as our afternoon panelists including Senator Chris Murphy who will participate in a discussion on the tackling the Opioid Epidemic. The celebration will also feature over 30 speakers and a networking Happy Hour featuring live music. Take a glance into the past during the lunch presentation on the history of CPHA and public health in the state, and look forward to the future and with innovations in health research, policy, and community programs. Don't forget to take advantage of the Early Bird discount before it ends on October 14.

More on our Keynote Speaker and Afternoon Panel:

Keynote Speaker: Camara P. Jones, MD, MPH, PhD, President, American Public Health Association (APHA)

Dr. Jones is a research director on social determinants of health and equity in the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion and President of the American Public Health Association (APHA). She seeks to broaden the national health debate to include not only universal access to high quality health care but also attention to the social determinants of health (including poverty) and the social determinants of equity (including racism). As a methodologist, she has developed new ways for comparing full distributions of data (rather than means or proportions) in order to investigate population-level risk factors and propose population-level interventions. 

Afternoon Panel: Tackling the Opioid Epidemic at the Federal, State, and Local Levels featuring Senator Chris Murphy's Director of Community Affairs, Sean Scanlon

Senator Chris Murphy's Director of Community Affairs, Sean Scanlon, has been invited to sit on a panel of policymakers, research scientists, and overdose prevention advocates to tackle the conversation on the opioid epidemic and provide insight what is being done at the local, state, and federal level to better understand opioid abuse and reduce exposure in the community. Explore how advocates are working hard to improve community efforts to prevent dependence and improve overdose outcomes. Visit CPHA's website for more information.

Interested in sponsoring, exhibiting or advertising at the CPHA conference? Take advantage of the opportunity and gain exposure to hundreds of public health professionals and advocates from around the state. Click here for more information!

*This is a fragrance free event in consideration of those with asthma and respiratory reactions.*

The Program Committee meets every two weeks via phone. If you would like to join and assist in these final weeks of planning, please email the program_committee@cpha.info.

CT STATE INNOVATION MODEL UPDATE

The Connecticut State Innovation Model (SIM) is a $45 million grant awarded to the State through the Centers for Medicare and Medicaid Innovation, a division of the Centers for Medicare and Medicaid Services established under the Affordable Care Act.  The SIM includes a variety of initiatives intended to establish a whole-person centered healthcare system through three main strategies: transforming the healthcare delivery system, reforming payment and insurance design, and developing population health capabilities.  An overview of the SIM and its strategies can be found here.

There are often opportunities to get involved with SIM initiatives, with announcements posted on our main page and our Facebook page.  You can also receive Newsletters and E-Alerts by signing up here.

HEALTH EDUCATION COMMITTEE MEETING UPDATE

The Health Education Committee wants to hear from you!

Join our next meeting on October 12 at 8:45 AM via phone or WebEx invite. It’s easy to join- just contact us at hec@cpha.info to receive call-in information. This month’s presentations will feature:

·         Emerging Trends - Amy Hanoian-Fontana, MA, EMT-B, Community Education Specialist, CT Poison Control Center - UConn Health

·         Lead 101 - Basics about Lead - Kim Ploszaj, Lead Program and Healthy Homes, CT Dept. of Public Health

Thanks to all who participated in our September meeting. Please find the meeting minutes here.

September meeting highlights:

·         Medical Orders for Life-Sustaining Treatment (MOLST) Pilot Project – presented by Suzanne Blancaflor, MPH, MS, Chief, Environmental Health Section, CT Dept. of Public Health. Find more details, information, and resources about Medical Orders for Life-Sustaining Treatment.

·         Who’s in charge, the parasite or the host? How bed bug-human behaviors contribute to the insect’s success Bed Bugs – presented by Dr. Gale E. Ridge, Assistant Scientist, The CT Agricultural Experiment Station. Check out the “Connecticut Coalition Against Bed Bugs (CCABB) - Bed Bug Information” website for flyers and other information to share with the public

MENTORING ORGANIZATION REGISTRY (MOR) UPDATE

National Public Health Week: Success by the Numbers

Our National Public Health Week (NPHW) activities reached over 4,000 high school and community college students from over 80 communities, significantly surpassing our 2015 outreach efforts of 2,500 students in 70 communities!  How did we accomplish this?

1.       Through our broad and active membership: MOR paired several member organizations with schools across the state, with CT HOSA (CT Association of Future Health Professionals) and Area Health Education Centers (AHEC) public health presenters led student contacts reaching over 3,000 through their combined activities.

2.       By Sharing Resources: The CPHA MOR posted events, free existing resources and new ones developed with the support and creativity of mentored MPH candidates.

3.       By Listening to our Education Partners: We extended NPHW activities past April at the request of educators to accommodate their spring vacation and testing schedules.

MOR Public Health Awareness among CT High School Students

At the 2016 statewide HOSA (Future Health Professionals) Annual Competition in New Haven, there was a clear indication that Public Health is no longer an unknown term among high school students. According to CT HOSA President and MOR member, Susan Troupe, 350 high school students presented innovative team driven and designed health projects.  Students selected from several categories to develop their project, e.g., Behavioral Health, Medical Innovation, Pathophysiology and Public Health.  More Public Health teams entered than any other type of team. In 2012, Public Health wasn’t even a choice.  We have come a long way through our joint efforts.

MOR and UCONN MPH Students Pilot a New Health Literacy Curriculum

In keeping with this year’s NPHW theme, the CPHA MOR aimed to “Reach the Next Generation” with a new two-three week curriculum:  Health Literacy: Don’t Leave High School Without it.” Graduate students, Fawatih Mohamed, MD and Rabale Hasan, working with MOR leaders, Cyndi Billian Stern and Amanda Durante, developed a blended curriculum aligned to standards in health education, medical careers and Public Health 101 classes for the high school.

A New Britain Medical Careers class completed the new lessons with educator Darlene Clark using a pre and post-test with her students which indicated its effectiveness on a small sample.  We continue to tweak the curriculum and are currently seeking funding to evaluate it following a broader student pilot in New Britain, Manchester, and Waterbury. Following the evaluation, our intent is to offer the online curriculum with training for educators.

Public Health 101 For the High School:  Now Free for ALL High Schools

Hyde Public Safety Academy is the latest high school to launch PH101 full year course developed by CPHA MOR leaders and EdAdvance (formerly Education Connection).  The 2016 version, updated by Newtown’s PH101 teacher, Susan McConnell, can be accessed at http://www.publichealth101skills21.org/.

MOR Mentoring for College Students of Public Health

Research indicates the exponential growth of public health majors at the undergraduate level.  In Connecticut, we have seen this growth with students enrolling in greater numbers in public health courses at University of CT, St. Joseph University, Goodwin College, CT Community Colleges and Yale.   In the coming months the MOR will determine the best way to serve this population, regarding experiential learning and career advice with the help of the leaders of those programs, who are also MOR members.
                    To get involved or for MOR information contact Cyndibilllianstern@cpha.info.

ADVOCACY COMMITTEE UPDATE

The Advocacy Committee is preparing to take an active role in the 2017 legislative session, and will be determining priorities in the coming months. If you would like to get involved, please contact Jenna Lupi, jenna.lupi@gmail.com

Set to go into effect on October 1, 2016, here is a summary of seven bills of public health interest that were passed during the 2016 legislative sessions:

HB 5350  AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS ON FLUORIDATION OF THE PUBLIC WATER SUPPLY

This act reduces the public water supply's mandated fluoride content. Specifically, it requires water companies serving at least 20,000 people to add enough fluoride to the water supply to maintain an average monthly fluoride content that varies no more than 0. 15 milligrams per liter (mg/L) from the U. S. Department of Health and Human Services' (HHS) most recent recommendation for optimal fluoride levels in drinking water to prevent tooth decay (currently 0. 7 mg/L).

SB 70 AN ACT CONCERNING TELEHEALTH PROVIDERS

This act adds licensed speech and language pathologists, respiratory care practitioners, and audiologists to the list of health care providers authorized to provide health care services using telehealth. Under the act, they must provide telehealth services within their profession's scope of practice and standard of care, just as other telehealth providers must do under existing law.

By law, “telehealth” means delivering health care services through information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's physical and mental health.

HB 5053 AN ACT CONCERNING OPIOIDS AND ACCESS TO OVERDOSE REVERSAL DRUGS

This act contains various provisions on opioid abuse prevention and treatment and related issues. It:

1.       prohibits, with certain exceptions, a prescribing practitioner authorized to prescribe an opioid drug from issuing a prescription for more than a seven-day supply to (a) a minor or (b) an adult for the first time for outpatient use;

2.        makes various changes to the electronic prescription drug monitoring program, such as (a) expanding who may serve as a prescriber's authorized agent, (b) modifying reporting deadlines, and (c) decreasing required prescriber reviews for prolonged treatment with schedule V nonnarcotic drugs;

3.       allows any licensed health care professional to administer an opioid antagonist (e. g. , Narcan) to treat or prevent a drug overdose without civil or criminal liability;

4.       requires municipalities, by October 1, 2016, to amend their local emergency medical services (EMS) plans to ensure that specified first responders are equipped with an opioid antagonist and trained in administering it;

5.       prohibits certain health insurance policies that provide prescription drug coverage for opioid antagonists from requiring prior authorization for these drugs; and

6.       requires the Public Health Committee chairpersons to establish a working group on the issuance of opioid drug prescriptions by prescribing practitioner.

HB 5335 AN ACT CONCERNING THE RIGHTS AND RESPONSIBILITIES OF LANDLORDS AND TENANTS REGARDING THE TREATMENT OF BED BUG INFESTATIONS

This act establishes a framework to identify and treat bed bug infestations in residential rental properties, including public housing but excluding detached, single-family homes. It sets separate duties and responsibilities for landlords and tenants, including notice, inspection, and treatment requirements. It also gives landlords and tenants remedies when either party fails to comply with these duties and responsibilities.

HB 5537 AN ACT CONCERNING VARIOUS REVISIONS TO THE PUBLIC HEALTH STATUTES

This act makes numerous changes to Department of Public Health (DPH)-related statutes and programs, some of which include:

1.       makes changes affecting local health departments, such as establishing a process to address alleged impropriety by local health directors or their employees;

2.       creates a new dental assistant designation and requires dental professionals to take continuing education in infection control;

3.       allows nursing home patients to receive methadone treatment for opioid addiction at the nursing home under certain conditions;

4.       recognizes in statute a category of psychology technicians and allows them to provide certain psychological testing services if acting under a psychologist's supervision;

5.       as of July 1, 2017, eliminates the Office of Protection and Advocacy for Persons with Disabilities and requires the governor to designate a nonprofit entity to serve this function;

6.       creates a diabetes advisory council in DPH within available appropriations; and

7.       creates a nail salon working group and a medical records task force.

SB 218 AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS FOR REVISIONS TO THE STATUTES REGARDING HUMAN IMMUNODEFICIENCY VIRUS

This act makes changes to statutes related to HIV. Specifically, the act requires the Department of Public Health (DPH) to establish needle and syringe exchange programs in any community impacted by HIV or hepatitis C, not just the three cities with the most HIV cases among injection drug users, and expands the programs' service components. But it requires the programs only within available appropriations.

SB 20 AN ACT CONCERNING CARRYING A FIREARM WHILE INTOXICATED OR UNDER THE INFLUENCE OF ALCOHOL

This act lowers, from . 10% to . 08%, the blood alcohol content (BAC) level that triggers a presumptive violation of the law's prohibition on carrying a loaded firearm while under the influence of drugs or alcohol. The . 08% level is the same threshold as for state and federal driving under the influence (DUI) laws.

UPCOMING EVENTS

Second Annual Statewide Prevention Fitness Forum

Connecticut Prevention Network and Wheeler Connecticut Clearing House

Wednesday, October 19, 2016 from 9:00 AM - 12:00 PM

Savin Rock Conference Center, 6 Rock Street, West Haven, CT

JOB OPENINGS

Public Health Nurse, City of New Haven

Epidemiologist, City of New Haven

Healthcare Advocate, State of Connecticut Office of the Healthcare Advocate

Healthcare Policy Planning Specialist, UCONN Health

Director of Health, City of Bridgeport

Public Health Nursing Administrator - City of Meriden

• Fever
• Fatigue
• Loss of Appetite
• Nausea
• Vomiting
• Abdominal Pain
• Dark Urine
• Grey Colored Stools
• Joint Pain
• Jaundice (yellowing of the skin or whites of the eyes)

1. http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.VxV2KSMrJAY

Last September, Americans turned in 350 tons (over 702,000 pounds) of prescription drugs at more than 5,000 sites operated by the DEA and more than 3,800 of its state and local law enforcement partners. Overall, in its 10 previous Take Back events, DEA and its partners have taken in over 5.5 million pounds—more than 2,750 tons—of pills. 

This initiative addresses a vital public safety and public health issue. Medicines that languish in home cabinets are highly susceptible to diversion, misuse, and abuse. Rates of prescription drug abuse in the U.S. are alarmingly high, as are the number of accidental poisonings and overdoses due to these drugs. Studies show that a majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet. In addition, Americans are now advised that their usual methods for disposing of unused medicines—flushing them down the toilet or throwing them in the trash—both pose potential safety and health hazards.

For more information about the disposal of prescription drugs or about the April 30 Take Back Day event, go to the DEA Diversion website

The kidney’s are basically two filtration units for your blood and like any filter if the wrong materials are run through it, the filter breaks down. That is why during the month of March (National Kidney Month) we are going to focus on internal and external ways that you can keep your kidneys healthy.

            Internally, it is important to keep the blood (the fluid filtered by the kidney) healthy. A few ways to keep healthy kidneys are by lowering your blood pressure, reducing cholesterol, and if you are diabetic, keeping glucose at a normal level(1).

            Controlling your kidney health externally is all about options. First of all, it is important to get enough exercise, which can help lower blood pressure, cholesterol, and reduce the risk of diabetes(1). Other ways to keep your kidneys in working order is to reduce your sodium intake to less than 2,300 milligrams per day, drink less alcohol, and quit smoking(1). If you are having trouble reducing your sodium intake, start by making home cooked meals from recipes found at Davita or the Kidney Kitchen (links below). You can also reduce the amount that you eat out at restaurants(2). If you do have a kidney disease, it is important to limit the amount of protein in your diet because this can cause already stressed kidneys to work harder.

            In the United States, 26 million people have kidney disease, which can lead to more dire health consequences if untreated(3). Make sure that you look after the health of your kidneys for the long run, by exercising, eating well, and living a healthy lifestyle.

Davita: www.davita.com/recipes

Kidney Kitchen: www.kidney.org/patients/kidneyktichen

1.http://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/learn/causes-kidney-disease/keep-kidneys-healthy/Pages/keep-kidneys-healthy.aspx

2.http://www.kidneyfund.org/kidney-disease/kidney-friendly-diet-ckd/?referrer=https://www.google.com/

3.http://www.healthline.com/health/kidney-disease

Colorectal Cancer is a mashup of two words, colon and rectum. During the month of March we want to raise awareness of both cancer types and encourage people to take preventative action and get screened. Also, do not forget to wear blue on March 4th to support Colon Cancer Awareness.

The colon is part of the large intestine and normally supports the absorption of water and nutrients from the food we eat. The rectum is an area of the body where solid wastes are stored, both of these areas can be affected by cancer.

Colorectal cancer is the second leading cause of death by cancer in the United States(1). Men and women are equally likely to get both of these cancers, which is why it is important for everyone over the age of 50, to get a colonoscopy(1). Risk factors for colorectal cancers are family history, ulcerative colitis, polyps, and Crohn’s Disease(2). Other risk factors include previous cancers of the ovary, endometrium, or breast(2). Additionally, smoking, a high fat diet, obesity, abuse of alcohol, and diabetes are known to be linked with colorectal cancers(4). African Americans have a higher likelihood of developing these type of cancers(4).

There is good news, the CDC and Mayo Clinic both offer ways to reduce your risk of colorectal cancers. It is suggested by both institutions to exercise regularly and often, drink alcohol in moderation, and avoid using tobacco products(1,4). It is also thought the fiber and antioxidants in fruits and vegetables can play a key role in reducing the risk of colorectal cancers(4).

In the end, the risk of colorectal cancer can be dramatically reduced by staying active, eating well, and maintaining a healthy lifestyle. In addition, catching the disease in early stages can significantly improve your chances of survival. So, talk to your doctor or healthcare provider about a colonoscopy if you are 50 years or older.

Get Involved with the Colon Cancer Alliance at http://www.ccalliance.org/

1http://www.cdc.gov/cancer/colorectal/

2http://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq

3https://www.nlm.nih.gov/medlineplus/colorectalcancer.html

4http://www.mayoclinic.org/diseases-conditions/colon-cancer/basics/definition/con-20031877

March is National Endometriosis Awareness Month and we here at the Connecticut Public Health Association want to inform you about this condition. Endometriosis is when part or some of the endometrium of the uterus begins to grow outside of the uterus(1). The endometrium is that structure that grows and is shed on a monthly basis in women, which is also known as the typical menstrual cycle. However, approximately  1 in 10 women and girls in the United States are affected with endometriosis, not to mention more than 176 million women and girls affected in the world(2). The reason why we say that women and girls are affected is because the age range that can develop this problem is from 12-60 year old individuals(2).

Symptoms of endometriosis can be indistinguishable from other natural processes or maladies. For instance, the most common symptom of this condition is pelvic pain, but the pain may only happen during a woman’s menstrual cycle(3). The reason for this is that the endometrium outside of the uterus still acts like endometrial tissue inside of the uterus and goes through the same growing/breakdown cycle responding to hormones(1,2). So, for this reason, pelvic pain or cramping that happens during an activity that is known to cause cramping does not raise people’s suspicions. Endometriosis can also be misdiagnosed as Irritable Bowel Syndrome (IBS) because some people have symptoms of bowel disorders and nausea(2). Additionally, people diagnosed with this condition have symptoms of long and heavy periods, pain during intercourse, and infertility(1,2). For more information about symptoms, check out the links/sources at the bottom of this post.

Research has found there to be no risk factors associated with race, economics or area, women from all backgrounds are all equally affected(2). There are risk factors that can point to endometriosis, such as never giving birth, pelvic infection, family history, and inability of menstrual fluids to leave the body(1).

It is important for women to be aware of endometriosis because it can have an impact on your daily life and future ambitions. About 30-40% of women have fertility issues due to endometriosis. If you have questions or concerns, please see your healthcare provider and reference the below links(2,3). Additionally, there are support groups and where you can find them in the below links for those suffering from endometriosis.

1http://www.mayoclinic.org/diseases-conditions/endometriosis/basics/definition/con-20013968

2http://www.endofound.org/endometriosis

3http://endometriosis.org/

“Am I a bad person,” Friedman asks, “if I hope that when Norquist slips in that bathtub and has to call 911, no one answers?”

You’re probably asking how I intend to get from there to public health. The answer is by piggybacking on exotic microbes, specifically the Zika and Ebola viruses, tropical pathogens that still managed to sneak into Connecticut and get a big government response even when they didn’t actually show up in person.

But suppose they did? Nobody likes big government pushing its weight around until its cogs and gears are all that’s standing between us and the next pandemic.

So here’s the question: Do we wait until people in Connecticut actually get a disease before doing something about it, or do we launch a response as prudent preparedness and risk being accused of exceeding our legal authority?

Connecticut wasn’t spared from the Spanish flu pandemic in 1918, when a healthy young adult could come down with a fever before lunch and die from it less than 12 hours later. As the death toll peaked in October and November, government leaders ordered closing public events and even church services to prevent the spread of the disease.

Federal, state and local government agencies have the authority to order quarantines and isolation measures, and take measures as necessary in order to stop the spread of infectious diseases. In case any “small government” advocates believe the Founding Fathers intended something different, they need to explain why those same Founding Fathers didn’t object when city officials imposed strict quarantines and ordered people to receive prescribed medical treatment during the yellow fever epidemic in 1793 in Philadelphia.

Dr. Benjamin Rush, who signed the Declaration of Independence, supervised the public health response. Instead of passing laws to weaken the authority of health officers, Congress and President George Washington adjourned and left town until it was over.

Two recent stories in the news reminded us of the enforcement authority that public health officials possess to respond to epidemics, and raise the question mentioned earlier.

An ongoing Zika virus pandemic in parts of the Western Hemisphere is worrisome because the virus may cause birth defects if contracted during pregnancy. Connecticut has not seen a single case of the mosquito-borne illness, but Gov. Dannel P. Malloy announced that state government agencies would prepare a response should the disease appear. Although these measures aren’t supposed to include quarantines or isolation orders, it is easy to see how it could affect the state’s mosquito eradication program.

The same week, Malloy and state health officials were sued by people who were quarantined during the Ebola epidemic in 2014. The lawsuit argues that the quarantine orders were unconstitutional, since none of the people quarantined had come in contact with anyone showing symptoms of Ebola, and no cases ever broke out here. A spokesman for Malloy said the governor’s first priority was to protect the public and to take whatever steps were deemed necessary by health authorities.

It’s easy to see the problem. If preparedness waits until actual disease cases are prevalent in order to justify government’s powers and authority, what do we say to those who have paid a preventable cost?

CPHA E-Newsletter—Winter 2015

Nearly 300 public health professionals and students from around the state gathered in Waterbury, CT on October 23^rd for the CPHA Annual Meeting and Conference. Centered on the theme “Healthy by Design,” the meeting focused on how we can improve health outcomes from the ground up by creating health-conscious communities and working with partners to address health disparities.

The meeting was kicked off by our keynote speaker, Dr. David Katz, founding director of the Yale Prevention Research Center and Associate Professor at the Yale School of Medicine. His presentation, “Lifestyle is the Medicine,” described the steps we, as individuals and public health professionals, each can take to live healthier lives and support healthier communities. The meeting also featured 12 breakout session presentations sharing the latest information on evidence-based practices and emerging health issues.

We also had an excellent plenary session on community planning, “Lighter, Quicker, Cheaper (LQC)…and Healthier Approaches to Placemaking” presented by Kate Rube (VP, Project for Public Spaces) and Jennifer Smith (Program Manager, Downtown Providence Parks Conservancy). The session was moderated by Robert Miller, Eastern Highland Health District Director. PowerPoint presentations from the sessions can be found on the CPHA website. Our thanks to all our presenters, including our student posters, for an outstanding educational program!

CPHA would also like to thank all of our meeting exhibitors, sponsors and advertisers (see below) for their support. A huge round of appreciation goes to our Program Committee and volunteers!

This year is our 100 year anniversary, so come and celebrate with us at our Annual Meeting and Conference on November 10, 2016!

2015 Exhibitors

·         AJ Pappanikou Center for Excellence in Disabilities

·         Alzheimer’s Association

·         Andrea Borondy-Kitts

·         Community Health Network of Connecticut Foundation

·         Connecticut Athletic Trainer’s Association

·         Connecticut Department of Public Health – Asthma

·         Connecticut Department of Public Health – Health Surveillance and Statistics

·         CT School Health Promotion Programs and Activities

·         Healthy CT 2020

·         National Library of Medicine

·         Southern Connecticut State University

·         Stamford Clinical Services, LLC

·         University of Connecticut Health Center

·         Yale School of Public Health

2015 Advertisers

·         Connecticut Health Foundation

·         Data Haven

·         Southern Connecticut State University

·         University of Connecticut Health Center – Program in Public Health

·         Yale School of Public Health

Student Sponsorship

·         Tracey Scraba

·         William Faraclas

If you are interested in becoming an exhibitor, sponsor or advertiser for this year’s Annual Meeting and Conference, please contact the Program Committee at program_committee@cpha.info.

The Connecticut Public Health Association (CPHA) will be hosting a Public Health Awards Breakfast on Friday, April 8^th, 2016 at the Energize CT Center.  As part of National Public Health Week (April 4^th-10^th, 2016), CPHA will recognize and honor outstanding professionalism, dedication and contributions to the field of public health within the state of Connecticut.

The CPHA Call for Awards is an invitation to nominate an individual or agency from both traditional and non-traditional public health disciplines and sectors.  Nominees can be selected for one of the four awards:

·         The C.E.A. Winslow Award

·         The Ira V. Hiscock Award

·         The Charles G. Huntington III Award

·         The Michael J. Perlin Student Award

A description of CPHA’s awards can be found on the 2016 CPHA Call for Awards Nomination Form and on the CPHA website.  All nominees are evaluated on their strengths, talents and abilities, as well as their contributions to public health in Connecticut. Anyone is welcome to submit a nomination, even individuals who are not members of CPHA.

The deadline to submit the 2016 CPHA Call for Awards Nomination form is Friday, February 26^th, 2016.   All nominations can be submitted to cpha@cpha.info .   The CPHA Awards Committee will review all nominations and select award recipients to be acknowledged during the CPHA Public Health Awards Breakfast that will take place on Friday, April 8^th, 2016.

Please take this opportunity to nominate an individual or organization that has made contributions to the field of public health and the Connecticut community.   If you have questions about the nomination process, please send an email to the Awards Committee Chair, Kathi Traugh, at Kathi.traugh@cpha.info.

Plans for the 2016 CPHA Centennial Conference are underway. This year's theme is "Back to the Future: 100 Years of Public Health in CT and Beyond.”  The conference will be held at Anthony's Ocean View in New Haven on Thursday, November 10^th.  More details to come!

If you are interested in joining the Program Planning Committee and helping with the centennial celebration, please send an email to program_committee@cpha.info and Laura King or Courtney Butler (co-chairs) will add you to the distribution list. Currently, we are meeting telephonically on a monthly basis. 

CPHA welcomes new Board Members:

·         Joann Ascheim, Director-At-Large, Department of Public Health

·         Andrea Boissevain, Ex-Officio, CT Association of Directors of Health Representative, City of Stamford Health District

·         Courtney Butler, Director-At-Large, Director Hospice Clinical Support Services, Kindred at Home

·         Natalee Martin, Director-At-Large, March of Dimes

·         Jeff Shaw, Director-At-Large, CT Association of Non-Profits

CPHA welcomes back Board members:

Officers

·         Brittany Allen, President, Department of Public Health

·         Jonathan Noel, President Elect, PhD student in Public Health – University of Connecticut

·         Susan Logan, Treasurer, Department of Public Health

·         Morgan Spencer, Secretary, Membership Committee Co-Chair, University of Connecticut Health Center

·         Kathi Traugh, Past-President, Yale School of Public Health

Members

·         Pat Checko, Director-At-Large

·         Renee Coleman-Mitchell, Ex-Officio, Department of Public Health Representative

·         William Faraclas, Ex-Officio, Faculty Representative, Professor and Chair – Southern CT State University and Department of Public Health

·         Steve Huleatt, Ex-Officio, Finance Committee, West Hartford-Bloomfield Health District

·         Paul Hutcheon, Director-At-Large, Town of Killingworth Health District

·         Laura King, Ex-Officio, Program Committee Chair

·         Jenna Lupi, Ex-Officio, Advocacy Committee Co-Chair, SIM Program Management Office

·         Linda Mako, Ex-Officio, Health Education Committee Co-Chair, Aetna

·         Richard Melchreit, Director-At-Large, Department of Public Health

·         Colleen O'Connor, Ex-Officio, Advocacy Committee Chair, Public Health Consultant

·         Jill Spineti, Director-At-Large, The Governor’s Prevention Partnership

·         Carolyn Wysocki, Ex-Officio, CABOH Representative

The Connecticut State Innovation Model (SIM) is a $45 million grant awarded to the State through the Centers for Medicare and Medicaid Innovation, a division of the Centers for Medicare and Medicaid Services established under the Affordable Care Act.  The SIM includes a variety of initiatives intended to establish a whole-person centered healthcare system through three main strategies: transforming the healthcare delivery system, reforming payment and insurance design, and developing population health capabilities.  An overview of the SIM and its strategies can be found here.

SIM initiatives include the Advanced Medical Home initiative, Community and Clinical Integration Program, Medicaid Quality Improvement and Shared Savings Program, Health Information Technology, Value Based Insurance Design, Quality Measure Alignment, the Community Health Worker Initiative, and the Population Health initiative.  Monthly updates on the initiatives can be found here.  The SIM governance model includes a variety of Councils and Committees representing a diverse group of stakeholders from around the state.  Details on these groups and how they impact the initiatives can be found here.  The Steering Committee and the Consumer Advisory Board oversee the SIM process.

The SIM Program Management Office is currently accepting RFPs for a Consumer Engagement Coordinator to support meaningful integration of the consumer perspective into SIM initiatives.  Please find details here.

There are often opportunities to get involved with SIM initiatives, with announcements posted on our main page and our Facebook page.  You can also receive Newsletters and E-Alerts by signing up here.

The New England Public Health Training Center, with a local performance site at the Yale Office of Public Health Practice, would like to announce our free online courses and upcoming webinars. These programs were developed in partnership with the CT Department of Public Health and CT Association of Directors of Health. To register, visit TRAIN at www.ct.train.org  

Health Homes Webinar Series:

“Liability and Code Enforcement: What Public Health Needs to Know”

Thursday, February 18, 2016

12:00-1:30 PM

Train.org Course #1060896

“Connecticut’s Approach to Public Drinking Water and Public Health Protection”

Thursday, March 17, 2016

12:00-1:30PM

Train.org Course #1060897

Hot Topics Webinar Series:

“Personal Professional Development Plans for Public Health Agencies”

Thursday, March 3, 2016

12:00-1:00

Train.org Course #1062070

“Hot Topics: Community Engagement Models and Stories from the Field”

Train.org Course #1061266

Online Courses for new staff, boards of health and public health partners:

 “Orientation to Connecticut’s Public Health System”

Train Course #1056669

 “Cultural and Linguistic Standards 101 – CLAS 101”

Train.org course # 1058875

For a complete list of our on-demand courses and recorded webinars, visit our website.

The Health Education Committee wants to hear from you!

The 2016 meetings are tentatively scheduled for April 13, June 8, and September 14 from 8:30 AM- 12:00 PM.  Because the annual conference is in November, no date has been set. Stay tuned for an announcement on meeting location and details on call-in and webinar options.  We welcome all suggestions and comments, and CPHA’s Health Education Committee (HEC) always welcomes new members.

For more information, please email the CPHA Health Education Committee Chairs, Linda Mako or Laura King.

The CPHA MOR has begun the new year with three significant goals: 

·  Pilot health literacy units for high school students in greater Hartford and New Britain communities as well as in Public Health 101 classes established under Education Connection.

·  Introduce 2,500 students to public health topics and careers through our MOR members to commemorate National Public Health Week. 

·   Secure funding for a MOR coordinator.

We are happy to report that we are well on our way to accomplishing our health literacy pilot, thanks to the support of two University of Connecticut MPH students, Fawatih Mohamed and Rabale Hasan.  The students are working with co-chair, Cyndi Billian Stern, to carry out a plan that involves several educators and public health professionals in the design and implementation of the pilot lessons.  Working with us, providing us with curriculum development expertise, feedback and connections to educators and students are:

·      Maureen Couvares, Manchester High School

·      Jane Donn, Education Connection  

·      Chris Willems, Public Health 101, teacher at New Haven’s MBA Academy

·      Pierrette Silverman, Planned Parenthood of Southern New England

·      Natasha Rabinowitz, Hartford Public High School  Academy of Nursing and Health Sciences  

·      Susan McConnell, Public Health 101, teacher Newtown High School

·        Jennifer Searfoss , APRN, Clinical Skills Patient Instructor University of Connecticut Health Center

·      Michele Stewart-Copes, Consultant, Health and Equity 

·      Petra Clark-Dufner, CT Area Health Education Centers 

·     Jill Spinetti, The Governor’s Prevention Partnership  

For the third consecutive year, the MOR will work to reach students in high schools and community colleges during (and around) National Public Health Week (NPHW) 2016.  We have updated last year’s successful NPHW Film Festival, a PowerPoint with several short videos on different aspects of public health, a tool that makes it easy for mentors to present.  

Please email either Amanda.Durante@cpha.info or Cyndi.Billianstern@cpha.infofor further information. We appreciate your help in recruiting new schools.  Please go to our MOR NPHW page for further information. 

The CPHA MOR bid farewell to co-chair Pamela Kilbey-Fox in December.  Her leadership and commitment over the past four years has been instrumental in growing the MOR from 29 member organizations in 2012, to 41 in 2016.  She will remain an active MOR member as we welcome new co-chair, Amanda Durante.  Amanda Durante holds a PhD in epidemiology and public health and is on the faculty of University of Connecticut Graduate Program in Public Health, where she teaches epidemiology and oversees internship and practicum programs.  She has been active in community needs assessment and health improvement planning in Connecticut with a focus on health disparities, and has strong ties to both New Haven and now the central Connecticut area.  We are thrilled to have her on board and look forward to a productive year.

Over the past year, CPHA has been developing an updated strategic plan that broadens our mission and vision to more directly address Connecticut’s public health concerns. The Board recently approved the strategic plan, which focuses our efforts for the next 2 years on the following goals:

1)      Enhance Public Health Education

2)      Promote Health Through Advocacy

3)      Strengthen Membership and Organizational Capacity

4)      The plan is attached to this newsletter, but you can also find it on the CPHA website.

JOB OPENINGS

Public Safety Dispatch Supervisor, Town of Stratford

Public Health Charge Nurse, City of New Haven

Public Health Nursing Coordinator, City of New Haven

Deputy Community Services Administrator, City of New Haven

Public Health Nurse, City of Hartford

Nutrition Aide, City of Hartford

Public Health Preparedness Coordinator, City of Hartford

Clinical Research Associate II (PTN) Project Coordinator, Center for Public Health and Health Policy, UConn Health

Program Nutritionist- WIC, City of Stamford

So, with this thought in mind, I thought we should focus on the prevention of heart issues and maintenance of heart health in five basic areas: Exercise, nutrition, stress, and weight management

Exercise for a healthy heart.

The American Heart Association recommends that individuals “engage in 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150” minutes of total exercise(1). Another option is “25 minutes of vigorous” activity 3 days per week and moderate to high-intensity muscle strength training 2 days per week(1). It is a common misconception that you have to be a marathoner running many miles to get aerobic exercise. Simply put many of the aerobic exercises can be done with a partner or on a lunch break. Some of the suggested activities include: walking briskly, running/jogging, dancing, swimming, biking, climbing stairs at work, or playing sports such as tennis, basketball, soccer, or racquetball(1). However, the activities are not just limited to these, anything that increases your heart rate for 30 minutes can help with heart health and prevent disease.

            Start today to make your heart healthier only 30 minutes a day, by creating a walking group with colleagues, joining a club sport, or going to the gym with a motivated friend.

1 http://www.heart.org/HEARTORG/

2 https://www.goredforwomen.org/home/live-healthy/

3 http://www.ct.gov/dph/lib/dph/hisr/pdf/2010cvd_burdendoc_final.pdf

Nutrition for a Healthy Heart

In an automobile it is important to use high quality oil and the correct gasoline. The lower quality of each we put in, the less likely it is that the car will maintain the same performance as it had when it was new. The same goes for food, the oil and gas of our bodies, can have a direct impact on the heart, the human engine. If we eat food that is unhealthy for us, high in cholesterol and sodium, the heart begins to have to work harder. It is important to eat healthy food because just like changing the oil in a car, it is preventative maintenance for our bodies.

The American Heart Association recommends reducing the amount of cholesterol in the blood by eating the following foods:(2)

·         whole/multi-grain foods (bran and oats)

·         Fatty fishes (salmon, mackerel, and albacore tuna)

·         Antioxidant rich foods (fruits and vegetables)

·         Foods high in omega-3 fatty acids (avocado, flax seeds, canola oil, olive oil)

·         Plant sterols (walnuts and almonds)

On the other hand it is important to avoid foods such as:(2)

·         Fried foods

·         Animal products high in saturated fat

·         Simple sugars

·         High fat processed meats

·         Saturated oils (coconut and palm oil)

·         Shortening (partially hydrogenated margarine and lard)

In addition, reducing the amount of salt/sodium in one’s diet can reduce the blood pressure, therefore making the heart work less to pump blood around the body. There are many resources for reducing sodium in your diet, but one suggested one is the Dietary Approaches to Stop Hypertension (DASH) diet. Changing your diet does not have to be a huge undertaking, it can be as simple as drinking water instead of soda and ordering a salad with grilled chicken instead of a hamburger and fries. Every little bit of effort matters when it comes to your health.

            In the end it is up to you, good food in gets good energy out. In other words, you can feed your body what it needs and maintain amazing health or you can choke it with unhealthy foods and be in the “shop” every other year.

1 http://www.heart.org/HEARTORG/

2 https://www.goredforwomen.org/home/live-healthy/

Stress Management for a Healthy Heart

            Let’s face it, nobody likes stress. It can take a toll on your emotions, relationships, and heart health. That’s why it is important to take the steps to manage stress. The American Heart Association recommends the below tips for reducing stress in your life. The great thing about this list is that if one of the steps does not work for you, there are nine other routes to take. Also, check out the TED talks video link that is attached to the bottom of this post for research on how your perception of stress can actually make you less stressed.

1.    Talk with family and friends.

2.    Engage in daily physical activity.

3.    Embrace the things you are able to change.

4.    Remember to laugh.

5.    Give up the bad habits.

6.    Slow down.

7.    Get enough sleep.

8.    Get organized.

9.    Practice giving back.

10.  Try not to worry.

Source for stress fighting health habits: http://www.heart.org/HEARTORG/HealthyLiving/StressManagement/FightStressWithHealthyHabits/Fight-Stress-with-Healthy-Habits_UCM_307992_Article.jsp#.VqQELBgrJAY

Great TED talks video about “How to make stress your friend”: https://www.youtube.com/watch?v=RcGyVTAoXEU

Weight Management for a Healthy Heart

Another aspect of heart health is managing a health body weight. It is important for an individual to have a healthy weight, because then the heart does not have to work as hard in your day-to-day activities to pump blood around the body.

The most important way to begin managing your weight is to filter what is going into the system (aka food). Eating healthy foods with nutrients and fiber are going to help manage weight more readily than junk food and simple carbohydrates. Additionally, regulating portion sizes can reduce the amount of food eaten in a setting and excess calories consumed. Two great resources for weight management can be found at The American Heart Association and The National Institute of Health, both of the links can be found at the bottom of this post.

Managing body weight is not only important for your heart health. Excessive body weight can affect all body systems from causing back and knee pain, development of diabetes, and muscle atrophy.

So, when you manage your weight to have a healthy heart you are also helping the rest of your body. Reducing body fat, eating healthier foods, and exercise will all help to make you more resilient to diseases.

The American Heart Association- Weight Management: http://www.heart.org/HEARTORG/HealthyLiving/WeightManagement/LosingWeight/5-Steps-to-Lose-Weight_UCM_307260_Article.jsp#.VqURWRgrJAY

National Instiute of Health- Weight Management: https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000330.htm

 “Take your left hand and cover your left eye, now make a fist with your right hand. Take your right fist and place it directly in front of your right eye. The only thing you should see is images in your periphery or side vision. Now imagine that this is how you are to function within the world.” (1)

A survey by the Vision Health Initiative in the United States describes 1.6 million people over the age of 50 say they have macular degeneration(2). In Connecticut, approximately 2.49% or 30,804 residents suffer from this disease(4).

AMD can be a slow condition in some and fast in others, but most people affected are over the age of 50(1,5). In the slow version of AMD, many people do not know they have lost much of their vision until the later stages(1). Risk factors include family genetics, smoking, and high blood pressure(1,3). It is also found that obesity and race (caucasians more susceptible) play roles in the development of AMD(1,3). However, researchers at the National Eye Institute part of the National Institute of Health, say that reducing some or all of the risk factors such as smoking can help reduce the impact of the disease(3). Additionally, exercise, eating nutritious foods and maintaining a healthy cardiovascular system can reduce the likelihood of AMD(3).

Macular degeneration comes in two major varieties and three stages(3,5). The three stages are Early, Intermediate, and Late, which all related to the amount of degradation of the macula/vision loss of the individual(3). One of the varieties is Dry Macular Degeneration, and begins as a slightly blurry area in the central vision of an individual(5). The more severe type of the disease is known as Wet Macular Degeneration, and is due to blood vessels nearby leaking fluid into the macula causing the macula to raise from the back of the eye(5,7).

It is important to be aware of AMD as you and others you care about grow older. Early and intermediate stages of degeneration usually have no symptoms, however, it can be detected with a comprehensive dilated eye exam(3). If you do have AMD, there is recent research showing methods (surgical, medicine, and holistic) that help reduce the progress of macular degeneration, but please talk to your healthcare professional for more information(3).

1http://www.ehnpc.com/blog/detail/2012/02/22/february-is-national-amd-low-vision-awareness-month.html

2http://www.cdc.gov/visionhealth/data/national.htm

3https://nei.nih.gov/health/maculardegen/armd_facts

4http://www.visionproblemsus.org/amd/amd-map.html

5http://nihseniorhealth.gov/agerelatedmaculardegeneration/agerelatedmaculardegenerationdefined/01.html

6http://www.mayoclinic.org/diseases-conditions/dry-macular-degeneration/home/ovc-20164874

7http://www.mayoclinic.org/diseases-conditions/wet-macular-degeneration/home/ovc-20164274

The history behind radon is interesting because it was technically discovered by two scientists, who discovered different aspects of this gas. In 1899, Ernest Rutherford discovered that a gaseous element was releasing a type of radiation known today as alpha radiation(2). The next year, Friedrich Ernst Dorn found that radium was releasing a gas, in fact the heaviest gas known(2). Radon is released from the natural decay of uranium, thorium, and radium in the earth(1,3). This gas was found to be a causative agent of lung cancer when it was noticed that many uranium miners were dying of lung cancer(3). Radon moves through the earth toward the surface and since it is so heavy can accumulate in buildings without adequate ventilation. It does this by permeating the home through cracks in the building materials(2,3). This gas is soluble in water and can therefore be ingested or breathed if people use contaminated ground water supplies(6).

So, what are the risks of radon in a home, school, or business? Well according to the National Cancer Institute, Environmental Protection Agency (EPA), and World Health Organization (WHO) it is estimated that between 15,000-22,000 lung cancer deaths in the United States are caused by radon and is second leading cause of lung cancer(1,3,4). Lung cancer is caused by the inhalation of the radioactive gases causing damage to lung tissue(8). Since radon is soluble in water there is a risk of stomach cancer from ingestion, however, a higher risk comes from aerosolization of the contaminated water when showering(1). The EPA’s action level for radon in buildings is 4 picocuries/Liter of air(1,8). At this level of exposure over a lifetime it is expected that 7 out of 1000 people could get lung cancer(1). If these 1000 individuals were smokers and exposed to this level over a lifetime, it is expected that about 62 people would get lung cancer(1). In short, smoking further exacerbates the risk of lung cancer. These are the reasons why the “Surgeon General recommends that all homes in the U.S be tested for radon”(8).

There are three different methods (short-term, long-term, and water testing) that a home or building can be tested for radon. Short-term testing remains in the area for 2-90 days depending on the method(1). These type of tests are not going to tell you your yearly average level radon, since levels vary from day-to-day and during the season(1,3). The other option is long-term tests, which are in an area for greater than 90 days(1). This is useful for finding the overall yearly average of radon in a building(1,3). According to the Connecticut Department of Public Health Radon Fact Sheet, test kits can be purchased from the American Lung Association and National Radon Program Services, the contact information of both will be available at the bottom of this post(8). The third method tests the potable water for radon(6). The Connecticut Department of Public Health states that if an “average of two or more waterborne radon tests is equal to or greater than 5,000 picocuries/Liter” then the water should be treated(6).

If your home does have an average radon level greater than or equal to 4 picocuries/Liter of air, there are options to reduce this hazard. The CT DPH has a list of qualified radon mitigation professionals that are able to handle this job safely(5). Additionally, the EPA suggests that the home or building should be tested after the radon problem is fixed to ensure that the odorless, invisible gas is still not at high levels(1). Radon is a public health concern, but with the right amount of testing, knowledge, and prevention, there is no need to worry about the harmful side effects.

(Check out the Radon Potential Map and Radon Levels for Connecticut, sources 7 and 9 respectively, for a more in depth CT view)

Places to purchase radon test kits:

American Lung Association: 1-800-LUNG-USA

National Radon Program Services: www.sosradon.org/test-kits

CT DPH Radon Program List of Qualified Radon Mitigation Professionals: http://www.ct.gov/dph/lib/dph/environmental_health/radon/pdf/Nationally_Certified_Mitigation_Professionals.pdf

Sources:

1 A Citizen’s Guide to Radon: http://www.epa.gov/radon

2 Radon Fact Sheet: http://www.radon.com/radon/radon_facts.html

3 Radon and Cancer: http://www.cancer.gov/about-cancer/causes-prevention/risk/substances/radon/radon-fact-sheet

4 Radon: http://www.who.int/ionizing_radiation/env/radon/en/

5 CT DPH Radon Program List of Qualified Radon Mitigation Professionals: http://www.ct.gov/dph/lib/dph/environmental_health/radon/pdf/Nationally_Certified_Mitigation_Professionals.pdf

6 CT DPH- Radon Program: http://www.ct.gov/dph/cwp/view.asp?a=3140&q=387592&dphNav_GID=1828&dphPNavCtr=%7C#47072

7 CT DEEP- Radon Potential Map: http://www.ct.gov/deep/cwp/view.asp?a=2701&depNav_GID=1641&q=323456

8 CT DPH- Basic Radon Facts: http://www.ct.gov/dph/lib/dph/environmental_health/radon/pdf/Basic_Radon__Facts.pdf

9 Radon Levels for Connecticut: http://ct-radon.info/

This decision by one of the world’s biggest companies is an important news story. The year is young, but you can be sure that next December when news organizations list the top Connecticut news stories of 2016, this will be at or near the top of their lists.

Last year, GE announced it was considering moving in response to tax increases approved by the Legislature. This threat was serious enough for Gov. Malloy to call lawmakers back into session to roll back some of those tax increases.

So it was natural to assume to blame high taxes and the Democrats in Hartford for GE’s decision. That’s exactly what some politicians have done.

But that easy answer is not credible. If GE decided to move to get away from high taxes and Democrats, why go to Boston where there also are high taxes and Democrats?

In spite of its previous warning, GE itself did not blame those factors. In its announcement, the company cited unspecified “long-term costs” as one factor, which might be interpreted to include high taxes. But the other reasons it gave were “the business ecosystem, talent, … quality of life for employees, connections with the world and proximity to other important company assets.”

From a public health point of view, it is easy to see why GE would prefer the South Boston’s urban waterfront district to the Fairfield’s leafy suburban sprawl.

South Boston is a thriving, gentrifying, mixed-use area with walkable, pedestrian friendly streetscapes and a convenient mass transit district. Its active design features promote more physical activity, which the CDC says reduces obesity and obesity-related chronic disease rates. The Big Dig transportation project eliminated a highway that had cut off the Seaport District from the rest of South Boston and Boston’s downtown, improving street connectivity for pedestrians and bicyclists.

GE’s headquarters in Fairfield, by contrast, is only accessible by automobile. It is right off an exit of the Merritt Parkway at state highway Route 59, but it is not a walkable neighborhood, there’s no public bus route that goes there, and there’s little compact, high-density residential development nearby.

GE’s move points the way. Connecticut needs to be the healthy community state. What a great marketing strategy for economic development.

Those low-tax Sunbelt states already have the highest obesity rates in the nation. The E.P.A. predicts that global warming will roast the Sunbelt with prolonged heat waves and droughts as this century progresses. Businesses and workers will stream back to Connecticut, which is expected to weather the crisis in far better shape. Our state leaders must set policies now to guide land use and the built environment toward a healthy future. That’s how we want forward-thinking companies like GE to view us.

            There are six types of glaucoma known to doctors and all vary in symptoms and who is affected.

1.    Primary open-angle glaucoma. This is known to be the most prevalent type of glaucoma and can develop slowly with no pain(1,4). The fluid in an eye normally flows through an area called the trabecular meshwork and the angle formed by the cornea and iris (drainage angle), two common areas where the flow of fluid is impeded(1,2). In this type of glaucoma the trabecular meshwork is slightly occluded, causing fluid pressure in the eye to increase slowly and damage the optic nerve(4).

2.    Angle-closure glaucoma. This is caused by decreased fluid flow through the drainage angle and can happen slowly (chronic angle-closure glaucoma) or quickly in acute-angle-closure glaucoma, which is a medical emergency(1,4).

3.    Secondary glaucoma can be due to medical or physical injuries, medications, or other causes(1,2,4).

4.    Normal-tension glaucoma. As the name suggests, in this type it is common to see eyes that have a typical fluid pressure, but the individual still has optic nerve damage(1,4). The cause of normal-tension glaucoma is unknown.

5.    Pigmentary glaucoma. The iris of the eye has pigment particles/granules which are sometimes shed from the iris and can block the drainage of fluid from the eye(2,4). This in turn causes increased eye pressure and optic nerve damage.

6.    Pseudoexfoliation glaucoma. This type of glaucoma is similar to pigmentary glaucoma, however is associated with any material released from the internal eye that blocks the flow of the draining fluid(2).

There are risk factors for glaucoma such as physical injuries, medical conditions (diabetes, high blood pressure, and heart disease), and previous family history(1). Age can also be a factor, where people over the age of 60 and African Americans over the age of 40 have an increased risk(1,2,4). Individuals taking corticosteroids, women with an estrogen deficiency, and nearsightedness can be risk factors as well(4). Please see the below links for more information on risk factors leading to glaucoma.

Preventing glaucoma can be as easy as getting both eyes checked regularly by a qualified professional. If treatment is necessary, there are two options: medications and surgery(1). Medications are used to relieve the fluid pressure inside the eye, thus reducing damage to the optic nerve(1). Surgeries available for glaucoma come in three flavors: laser surgery, conventional surgery, and drainage implants(1,2). All of these have the goal of releasing trapped fluid in the eye to reduce the intraocular pressure(1).

Glaucoma is a disease that costs the U.S over $1.5 billion annually and has no known cures(3). Fortunately, with preventative care more cases of glaucoma can be caught and treated with the right medicines or surgery before they cause lasting damage.

Sources:

1 Glaucoma: http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/glaucoma?sso=y

2 Facts About Glaucoma: https://nei.nih.gov/health/glaucoma/glaucoma_facts

3 Glaucoma Facts and Stats: http://www.glaucoma.org/glaucoma/glaucoma-facts-and-stats.php

4 Glaucoma: http://www.mayoclinic.org/diseases-conditions/glaucoma/basics/definition/con-20024042

By Michael Craven

Here are 5 excellent reasons to attend this year's conference:

1. You will get to learn a whole lot about the new research and strategies that public health in Connecticut is adopting. Choose from 12 breakout session presentations that share the latest information, promote evidence-based practices, and raise awareness of emerging health issues in the field. Learn current strategies that are working for others and be inspired to initiate your own.

2. Network with hundreds of fellow public health professions from around the region. Meet the experts face-to-face and talk one-on-one with exhibitors who could one day become your partners. Connect with old friends, develop new relationships, and chat with like-minded people!

3. Meet up-and-coming public health professionals at the Student Poster Session and explore the research, projects, and experiences that students have worked hard on to share with the rest of Connecticut. 

4. Reflect, refocus, refresh your ideas about how to improve health outcomes in CT. Listen to and engage with our Keynote Speaker, Dr. David Katz, founding director of Yale University's Prevention Research Center, and associate professor of public health practice at the Yale University School of Medicine.

5. Earn Continuing Education credits for Certified Health Education Specialists (CHES) (additional fee does apply)

BONUS: Expand your network! Take the networking challenge and earn your chance at a gift card drawing!

Healthy By Design

2015 Annual Meeting and Conference of the CPHA

Friday, October 23, 2015

8:00am - 4:00pm

CoCo Key Convention Center, Waterbury, CT

REGISTER

If this fact ever gets brought up in conversation, people are going to give you plenty of reasons why the numbers seem to keep going up and plenty of ways to get them to go back down again.  New research demonstrates that 1 much debated reason may be more important than some others.

Guns.

Specifically, states that have the highest gun ownership rates also have the highest rates of homicide of police officers.  Gun ownership didn’t have a huge effect on the homicide rate (~ 4-5% increase) but it was the only variable studied that was statistically significant.  And in our age of numbers, statistical significance is everything.

So, more guns result in more homicides.  Less guns result in fewer homicides.  That seems pretty straightforward to me.

1. Breastfed babies typically get sick less. Breastfeeding reduces the risk of ear infections, diarrhea, and stomach problems.

2. Children who are breastfed have a lower rate of certain illnesses as they grow up. Babies who are not breastfed have a higher risk of asthma, diabetes, and childhood obesity. Since African-Americans are at an increased risk for these conditions, it’s important to understand the long-term benefits of breastfeeding.

3. Your baby can smell you. Newborns have a strong sense of smell and know the unique scent of your breast milk. That is why your baby will turn his or her head to you when he or she is hungry.

4. Your baby can see you up close and personal. Babies are born extremely nearsighted, which means they can only see things about 8 to 15 inches away. That also happens to be the distance between your face and your baby’s face when breastfeeding. So when your baby locks eyes with you, it’s a true bonding moment.

5. Breastfeeding allows your body to recover from pregnancy and childbirth more quickly. The hormones released when you breastfeed make your uterus contract back to its pre-pregnancy size.

6. Breastfeeding exposes your baby to many different tastes. Formula has one taste. But through your breast milk, your baby eventually gets a slight taste of whatever you eat, although not directly. This will later make introducing solid foods easier.

7. Breastfeeding may help you to lose weight. Mothers who exclusively breastfeed can burn as many as 600 calories a day, which may help you get back to your pre-pregnancy weight.

8. Breastfeeding reduces the risk of breast cancer and ovarian cancer in moms.

9. Breastfeeding can save a family more than $1,200 to $1,500 in formula-related expenses in a baby’s first year alone.

10. Your body starts getting ready to breastfeed during pregnancy. After you give birth, your body gets the final signal to make milk, which is usually more than one newborn can handle. Why? Your body doesn’t know whether you have one, two, three, four, or more babies to feed. Your supply then regulates to meet your baby’s (or babies’) needs.

11. Before your milk comes in, in the first few days after birth, your breasts make a thick, sticky, yellowish fluid sometimes referred to as “liquid gold.” Called colostrum, this liquid has the calcium, potassium, proteins, minerals, and antibodies your baby needs. Your baby needs only a few teaspoons to feel full and stay healthy until your milk flow increases, about two to five days after birth.

12. Your breast milk changes during a feeding session. When your baby first starts to nurse, your milk is a watery bluish color. Toward the end of the feeding session, your baby gets to thicker, fattier milk, which gives your baby the calories needed to grow healthy and strong.

13. Breast milk heals. Breast milk is filled with special components that are designed to help fight infection and cut down on swelling in the breast. So, if your breasts are sore those first few days, gently massaging some of your milk into your nipples and breasts can soothe the soreness and speed up recovery.

    I think so, since the public health profession, in Connecticut and across the United States, has turned its focus on developing healthy communities to address the ongoing epidemic of noncommunicable chronic diseases.

    This new focus has turned public health into a powerful ally of the school of urban planning known as New Urbanism, which looks to make cities of the future more livable places.

    The key elements of New Urbanism include walkability (pedestrian friendly), connectivity (avoiding infrastructure that creates man-made barriers between or within neighborhoods), mixed-use and diversity (of building uses and people alike), mixed housing (of unit size, function and cost), quality architecture and urban design (to create a sense of place), traditional neighborhood structure (modeled after how neighborhoods were a century ago), increased density (to maximize efficiency, conservation and convenience), smart transportation (reducing dependence on private automobiles), sustainability (minimizing the impact on future generations), and quality of life (for all, not just for a few).

    That’s a short summary of a tall order. Consult this web page for a more detailed explanation.

    The reason public health professionals are interested in this is we know that suburban sprawl, with its emphasis on the automobile, has played a role in the epidemic of overweight and obesity. New Urbanism’s de-emphasis of the automobile is consistent with the need to increase the amount of physical activity in the average person’s daily life.

    But what does this have to do with affordable housing? I’m glad you asked.

    You’ll notice in that list of the key elements of New Urbanism, the third item is diversity. One of the criticisms of New Urbanism is that it promotes gentrification and displaces poor people from their spruced-up neighborhoods. If that happens, it defeats some of the purpose that public health has in aligning with New Urbanism, because lower-income people have higher rates of overweight and obesity. It doesn’t make sense to displace them from neighborhoods that are transformed into healthier, more pedestrian-friendly environments.

    A slide presentation prepared by the Connecticut Department of Public Health, “Healthy by Design: The Connection Between Where We Live and Chronic Diseases,” indicates that income inequality in Connecticut correlates with chronic diseases. If this slide presentation looks familiar, it’s because Dr. Mehul Delal, DPH’s Chronic Disease Director, presented it several times during the past year at CPHA-sponsored events, including at our annual conference last October.

    Your ZIP code might make a bigger difference to your health than your genetic code.

    When we use planning and zoning to exclude low-income people, we limit those people to a few unhealthy alternatives. These are neighborhoods with higher pollution levels, more lead paint contamination, more substandard housing, more crime, more stress, and usually a much less healthy urban design.

    Affordable housing is a way to break this pattern. All Connecticut municipalities are supposed to meet target levels for affordable housing, but few of them do.

    In fact, affordable housing has become a dirty word in most suburban cities and towns, because it is used exclusively by developers to override local zoning and environmental codes and gain approval of high-density housing developments.

    But wait a minute, isn’t high-density development another part of New Urbanism? Yes, if it is mixed-use and located near mass transit connections. And as affordable housing is used by these developers, it almost never is.

    Whose fault is this? Some of the blame goes to municipal officials who refuse to include affordable housing in their plans of conservation and development.

    If local planning and zoning officials were to develop village centers consistent with the principles of New Urbanism, and require, possibly through special overlay district zoning, that the village development include affordable housing, then they would have a defense against those developers who would use the affordable housing law to plant high-density development in locations where it is not appropriate.

    Two new developments make this even more important. One was the Supreme Court decision on June 25 (Texas Department of Housing and Community Affairs v. The Inclusive Communities Project, Inc.) that strengthened the 1968 Fair Housing Act. The other was a new rule issued on July 8 by the U.S. Department of Housing and Urban Development that requires municipalities to account for their use of federal funds to reduce racial discrimination in housing.

    The court ruling and the new HUD rule may increase pressure on Connecticut municipalities to meet those affordable housing targets that state law says they are supposed to be meeting anyway.

    The public health profession must be ready to use this pressure to push for policy reforms that will promote the development of healthier neighborhoods for all the state’s citizens.

I wanted to bring a recent example to light.  In the July issue of the Mayo Clinic Proceedings, a well-cited medical journal (It has an impact factor of 6.2.  I consider anything above 2 a pretty good journal), an article was published that attempts to completely discredit a widely used method for collecting diet data and how such data should not be used to inform policy.  Now, under normal circumstances, I’m in favor of critiquing existing science because all methods have their flaws and can be improved upon.  But one sentence caught my eye:

“…we posit that the American diet is no longer a significant risk factor for disease for most individuals.”

If you blinked and had to read that sentence again, you aren’t alone.  In a country where the obesity rate is at 35% and another 34% overweight, carrying an extra few pounds, and more than an extra few pounds, is no longer the exception but the rule.  And we are supposed to believe that diet is somehow not involved?  Something doesn’t seems right.  Then I found this:

“Dr Archer has received honoraria from the International Life Sciences Institute and The Coca Cola Company. Dr Lavie reports receiving consulting fees and speaking fees from The Coca-Cola Company and writing a book on the obesity paradox with potential royalties.”

Ok, now it makes sense.  The authors are being paid by the largest soft drink company in the world and a “research institute” (yes, the quotes are necessary) that is funded by nearly every food and agriculture company in the world.  Of course they are going to conclude that nearly all of the existing dietary science should be discounted when making policy and that diet is no longer a risk factor for disease.

At this point, these authors have lost nearly all of their credibility in my eyes.  Perhaps you think differently, but whenever you see such far ranging conclusions as “…the American diet is no longer a significant risk factor for disease…” always check who is paying the speaker.  It’s often a company, corporation, or entity with ulterior motives.

At the end of the legislative session, the Connecticut General Assembly passed An Act Concerning The Use of Digital Open-Source Textbooks In Higher Education.  The Act creates a pilot program that encourages the use FREE, open-source textbooks at state colleges and universities (i.e. UConn, CCSU, SCSU, ECSU, WCSU).  Hm, perhaps I didn’t put enough emphasis on the FREE in that last statement.  Is that better?

I know, I know.  Your next question is why am I bringing up textbooks, particularly when the cost of tuition is rising faster than inflation.  Well, books are expensive too.  Try $1,200 a year expensive, and textbook costs have been rising at triple the rate of inflation since 2002.  Heck, I remember spending over $200 for textbooks that I’m fairly confident were never even opened, although they do fill up the book shelf quite nicely.

If we keep pushing for more educational opportunities and keep promising that more education will lead to a better life, then we also need to make sure such education is affordable, from tuition to fees, and yes, to textbooks.  With all the caveats that always come with these pilot programs, I think this Act could make a real difference.

In the meantime, here are some sites that offer open-source textbooks and other information:

• Community College Consortium for Open Educational Resources

• MERLOT

• Flat World

• OpenStax College

And if you want to learn something new but can’t afford to enroll in a course, here are a couple sites with open-source courses:

• MIT Open Courseware

• Khan Academy

• OEDb

    Each summer, Columbia University sponsors EPIC, the Epidemiology & Population Health Summer Institute at Columbia, at the Mailman School of Public Health. Most of the courses are of the hands-on, how-to type: Geographic Information Systems, Social Network Analysis, courses on research study design and analyzing epidemiological data, program evaluation, and other interesting topics.

    I am working on my MPH these at Southern Connecticut State University on a topic associating urban design and public health, and one course stuck out as too relevant to pass up.

    The course, Designing Healthy Cities to Reverse Obesity and NCD Epidemics, was taught by Dr. Karen Lee, a consultant on healthy built environment design and policy development. She formerly served as the New York City Health Department’s Built Environment Director and was a leader in the development and implementation of NYC’s Active Design Guidelines.

    The “NCD Epidemics” referenced in the course title are non-communicable diseases¾notably heart disease, strokes, cancer and type 2 diabetes¾that have replaced infectious diseases as the leading causes of death and rising healthcare costs. While these chronic diseases have always been endemic, their incidence rates have increased to epidemic levels. Some public health experts warn that if this trend is not reversed, current generations may be the first in modern history to have lower life expectancies than those that preceded them.

    Research shows that overweight/obesity is an important risk factor for these NCDs, while physical inactivity and unhealthy diets are key risk factors for overweight/obesity. This has led to a partnership between public health and urban planning professionals to create human living environments that encourage physical activity and improve access to healthy food as a way to combat the overweight/obesity epidemic.

    My Designing Healthy Cities classmates were a diverse group. Course participants came from the tri-state area, of course, but also from Canada, Taiwan and Brazil. They included an undergraduate student, a graduate student (me), and a college professor, as well as several employees of municipal and regional agencies, and they overlapped the public health, urban planning, and medical services professions.

    We followed Dr. Lee around the city, traveling mostly by subway, for meetings with city officials responsible for neighborhood development, transportation and affordable housing.

It is exciting to see these urban design features actually implemented. We visited a neighborhood in lower Manhattan where the bike paths have been placed between the sidewalks and curbside vehicle parking, turning parked cars into a shield to improve safety for cyclists and pedestrians.

At W16th Street and 8th Avenue, parked cars provide a traffic safety barrier for cyclists and pedestrians. Neighborhood design features that improve traffic safety encourage more physical activity by residents and visitors.

    Urban planners found that closing streets and creating pedestrian plazas not only made neighborhoods more “walkable” places, but it also promoted economic development, and that has helped build support for these unorthodox design features among business people and elected officials.

A pedestrian plaza at W14th Street and 9th Avenue provides a welcome space for people to gather, which attracts new restaurants, shops and other businesses to the scene.

    We got to see the new Citi Bike bicycle sharing system, run by a private company. Bicycles can be rented from and returned to self-serve docking stations placed around the city.

A man departs from a Citi Bike bicycle sharing station at W16th Street and 9th Avenue.

    We also got to stroll the length of the High Line, a public park created out of an abandoned elevated freight railroad line. Parks and open space are more likely to be used, and thus promote physical activity, if they are within a 15-minute walk of residents’ homes.

The High Line Park, which offers views of the city skyline and the Hudson River, was created from an abandoned elevated railroad spur.

    One morning we visited an affordable housing complex in the South Bronx that had a community garden on the roof.

Residents grow fresh vegetables for their dinner tables in a community garden on the roof of Intervale Green, an affordable housing complex.

    We discussed the role of architectural design in promoting physical activity and healthy communities with Hilary Sample and Michael Meredith at MOS Architects in Harlem.

Architects Hilary Sample and Michael Meredith explain how building design policies and architecture improve public health.

    Some of these ideas have begun to be implemented in Connecticut. They are concepts in which our state’s big cities are leading, but a handful of suburban towns have adopted them, too.

If we’re going to reduce the incidences of chronic diseases, control health care costs, and improve our quality of life, we can’t continue to follow the same formulas and prejudices that got us where we are.

Connecticut’s Top 10 Hiking Trails

Don’t know where to go?  Here is a list of the best places for all skill levels and all distances.  Want to keep it short?  Head to the Mattabesett Trail.  Have a desire to spend the day outdoors?  Take advantage of the Devil's Den Preserve.

Connecticut Forest and Park Association Events

Ever been outside and seen something beautiful, but have absolutely no idea what it is?  Walk along with CFPA and learn about the birds and the bees from a whole new perspective.

Feeling Adventurous?

Let’s be honest.  Connecticut’s mountains aren’t all that impressive.  If want a better challenge and are willing to drive just a little out of the way, head to Mt. Greylock in northwest Massachusetts.  It’s the tallest mountain in MA and has gorgeous views on a clear day.  Be sure to stop and rest in the lodge at the peak.

Feeling Really Adventurous?

For those who want a challenge, head up to Mt. Washington.  A more than 1 vertical mile hike will tire even the best of us.  I wonder if you get a bumper sticker when you reach the top?

End Hunger Connecticut is sponsoring Summer Meal Outreach Blitz Days in a town near you soon. Volunteers are needed to go door to door to let residents know about the free meals available for kids and teens 18 years of age and younger this summer. The meals are funded through federal programs such as the National School Lunch Program and the Summer Food Service Program.

The Summer Meal Blitz Days reach all corners of Connecticut:

New Haven

Saturday, June 20, 12:30-4:00 PM, Goffe Street Park

Thompson/North Grosvenordale

Monday, June 22, 1:00-4:00 PM, Riverside Park

Stamford

Tuesday, June 23, 9:00 AM-12:00 PM, Boys and Girls Club, 347 Stillwater Ave.

Windsor

Wednesday, June 24, 12:00 PM-4:00 PM, Goslee Park

Hartford

Thursday, June 25, 11:00 AM-2:00 PM, Camp Field Library, 30 Campfield Ave.

Plainville

Friday, June 26, 12:30-3:00 PM, Norton Park Bandshell

If you can’t make it to one of the Blitz Day events, you can help by spreading the word online or through your organization. To learn how, see www.ctsummerfood.org.

Free summer meals for kids and teens are served at many locations throughout the state. For example, New Haven plans more than 60 meal sites this summer. The End Hunger Connecticut website has a handy location finder that will be updated soon: http://www.ctsummerfood.org/location-finder. A look at last year’s locations showed meal sites everywhere from Greenwich to Groton, and from Danbury to Dayville.

    Although this may be a comfort to many state residents who are fortunate enough to live in favorable locations, it is also a substantial source of preventable illness that will cause higher taxes and health insurance costs for all state residents in years to come.

    Some neighborhoods are very healthy places. They have lower than average rates of every chronic disease. Other neighborhoods are just the opposite. The people who live there have higher than average rates of asthma, diabetes, hypertension, coronary heart disease and stroke.

But aren’t these diseases mostly caused by behavior, diet or genetics?

    It is true those may also be factors, but public health research has shown that zoning and economic development decision-making on the local level is the most important cause, at least in Connecticut. Restrictive zoning limits the housing opportunities for lower-income families. Comparisons of lower-income and high-income neighborhoods indicate higher incidence of obesity and chronic diseases in the poorer areas.

    But low-income people aren’t the only ones negatively affected by these planning and zoning decisions. Outdated, post-World War Two suburban sprawl created inefficient bedroom communities by sucking the economic vitality out of the central cities. It’s no surprise that suburban residential streets don’t have sidewalks. They are designed for motor vehicles. Public health research has linked sprawl and obesity. The more sprawl, the higher the BMI scores.

    Income inequality also plays into this. It is calculated using a statistical tool known as the Gini coefficient, which measures inequality in a frequency distribution. Confused? It boils down to this: the higher the Gini score, the greater the inequality. Where income inequality is concerned, Connecticut has a higher Gini score than all other states except for New York and Washington DC.

    Forbes Magazine lists Connecticut as the second richest state, but its income inequality creates sharp social and economic contrasts. Pockets of poverty exist where chronic disease prevalence is very high, compared with wealthier, and healthier, geographic areas only a few miles away.

    Research by the state Department of Public Health shows the effects of concentrating poor families in a few areas. When epidemiologists prepared Connecticut map overlays showing census tracts, they showed that high prevalence rates of chronic diseases (asthma, diabetes, hypertension, coronary heart disease and stroke) occurred only in neighborhoods with high density minority populations and high density low-income populations.

    The good news is Connecticut was ranked as the 4th healthiest state by the United Health Foundation’s annual America’s Health Rankings report for 2014. The bad news is we still have a number of challenges related to chronic diseases. Furthermore, populations defined by race and ethnicity, age, poverty and associated factors bear a disproportional burden for those illnesses.

    Land-use policies have geographically concentrated those populations in urban areas where air pollution, traffic congestion, crime, and stress are higher, and where access to recreation and stores selling fresh fruit and vegetables are lower. This increases those residents’ risk for chronic diseases.

Moreover, the long history of post-war suburbanization has stripped those urban areas of their tax base, depriving them of the economic resources needed to address problems associated with concentrated poverty.

    Connecticut has spent billions of taxpayer dollars for Educational Cost Sharing grants and economic development programs without successfully balancing these inequities. Now add the health costs, which are already substantial and will rise in the future.

    State taxpayers pay millions of dollars each year for health education programs aimed at getting residents to adopt healthier lifestyles and more nutritional diets. At the same time, their local elected and appointed officials adopt land-use policies that make it more difficult for the most vulnerable, highest-risk residents to follow recommendations to get more physical exercise and to eat five or more servings of fruit and vegetables a day.

    Not only does this make no sense on a rational annual budgetary basis, it also makes taxpayers liable for billions of dollars, perhaps even trillions of dollars, in future Medicaid and Medicare spending.

I don’t think land-use decision-makers set out to raise taxes. In fact, their intention might be just the opposite, to save costs on a local level by, for example, keeping out families with children who would add to their local education budgets.

    But while they are focused on the trees, they have lost sight of the forest. Their “good intentions” will have negative unintended fiscal consequences, in addition to the moral problem of neglecting the public health risks of the state’s most vulnerable citizens.

    The award is named for Charles-Edward A. Winslow, one of the most important figures in the history of public health. It recognizes a public health professional that has demonstrated leadership and achievement in practice, research and/or education.

    Winslow’s 1920 definition of public health is still taught to all students in the field nearly a century later. Go ahead and try to remember it; we’ll add it at the end to see how well you did.

    Jeannette Ickovics is one of Connecticut’s public health leaders and has distinguished herself in a number of ways, each one which could have justified her receiving this award. It would not be superficial to compare her accomplishments to those of the award’s namesake.

    At the CPHA awards breakfast on May 29 at the Lyceum in Hartford, Ickovics was introduced by Elaine Anderson, a former CPHA president, the 2003Winslow Award recipient, and a retired Yale University colleague of this year’s recipient.

    Ickovics is a professor of chronic disease epidemiology and psychology, and the founding director of the Social and Behavior Sciences program at Yale. In addition, she is the director of the Community Alliance for Research and Engagement (CARE) at Yale, and the deputy director and director of training for the Center for Interdisciplinary Research on AIDS.

    Winslow, of course, was the founder of the Yale Department of Public Health, and helped write the legislation to establish the Connecticut State Health Department. He also served as president and co-founder for both the American Public Health Association and the CPHA.

    Anderson noted that she found it “particularly appropriate” to give Ickovics the Winslow Award as Yale celebrates the 100th anniversary of the establishment of its Public Health school. As Winslow before her, Anderson said Ickovics “sees involvement in practice as the means of clarifying the relevance of teaching and research.”

    Her interest and accomplishments in professional development, multi-disciplinary research, policy development, and the improvement of individual and community health status mirror those of the award’s namesake, Anderson noted.

    She pointed out that Ickovics’ community-based research has been funded by more than $25 million in grants from the National Institutes of Health, Centers of Disease Control and Prevention and private foundations; that she is the author of more than 150 peer-reviewed publications, and that she is the recipient of numerous other prestigious awards for her public health work.

    Speaking to the CPHA awards breakfast gathering, which included numerous other association past presidents and Winslow Award winners, Ickovics said she was humbled to be a recipient herself.

    Ickovics is the daughter of Holocaust survivors, and quoted Nobel Peace Prize winner Elie Weisel’s enjoinder to take sides on behalf of the weak, because neutrality only helps the oppressor, never the victim.

    “I believe that public health and social justice go hand in hand every day,” she said.

She called on public health professionals to be engaged in creating the political will to improve conditions for all people. Imagine a world, she said, in which the resources for health were accessible for all.

    “I’d like to believe that there is so much more to do to achieve [Winslow’s] ideals,” she said.

And Winslow’s ideals were expressed well in his famous definition of public health: “The science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort.”

    The annual award, named for a professor of public health at Southern Connecticut State University who died in 2011, recognizes a graduate student or undergraduate student in an accredited public health at a Connecticut college or university who through student activities or community service demonstrates a commitment to leadership, volunteerism and high education standards.

Readers of this blog know him from his commentaries that are often published here.

    At the awards breakfast on May 29 at the Lyceum in Hartford, Jon said he felt honored to have been able to work with so many dedicated people who have advanced the public health profession through their work with CPHA.

    Yet few have shown as much of that dedication as Jon has himself.

    He was introduced for the Perlin Award by CPHA past president Kathi Traugh, who was a former student of Professor Perlin’s. “I know that he would be so proud to know someone of Jon’s caliber was receiving this award,” she said.

    Her introduction indicated what Jon means when he says he doesn’t heed his own advice. Kathi said she met Jon when she served as co-chair of the CPHA Annual Meeting Program Committee in 2008. Jon helped with its planning and program evaluation, and had served on the committee since 2006.

    She said Jon has volunteered in various capacities for CPHA, worked with every one of its committees, and played a role in in all of the organization’s major advances for nearly a decade. He developed and maintained CPHA’s web site, built its membership database, managed its communications and established its social media presence.

    Kathi said she came to rely on him so much during her three years as CPHA president that she referred to him as Saint Jon.

    Jon, who will be 30 in June, will not be the youngest-ever president of CPHA. He said the current president, Brittany Allen, is actually younger.

    He was originally in pre-med and trained as an EMT, but once he started riding ambulances he found it wasn’t what he expected. A random email to the Connecticut Department of Public Health secured him an internship working on tracking the H5N1 flu a few years ago and soon he was hooked.

Jon is now a doctoral candidate in public health at the University of Connecticut, on track to receive his degree in 2017.

    His research focus is on how addictive products are developed and marketed.

    The annual award is named for a past CPHA president and associate dean and professor of the University of Connecticut medical school, who was known as a strong advocate for public health in Connecticut up to his death in 2009. The Huntington Award recognizes a Connecticut health care practitioner who has demonstrated public health leadership and a commitment to the health and well-being of populations.

    A pediatrician by training, Dr. Updegrove has embodied the spirit of the award by serving as a leader of community health centers for the medically underserved in Connecticut, as a member of numerous boards and commissions on health issues, and as a volunteer physician for displaced refugees in Thailand.

    Dr. Updegrove is well-known as an advocate for universal childhood vaccinations, and has worked for many years to make sure vaccines are available to all children regardless of their socioeconomic circumstances.

    He was introduced at CPHA’s awards breakfast on May 29 in Hartford by Connecticut State Epidemiologist Dr. Matthew Cartter.

    Dr. Cartter noted some of the prominent roles Dr. Updegrove has filled for the state’s childhood vaccination program:

• Member of the CT Immunization Advisory Council in 1993, representing the Association of Primary Health Care Providers, to advise the Department of Public Health on the state childhood immunization program.

• Advisor to the Commission on Children, the CT Chapter of the American Academy of Pediatrics, and the legislature, to help expand the state’s universal childhood vaccine program and provide vaccines to all children regardless of insurance status.

• Chairperson of the Connecticut Vaccine Advisory Committee, advocating policies and best practices for childhood immunizations in the state.

    While serving as the medical director of the Cornell Scott-Hill Health Center, a community health center in New Haven, he went back to school and received his MPH from the University of Connecticut in order to acquire medical administration skills and learn more about the social determinants of health.

    “A lot of things that predispose our health outcomes correlate with other factors such as socioeconomic status,” Dr. Updegrove said in an interview. Some others, for example, are our social contacts, social isolation, and cultural beliefs.

He said understanding how those factors affect us helps explain why people have the health status they do and how to improve them.

    At the CPHA awards ceremony, Dr. Updegrove said he thought of himself as a person who owed his professional success to being born with extraordinary advantages. Because of that, people like himself have a greater obligation to serve the public good, he said.

    Willems, a science teacher at the Metropolitan Business Academy (MBA), an interdistrict magnet high school in New Haven, who teaches America’s first high school course in public health, is this year’s recipient of the Ira V. Hiscock Award from the CPHA.

    He said students have responded enthusiastically to his course. “Enrollment is strong, so we plan to keep offering it.”

    In fact, one of his former students has switched majors from nursing to public health at Southern Connecticut State University, and told him his public health course influenced her decision.

    On June 6, his students will bring what they have learned to Hartford to interact with other Connecticut high school students who have taken specialized courses developed by the Education Connection, based in Litchfield.

    The course at MBA was the idea of Jane Donn, program coordinator at the Education Connection, which develops courses to meet the needs of students in local school districts. Cyndi Billian Stern of CPHA wrote the course, and Willems was recruited to teach it.

    At the CPHA awards breakfast on May 29 at the Lyceum in Hartford, Willems said it was an honor to receive the award. “I’m blown away by all the support I receive and all the wonderful things that you do,” he told the gathered CPHA members.

    The Ira V. Hiscock Award is presented annually to a Connecticut layperson or organization that made notable contributions to the advancement of public health through public service, education, advocacy and/or leadership. It is named for an internationally recognized epidemiologist and public health professional at Yale University.

    Willems has been teaching biology and other science curricula for 20 years, 17 of them in New Haven. In 2011, he was named an Outstanding Biology Teacher by the National Association of Biology Teachers, and in 2014 he received the Robert T. Yeager Foundation Excellence in Teaching Award from the National Science Teachers Association.

    This year was his third year teaching the course, known as Public Health 101.

    He was introduced at the awards breakfast by Stern, who called him “an early adopter of both experiential and blended learning.” Although he had no formal public health training, Stern said it was clear from his enthusiasm and preparation that he was the ideal candidate.

Willems invited CPHA members to go recall their teenage years and think of something interesting that happened to them. Then he asked how many thought of something that happened in school. Nobody raised their hand.

    “I firmly believe that learning is in the doing,” he said, and he hoped that if he comes back to a CPHA meeting years from now, more people will remember something interesting that happened to them in school.

Despite this, Gov. Malloy got approval for CT FastTrak, a dedicated busway designed to bring from the suburbs into Hartford (Personally, I think he got stuck in traffic too many times).  If you have ever used public transportation to get to work, you know it is a blessing and a curse, and there are plenty of curses that go along with CT Fastrak.  It cost too much (~$570 million).  It too long to build (just under 3 years).  No one will ever use it (well…).  It’ll never make any money (wait a second…).

Let’s start with ridership.  In the first 5 weeks of operation, over 7,000 riders a day were using the system.  There are certainly more than 7,000 commuters driving into Hartford every day, but for a state that does not use, let alone rely, on public transportation, this is a huge number.  7,000 people a day?  There are 50 towns in Connecticut with fewer than 7,000 people.  50.  So on this one, let’s call ridership numbers an early success.

Now, let’s move to money.  Figuring out if CT Fastrak will break even is pretty tricky, and we’ll have to make some assumptions.  Let’s saw there are 7,000 riders a day and the average commuter pays $6 ($3 each way).  Under this scenario, CT FastTrak makes $42,000 a day, $210,000 a week, or $10,920,000 a year on fares alone.  Now, if Connecticut was on the hook for the whole bill, it would take about 52 years to pay off the constructions costs.  Thankfully, we are not.  We are on the hook for only about $170 million, meaning we can pay off the construction costs in fares alone in less than 16 years.  Considering the massive debt the MBTA in Boston (~$8 billion) and the MTA in New York City (~$34 billion) has, I think we are doing ok.

CT Fastrak doesn’t just earn money.  It also saves us money elsewhere.  For the person using the system, less driving into work means less money spent on gas and less wear and tear on the car.  I used public transportation every day when I worked in Boston.  I bought gas once a month and had an oil change once a year.  Now that I have to drive into work?  I buy gas once a week and have at least 4 oil changes per year.  Trust me, the difference is noticeable.  For the person who either chooses to, or has to, drive into Hartford, less cars on the road means quicker travel times and better fuel mileage. 

Even if you don’t work in Hartford, you will still benefit from less pollution caused from car emissions.  How so?  Well, less pollution means better air.  Better air means less heart attacks and less asthma and less death.  That means less healthcare costs overall and smaller healthcare premiums for those with private insurance and smaller tax burdens supporting those who rely on Medicaid down in the future.

CT FastTrak has finally been put into service.  Let’s make sure it is a success.

In Pittsburgh, pop-up-shop owner Elana Schlenker is raising awareness about the pay gap by charging women 76% of each retail dollar she charges men (women in Pennsylvania earn 76% of men’s earnings).  She plans to take her shop on the road and adapt her prices to reflect each state’s pay gap.  A similar approach was taken recently by a group of students at Jordan High School in Utah who charged girls 77 cents for items at their bake sales while they charged boys one dollar.

So what is Connecticut doing to address the pay gap?  In 2013, Governor Dannel Malloy created the Gender Wage Gap Task Force which released a series of recommendations to bridge the gap.  One of these recommendations was to stop the practice of “pay secrecy.”  The Task Force found that one of the best ways to address the problem of equal pay is to allow for open discussions about wages in the workplace.

Legislation was introduced by Governor Malloy in the current legislative session to prevent “pay secrecy” in the workplace.  While the bill does not require workers to disclose wage information, it does prohibit rules that prevent employees from sharing that information.  House Bill 6850, An Act Concerning Pay Equity and Fairness, was unanimously approved by the Labor and Public Employment Committee and is currently pending on the House calendar.

On the national level, Congresswoman Rosa DeLauro reintroduced the Paycheck Fairness Act, which would help close the gap by enforcing key provisions of the 1963 Equal Pay Act.  Some of the provisions include that employers demonstrate that wage differentials are based on factors other than sex and that retaliation against workers who inquire about wage practices or disclose their own wages is prohibited.

As women are often the drivers of positive health changes in their communities, bridging the pay gap is crucial to fully empowering and enabling women to lead the way in reducing health disparities across the state.

Looking back now, I realize the media covered Boylston’s street and the many heroic people who reacted quickly and saved many lives. However, there was also valor, solidarity, and many heroes one street over on Commonwealth Avenue where most of the runners who didn’t finish were sectioned off to. The media did not show this. Runners who had finished before the bombings came out and gave us their blankets, shared their water, gave us their shirts, jackets, sweat pants, bananas, anything they had to provide some comfort. Many other runners who were with me when the bombs went off offered their cellphones, a hug, and a helping hand when my legs gave under me and I fell. Residents of Commonwealth Avenue opened their homes to us to use the bathroom and get water. I was fortunate enough that a complete stranger who saw me in panic stayed with me until I was able to be reunited with my partner hours later.

Exactly, one year later I found myself in that same traffic heading up to Boston a few days before the marathon. The 26.2 bumper stickers were still there, but now a yellow and blue ribbon magnet was next to it. This blue and yellow ribbon became an emblem of love, courage, unity and kindness to remind us of that tragic day and bring us even closer. Cars had “Boston stands as one,” written on their windows, the Boston Marathon jackets were still proudly worn, but this time there was less fear and anxiety in people’s faces. Determination, pride, and fearlessness were the new feelings. The 35,000 of us running the 2014 Boston Marathon knew we were closer than ever before and we knew we stood as one. Tears filled my eyes as I embarked on a new journey to heal, process and finish what I had started a year before. The crowds were bigger and louder, the pats in the back from others runners were more frequent and the high fives from the children were nonstop. I chose not to care about my time. I enjoyed my journey and smiled, laughed and met hundreds of new runners. This coming year, I will not be running. I will be a spectator. I will stand on the side lines cheering on the many thousands who took on this challenge. I will never forget the horror of that day, but I always remember the comradery. At the end, no matter how many years go by we will continue to stand as one.

Gambling

A bill is currently making its way through the legislature that would allow the Mashantucket and Mohegan tribes to jointly open up to 3 new casinos in Connecticut.  Connecticut is highly reliant casino revenue to plug budget deficits.  As early as 2008, Foxwoods and Mohegan Sun contributed nearly $5 billion dollars to the general fund since their inception. This has not come without consequences.  Here are the results of a 2009 study prepared for then Governor Jodi Rell.

• The city of Norwich experienced a 27% increase in the number of motor vehicle accidents between when the Foxwoods casino opened to 2008 and was required to spend over $280,000 in police overtime in 2008 due to a 76% increase in the number of service calls.

• Connecticut’s casinos cost nearby towns $1-2.5 million a year, and the casinos have cost the state nearly $16 million from 2004 to 2008 in regulatory costs.

• Since casino gambling was legalized in Connecticut, arrests for embezzlement have increased by nearly 500%.

• The proliferation of sub-standard housing in surrounding communities have forced cities to hire “Blight Officers”.

• The prevalence of pathological and problem gambling increased over the last decade.

These are the costs of expanding gambling in Connecticut. 

Smoking

Connecticut has one of the worst records in the country for spending on anti-smoking efforts.  Of the $2 billion dollars given to the state from the Master Settlement Agreement since 2000, just about 10% has gone to Connecticut’s Tobacco and Health Trust, created to support tobacco prevention, education and cessation efforts.  The majority of this money, $170 million, has been taken by the state to help balance the budget or for other programs.  To put that in perspective, we spend $430 million for Medicaid costs each year for diseases caused by smoking.   Funding that would be well spent on tobacco cessation efforts is again slated to be taken for close budget loopholes.  Legislation has already been passed to suspend the Trust’s activities for 2016.

Drinking

In 2012, Gov. Malloy succeeded in lifting Connecticut’s ban on Sunday alcohol sales.  In 2015, Malloy is pushing for even greater expansions of alcohol availability and lower prices.  To say these efforts are misguided in an understatement.  There are numerous, consistent results from around the world that increasing alcohol availability increases alcohol use and alcohol-related problems.  These problems include more DUI’s, more motor vehicle accidents, more violence, and more deaths.  Not surprisingly, if we strengthen alcohol control policies, we see less alcohol use and less alcohol-related problems.  Connecticut already has an alcohol problem.  Over 18% of adults are binge drinkers with over 6% being classified as heavy drinkers.  Over 1/3 of our middle and high schoolers are current drinkers and 20% are binge drinkers.  These numbers scream for greater control, not less.

http://courantblogs.com/capitol-watch/blumenthal-esty-push-for-new-e-cigarette-regulations/

http://ctmirror.org/esty-introduces-e-cigarette-bill/

http://www.ctnewsjunkie.com/archives/entry/blumenthal_esty_tackle_bubblegum_flavored_e-cigarettes/

http://www.wfsb.com/story/25093297/18-million-students-have-tried-e-cigarettes

http://mms.tveyes.com/Transcript.asp?StationID=1260&DateTime=4%2F7%2F2014+5%3A58%3A01+PM&LineNumber=&MediaStationID=1260&playclip=True&RefPage=

http://mms.tveyes.com/Transcript.asp?StationID=1260&DateTime=4%2F7%2F2014+12%3A02%3A04+PM&LineNumber=&MediaStationID=1260&playclip=True&RefPage=

http://mms.tveyes.com/Transcript.asp?StationID=1270&DateTime=4%2F7%2F2014+11%3A03%3A52+AM&LineNumber=&MediaStationID=1270&playclip=True&RefPage=

http://mms.tveyes.com/Transcript.asp?StationID=2780&DateTime=4%2F7%2F2014+5%3A53%3A11+PM&LineNumber=&MediaStationID=2780&playclip=True&RefPage=

http://mms.tveyes.com/Transcript.asp?StationID=1275&DateTime=4%2F7%2F2014+9%3A11%3A51+AM&LineNumber=&MediaStationID=1275&playclip=True&RefPage=

Wait, what?

Corporations, particularly those who try to sell us products known to cause harm, buy sponsorship deals for sporting events all the time.

Coca-cola and McDonald's are sponsors for the Winter Olympics.

Anheuser-Busch, Taco Bell and Pepsi are sponsors for Major League Baseball.

Bud Light is the official beer of the NFL.  Coors Light used to be.

And it took massive lawsuits and federal law to ban Winston cigarettes from sponsoring NASCAR.

That's a lot of exposure for food and drink which aren't good for you.  Anyone else hear of the countless success stories of people on the Taco Bell diet? Neither have I.  And it is disingenious to say that it is entirely personal choice to eat, drink, or, formerly, smoke a product that is advertised.  It can't be entirely a personal choice because we, the consumer, don't have all the facts to actually make an informed decision.

The Coca-cola ad where God Bless America was sung in multiple languages was intended to both link Coca-cola with patriotism and Coca-cola with all of those linguistic communities.  Those languages and  images were picked for a reason, and were likely very effective.

All of the major beer producers plaster the airwaves during the NCAA basketball tournaments and the Bowl games with countless ads and in-stadium advertisements, all during games played primarily by underage people.

Now we have pictues of Olympic athletes with a dozen Big Macs on a tray during the Olymipcs.  Not afterwards, when people can relax and/or celebrate.  During.

To me, that's a problem.  The fact that more people don't see that as a problem, is also a problem.

Tobacco and pharmacies always seemed like the ultimate contradiction.  How is it that the same store can sell you a product that is a leading cause of death and disease while also selling you a separate product that is supposed to treat those caused by the first product?  The classic example is someone buying a pack of cigarettes in the front of the store while waiting for the emphysema prescription to be filled at the back end of the store.  It just seems wrong.

But, sadly, tobacco in pharmacies is widespread.  I was lucky enough to play a small role in a project studying just this thing while at the Harvard School of Public Health.  Not only did a majority of pharmacies have a tobacco license, nearly all that had a license sold cigarettes and many sold other types of tobacco as well.  Of course, they also sold nicotine replacement therapy.  Talk about double-dipping.

This move by CVS is very promising for a couple of reasons. They did it voluntarily, which seems rare in the public health world, and they are large.  This isn't your Mom and Pop place trying to set an example for their kids.  This is a billion dollar decision.  Hopefully, this will pressure other pharmacy chains to follow suit. 

 All pharmacies are pretty much the same to me, but if given a choice, I'll probably choose CVS now, for no other reason that to support a business that doesn't support a dangerous habit.

Six things we learned from the State of the Union

5 takeawards from Obama's State of the Union

Obama said what?! State of the Union explained

State of the Union Poll Gives Obama Positive Marks

Obama declares 2014 a 'year of action'

State of the Union 2014: President Obama's tough talk

State of the Union speech: Did Obama give up on Congress? Not exactly

Obama lowers expectations with State of the Union address

State of the Union: Obama's era of limits

President's State of the Union: A plan without action isn't a plan. It's a speech. Let's act on energy

The real state of the union is inescapable

Fact check: Obama's State of the Union

Or so we thought.

For Facebook, instead of our messages getting out to everyone who Likes the page, I'm lucky if a dozen people see it, and I think that is pitiful.

But why you ask?  Shouldn't a post go out to all the followers? Isn't that the point of posting after all?

Well, it should be, but it's not.  It may be due to the time when things get posted versus when people log in and it could be that people who follow our page simply don't log in very often.  But I'm skeptical of those reasons.  I see plenty of professionals online all the time, day and night.  Simply put, if you have a Facebook account, you are going to check it.

No, there is something far more annoying afoot...profit. 

And I get it.  Facebook is a publicly traded company and to appease the stockholders (I am not one of them), they need to generate revenue.  They do that primarily through ads.

What does this mean for our posts?  If I want it to reach more people, I need to pay for ad space.  They even put a hypothetical ad on the side of the screen for me to see what a potential could possibly look like.

But we can't afford that.  There are likely 100's of similar organizations around the state (1,000's around the country) in the same position.  So our messages, no matter how relevant or interesting they may be, get seen by only a select few, chosen by some hidden algorithm.

Annoying. Frustrating. A bunch of other words I can't say in a public forum.

Social media? Nah, I'm going back to a tried and true method...Smoke Signals.  Or maybe a skywriter.  Everyone will see a skywriter.

Is it even tobacco?

First, e-cigarettes are a tobacco product, not a drug/delivery device, not a food/drink product, just a tobacco product. Whether you believe it or not, that’s what the courts have said and the FDA has not appealed that ruling.

The FDA has the ability to label any tobacco product as a modified risk product, which is any tobacco product sold that is known to reduce harm. It requires a formal application and decision by the FDA, and seems fairly onerous. E-cigarettes may qualify…someday, but as far as I can tell, e-cigarettes are still in the same category as all the other high risk tobacco products out there.

No Smoking Sections

The biggest issue at the moment is whether or not e-cigarettes should be included in indoor smoking bans. Proponents will argue that e-cigarettes are safer than cigarettes, users are just trying to quit smoking and if you send them outdoors, they’ll just smoke regular cigarettes. I think this argument misses the point of indoor smoking bans. The bans having nothing to do with the smoker and everything to do with the people who are around the smoker. In this instance, I think the question to be asked is really, has e-cigarette vapor been proven safe to non-users? (I don’t think it’s appropriate to assume it is safe until someone proves it is dangerous.)

So is e-cigarette vapor safe for non-users? I have no idea. There hasn’t been nearly enough reports published or nearly enough data collected to even answer that question. It’s still very much in a theoretical world without much ground for either side to stand on. That said, because of this unknown, I believe e-cigarettes should be included in smoking bans, although that is subject to change pending new research.

Taxes

If e-cigarettes are a tobacco product and all tobacco products are taxed, e-cigarettes should be taxed, right? (Thank you transitive property) Yes, e-cigarettes should be taxed. The better question is how should they be taxed? They really aren’t like cigarettes, even though some look like it, but they REALLY aren’t like smokeless tobacco. If the absence of a separate tax status, I think a compromise would be to tax them similar to cigars. Cigars are taxed at a lower rate than cigarettes but may be high enough to dissuade non-smokers from trying them.

Advertising

If e-cigarettes are a tobacco product and tobacco advertising is banned (from most media), e-cigarette advertising should be banned too, right? (Thank you again transitive property). I believe the answer is yes, at least for TV and radio. These products are still considered tobacco products and tobacco ads have been banned from TV and radio for 40 years. I don’t understand why people think there is an exception to the rule for e-cigarettes. All of that could change in the future, but with the current way e-cigarettes are classified, I don’t see how broadcasting a e-cigarette TV commercial is legal.

(As an aside, I’ve seen e-cigarette commercials on more than 1 channel, from science shows to Red Sox programming. They are out there. No doubt about it.)

Warning Labels

I’m going to play this game 1 last time. If e-cigarettes are a tobacco product and all tobacco products have warning labels, e-cigarettes should have warning labels too, right? Just as before, I believe the answer is yes.  There's just not enough data to conclude they are safe enough to not need warning labels and the FDA still classifies them with other tobacco products.  There are 2 possible sets of warning labels that could be used: the warning labels for smoked tobacco and the warning labels for smokeless tobacco. Since e-cigarettes more closely resemble smoked tobacco products (inhalation of the product versus ingestion), I would favor using cigarettes warning labels. Our current warning labels really aren’t that bad, or all that effective, anyway. Nothing like the graphic warning labels of Canada or Brazil.

The Wrap-Up

So there you have it. These are the basic pieces of information I think anyone needs to talk about e-cigarettes. As for the products themselves? I’m not convinced they are a magic bullet that will make all of our cigarette problems go away. I think as more evidence comes out, the data will show they are not safe, just safer than cigarettes. I also think hazards to non-e-cigarette users will also be characterized.

There is just a lot of unknowns right now and it’ll be a few more years before the science has had a chance to catch up.

As far as I can tell, there are 3 main e-cigarette parts to be concerned about: the battery, the cartridge/liquid and the vapor. There’s also that whole smoking cessation thing to review as well.

The Battery

There are no reports on PubMed that I could find relating to the battery component of e-cigarettes. That doesn’t mean they are safe or not safe. It just means no one has published about it yet. But there have been reports in the media on e-cigarette batteries that have exploded. Some are attributable to users modifying the devices whereas others may have just been faulty construction. In the worse cast scenario, there is a systematic problem with e-cigarettes (Too much current for the wiring? Poorly constructed batteries?) and a regulatory agency needs to issue warnings or recalls. In the best case scenario, the problems are a long the lines of the brake problems Toyotas had a couple years ago. You doubt it’ll ever happen to you, but your trust in the product drops just a little bit. 

The Cartridge/Liquid

The liquid used in e-cigarettes is made up of a solvent (propylene glycol, glycerin, etc.), flavorings, and nicotine. There is no water in the cartridge (meaning there can’t be any water in the vapor either!). The heating elements of e-cigarettes are about 50% efficient at converting the liquid into a vapor, which leaves 50% of the nicotine and other chemicals that are supposed to be inhaled still in the cartridge. Levels of which can be toxic. Exposure of any kind to e-cigarettes caused 29 poisonings at the California Poison Control Center between 2010-12. Is this a small number? Absolutely, but there are also a small number of e-cigarette users, particularly 3-4 years ago. The point is there is a risk, and cases will likely increase with an increased numbers of users.

The Vapor

The single most important thing I can tell you about the e-cigarette vapor is that it is NOT water vapor. Nope. Nada. Not a drop of water in the thing. It is one of the few things I will say with any definitiveness. If you hear anyone, particularly an e-cigarette company, say it is just water, they either don’t know what they are talking about or are lying.

That said, everything in the liquid will appear in the vapor, well half of everything anyway, meaning the vapor is composed of a solvent (not water!), flavorings, and nicotine.

The main solvent is propylene glycol, which is used for the delivery of some pharmaceuticals into the lungs and appears safe in low doses, but there is a BIG but here. The dose of propylene glycol from a pharmaceutical product used a few times a day may be much less than from an e-cigarette which may be puffed hundreds of times a day. Could it be safe? Sure, but we can’t make the assumption that high levels of exposure are safe just because lower levels of exposure are. That would be some kind of strange logic.

There have been some lung function studies of e-cigarette vapor showing increase inflammation and decrease lung function, but they did not isolate the solvent from the other components so it’s not possible to associate the changes with any 1 component. There is also evidence of increase NO release when exposed to e-cigarette vapor, a sign of oxidative stress.

Findings on the flavorings that are being used are somewhat surprising. In lab settings, some of the flavorings have been shown to be cytotoxic (i.e. they kill cells), particularly embryonic cells, indicating there may be increased risk of exposure to neonates.

As for the nicotine…As I said yesterday, I’m not convinced that nicotine is a safe chemical. Somewhere between seeing researchers use full hazmat gear in the lab when using it to talking with drug users who quit every drug under the sun except nicotine, I said to myself this isn’t a good thing. There are some positive consequences of nicotine use, such as increased alertness, but I just think the negative consequences out-weigh the positives. Nicotine’s effects are concentrated in the cardiovascular system where exposure can lead to increases in heart rate, blood pressure, and breathing rates, and is known to increase the risk of heart attacks. There’s a reason this stuff was used as a pesticide instead of caffeine.

A few other things have been found in the vapor as well, including nitrosamines, which are known to cause cancer, and carbonyl compounds, which induce oxidative stress in the body. I’m sure there are more, but regardless, they occur at much smaller concentrations than those found in cigarette smoke. More troubling is the presence of metal particulates. Metal particulates don’t originate from the liquid but actually come from the heating element. Apparently, the heating elements get so hot as to slowly break off. I don’t know if the concentrations are physiologically significant, but it may be a sign of poor manufacturing standards.

Smoking Cessation

The good news is that e-cigarettes appear to help people stop smoking or at least cut down on the number of cigarettes per day. There are also cases studies where they were effective in some very extreme cases involving schizophrenia and/or dementia. But there are still high numbers of dual users, indicating full cessation hasn't been achieved. There may also be large numbers of e-cigarette users who never used cigarettes. A report out of South Korea showed that 23% of e-cigarette users never smoked cigarettes, indicating that e-cigarettes may be effective at smoking cessation but ineffective at nicotine cessation.

Normalization

What I think is the most dangerous thing about e-cigarettes is that when children see someone using them, children think the user is smoking a real cigarette. This is potentially the most dangerous aspect of the product. The legacy of the tobacco control movement is the denormalization of smoking. That’s what all the regulations are meant to do, from increased taxes, indoor and outdoor smoking bans, and warning label. By accepting a product that looks like smoking, there is a real threat that the efforts to denormalized smoking will begin to be unraveled and the act of smoking with be re-normalized.

Finally, if you end up doing you own research of e-cigarette science, always check who funded or supported the study. Some studies have been done with government funding, others with funding from public health foundations, and others have been done with industry support.

As I started to put this together, it got pretty long so I’ll break it up into 3 parts: 1) the important questions to ask, in my opinion, 2) the science, which has been published, and 3) the regulations that can be enforced. I’ll try to keep this as objective as possible, but let’s face it, it’s nearly impossible to be completely neutral on a subject and it wouldn't be a good blog if I didn't say at least a couple of things to get a reaction.

Part 1. Questions

There are a handful of important questions that I think need to be personally answered before a debate on e-cigarettes get started.  Too often I've been in an e-cigarette debate where we can't agree because we are arguing two completely things.

1) What is the reference point?

Are you going to compare e-cigarettes against cigarettes, approved smoking cessation products, or no nicotine or tobacco use at all? Each comparison offers support for very different conclusions. I’ll address the exact science briefly in the next post, but here’s the quick overview.

In terms of safety, if you are comparing e-cigarettes with regular cigarettes, you’ll conclude e-cigarettes are safer. How could you not? I’m hard pressed to find any non-prescription consumer product meant to be eaten, inhaled, injected, or absorbed that is more dangerous than a cigarette. They are just that bad.  If you see e-cigarettes as a cessation device, then you may want to compare them to the nicotine patch, lozenge, or inhalator, products which similarly deliver nicotine in the absence of tobacco. Since there are no regulations on e-cigarette manufacture, they likely contain higher levels of chemicals known to be dangerous than FDA approved nicotine products. And compared to complete nicotine cessation? I’ve yet to be convinced nicotine is a safe chemical, so I’m going to say that e-cigarettes are less safe than nothing at all.

2) Which should come first, proving the e-cigarettes are effective at reducing smoking or proving that they are safe?

As a country, we have taken the approach that a product should be considered safe before we test its effectiveness. That's the model the FDA uses for approving new pharmaceuticals and thats that standard all agencies take when determining levels of food safety.  Everything is not 100% safe (there will always be exceptions, but they are just that, exceptions), but we do minimize or eliminate risk whenever possible.  Traditionally, we do not promote a product as effective before showing that it is safe to use.  The definition of safety you want to use is has already been answered in question 1 (see how I did that there?).

3) Where is the impact?

Are you only focusing on the impact to the consumer? Or are you including in the debate the impact of those around the consumer? My public health training has taught me to look beyond the individual and determine the effects of a product on the entire population, not just individual users. With e-cigarettes, there are 2 additional populations beyond the consumer to think of: those exposed to secondhand vapor, and those who can’t differentiate between e-cigarette use and regular cigarette use at a distance. I’ll get into the implication of each of these in tomorrow's post.

4) What is your impact time-frame?

Are you looking at short-term or long-term impact? How long is the long-term impact you are looking at? 6 months? 1 year? 10 years? And are you looking at the short or long-term impact on the user or the surrounding population? These types of questions mount quickly, but we should think about them now rather than after the fact when regulations are easier to implement.  Remember, it took 3 decades after we knew cigarettes caused cancer to determine that secondhand smoke can cause cancer too.

Hm, I guess that was slightly less than a handful.  Eh. Tomorrow, I’ll do a brief review of the data that has been published, and only the data that has been published.  None of these one-off, potentially biased reports that have appeared on websites ranging from e-cigarette companies to the FDA.

CCSU on lockdown after reports of armed man spotted on campus

Yale on lockdown after report of gunman in area

Reports of gunman sends UNH into lockdown

Harvard on Lockdown: 4 Buildings Evacuated After Reports of Explosives

UMass Alert: University of Massachusetts Boston Evacuated, Reports of Gunman

Now, I'm no stranger to lock-downs or evacuations.  By the time I graduated high school, I was a pro.  There were gas leaks in 6th, 8th, and 9th grade.  Hit lists in 7th and 8th grade.  A PCB spill in 10th grade. A mercury spill in 11th grade. And dry ice bombs in 12th grade. (Wow, I never added it all up before, and in a "safe" suburb no less.)

But these seem strange.  5 lockdowns at 5 universities in 2 months in 2 states that are smaller than some of the counties out west. At the very least, the proximity of these events should have defied someone's odds. 

Which leads to a logical question, were the responses appropriate?  In hindsight, we know 4 were hoaxes (I think slightly less of Harvard students knowing it was done to miss a final), and 1 may have been caused by a halloween costume. But there's no way to know that when the email or call is received. 

(Isn't it a disturbing thought knowing anyone can alter the lives of thousands of people with a phone call, an email, or a text?  160 characters can make all the difference.)

So, were the responses appropriate?  Yes, in my opinion (and you can read here why it is just my opinion).  In today's climate, anything less than what occurred would have caused outcrys, but prevailing opinions on appropriate responses are never constant.  They will ebb and flow as opinions on most topics due. And someday, there may be 1 too many lockdowns caused by 1 too many students who didn't study for a final for people to take.  Then, the calls for more security will turn to calls for less, and the cycle will start anew.

We are nearing that time again.  The fall semester is over, and we look forward to winter break.  Well, most of us that is, because in addition to the holiday season, it's also the season for students to finalize thesis or dissertation topics.  And oh yes, there are always some mad scrambles to the finish line for those who keep putting it off.

But there is a silver lining...secondary data analysis.  If you have an idea, someone else has already collected some data on it at some point in time.  They may not have realized it, but they did, and any of us can be the beneficiary of the costly, labor intensive work of our peers. 

All for the low, low price of...nothing.

Here are some free sources of data for all of your project needs.

Project Tycho: Data for Health

Project Tycho has completed the digitization of the entire history of weekly Nationally Notifiable Disease Surveillance System (NNDSS) reports for the United States (1888-2013) into a database in computable format

Inter-University Consortium for Political and Social Research

ICPSR maintains a data archive of more than 500,000 files of research in the social sciences. It hosts 16 specialized collections of data in education, aging, criminal justice, substance abuse, terrorism, and other fields.

The Cancer Genome Atlas

TCGA is a national research program of NIH's National Cancer Institute. The goal is to provide publicly available genomic sequence data from over 200 difference types of cancers to foster research in bioinformatics, biomarker development, and cancer treatment.

And if those aren't enough, check out CPHA's Public Database Resource page for more publicly available datasets.

(For those of you worried about any regulatory issues, don't.  Yes, they'll likely have to be an IRB submission, but the use of public data can be submitted as an "Exempt" application. That means less time you have to worry about the IRB telling you what to do and more time to actually complete the research.)

Defining "fat" seems straightforward.  How could it not?  You see someone walking down the street with a beer belly, their fat.  But when you see someone coming out of the gym who is reasonably trim, they can be fat too.  It is the downfall of our reliance on BMI.  Muscle mass, which is good, is treated the same way as fat, which is bad.  And if you have a lot of either, you can be overweight or obese.  I'm technically overweight based on BMI alone, but I don't think many people would call me fat (they probably wouldn't call me fit either, but that's a different problem).

The meta-analysis analyzed studies which relied on BMI, and without providing incredibly detailed information on the study population, you just don't know if a handful of high muscle mass/low body fat individuals skewed the results of an individual study.    Waist/height ratio is probably the better measure of obesity if you could only pick 1, and yes, I've met people where that ratio is 1.  Sadly, they were in the healthcare field.

Defining "fit" can get a little trickier.  Is "fit" being able to run a mile or a marathon?  I recently read about a guy completing an ironman triathlon who openly admittedly he was fat, and he has a much higher athletic fitness level than me.  But that may not be the correct definition to use in the debate.  Instead, "fit" should mean inflammation, where the fitter you are, the lower state of inflammation your body is in.  Fat increases inflammation, and inflammation is linked with diabetes and cardiovascular disease.

 I think people can be fit and fat, but I haven't been convinced that they could be "fit" and fat.  And so the debate continues.  Now, where did I leave that donut...

5) Keep your kitchen clean.
Between raw vegetables, raw meat, and stuffing which is design to soak up anything around it, there are a lot of chances for cross-contamination, and about 1 in 7 home kitchens would fail a standard health inspection. Remember to wash your hands, knives, cutting boards, and pots/pans before switching to a new type of food. 

4) Refrigerate your leftovers quickly
I like my day-after Thanksgiving turkey sandwiches and I want to keep it that way.  But in the post-Thanksgiving meal haze, don't forget to throw whatever hasn't been inhaled into the fridge within at most 2 hours.  Bacteria can reproduce quickly.  E. coli does it in 20 minutes. If that isn't enough, check out the video below.

3) If you are going to drink, watch the game
Last year, there were 178 car crashes on Thanksgiving.  In 2011, there were 2 deaths.  If you want a glass a wine, pint of beer, or something stronger to keep you warm, go for it.  But stay home and watch football.  That's what it is there for.

2) Your turkey looks hot...and it should
A fully cooked turkey need to be at least 165 degrees in the very center of the bird to kill bacteria, viruses, and fungi living on and within the bird.  Still thinking about pulling the turkey out a few minutes early?  Watch that E. coli video again.  I dare you.

1) Don't Fry a Frozen...Anything
Fried turkey may be the best I've ever had, but make sure it is completely thawed first.  Make sure to pat it dry too.  When ice or water hits boiling oil, it instanly vaporizes, causes bubbles, causing the oil to overflow the pan, which then catches fire from the heating element you are using.  There are about 1,900 fires each year on Thanksgiving around the country.  Not all from turkey frying, but it is certainly the most dramatic example.

Have you guessed it yet?  I think the last one gave it away.

It's Public Health.  Public health professionals that is.

All of us spend so much time and effort on our projects, on our research, or on some email you received late at night that you absolutely swear is the last one you'll answer before going to bed, unless one comes in from the guy you've been waiting to hear back from. But how much time do we take for ourselves to stay healthy?

I say that I'll go running in the morning, but then use the cold weather as an excuse not to go.  I'll be in the office for 12-13 hours, eat dinner after 9, do another hour of work, then off for 5 to 6 hours of sleep before doing it all over again.  I'll eat salted snacks and fried food thinking of only how many napkins I'll go through by the end of the meal.

We drink. We smoke.  We gamble.  We eat foods that are bad for us and don't get enough exercise.  We work too much and don't take enough vacation time.  We have aches and pains that go unexplained.  We live on caffeine and that half a sandwich in the office fridge that was left over from yesterday's meeting. 

None of this should be surprising.  Everyone does those things.  But we are Public Health.  We are the ones telling you to stop doing that.  Shouldn't we at least be doing these things at a lower rate than everyone else?  Either way, I'd like to find out.  And if you're interested too, let me know, and fast.  I've got a dissertation proposal to write.

THE NUMBER ONE REASON EVERY PUBLIC HEALTH STUDENT SHOULD ATTEND THE CONFERENCE IS...NETWORKING. 

Now, instead of boring you with the same list of reasons that we have heard some many times on why networking is good, I'm going to share a brief story I learned from the conference.

An SCSU student began talking with one of the other conference attendees, who happened to be a director from one of Connecticut's public health non-profits.  The student had the same set of interests as the non-profit so the conversation was not unusual from a subject-matter standpoint.  But what was unusual was that the director was currently looking to fill a new position.  The director was so impressed with the student that an interview was set up for 5 days later.

5 days.  That's it.

If you told me coming out of college that all I had to do was talk to a few people at a conference and I could get an interview within the next week, no application or resume to put together, I would have wondered where to sign.

So students, come to our conference to potentially meet your next boss.  Bosses, come to our conference to potentially meet your next employee.  And for once in your life, talk to strangers.  It's allowed.

For the 1st ever 3 Questions segment, I am pleased to present Dr. Audrey Chapman, Professor at the UConn Health Center, Joseph M. Healey, Jr. Chair in Medical Humanities and Bioethics, and founding Director of the AAAS Program of Dialogue on Science, Ethics, and Religion. (She's also one of my professors and we just happened to talk about exchanges a couple of weeks ago).

I asked her 3 questions on Connecticut's new health insurance exchange.

1) The state health insurance exchanges are rolling out on October 1st; however we’ve already seen some states delay the role-out due to technical problems and the small business exchange has been pushed back by a year. How do those developments factor in to the participation rate of the exchanges and how do they affect the population’s trust that the exchanges will actually work?

I think the unexpected level of interest, which is far greater than Massachusetts experienced in the early days of its exchange, along with the inadequacy of the software to handle so many people, accounts for the problems with the roll out. It is more likely to engender frustration than distrust of the AC A. If the technical problems with the ACA can be resolved soon, they are unlikely to have a long or even medium term impact, especially since surveys show that the more people find out about the ACA, the greater their support.

2) Other countries are currently using health insurance exchanges but there are national requirements that all individuals must purchase health insurance in those exchanges. The exchanges in the U.S. don’t have that requirement. How do you see that affecting their ability to keep health insurance premiums affordable?

Like the US, many other developed countries require that their citizens have health insurance. I think that requirement matters more than where the insurance is purchased. What is more significant is that other countries, like Switzerland and the Netherlands, which use exchange mechanisms for the purchase of insurance, regulate the content of the basic health insurance policies offered more stringently to assure uniformity with the basic insurance policy offered. Also some countries, for example the Netherlands, require that basic health insurance policies be offered on a not-for-profit basis so as to be able to hold down the cost.

3) What is your realistic expectations for the affect of Connecticut’s insurance exchange on access to quality healthcare in the state?

The low cost and subsidized insurance policies for the poor offered through Connecticut’s insurance exchange, combined with the state’s decision to adopt the ACA supported expansion of Medicaid access to citizens and legal residents below 133% of the federal poverty level, will increase access to healthcare in Connecticut. However, the quality and affordability of healthcare will also depend on other components of the ACA. Also many analysts have pointed to a potential problem of an insufficient number of primary healthcare providers to be able to care for the newly insured populations. Unfortunately the ACA will not cover undocumented residents and documented residents in the U.S. less than five years, nor provide access to insurance offered through the exchanges. Approximately 12 % of Connecticut’s population is foreign born, of which about half have become citizens. So about six percent of Connecticut’s population will not be eligible for health insurance through the Connecticut exchange.

But really, who has the time for that? So I'm going to do the next best thing. Use somebody else's deep, thoughtful essays!

Below is a list of news articles on all the ways this shutdown is bad for the public's health.

Now, we pretty much already know how Connecticut's Senators and Representatives are going vote but that doesn't mean we can't pressure them to do more on the Hill to push the process along behind closed doors. So here are the sites Democrats website for the Senate and the House of Representatives. Emails works. Call are better. And if you happen to be in D.C., it's ok to hold your nose. They haven't been able to collect trash in a week.

• 9 Ways The Government Shutdown Could Affect Your Health
• The government shutdown and your health (Video)
• A Few Ways the Government Shutdown Could Harm Your Health (And the World’s)
• NIH, CDC feeling government shutdown's effects
• 6 Ways Government Shutdown Will Impact Science, Health
• Shutdown keeps 10 children with cancer from clinical trials
• Public Health Put at Risk by Government Shutdown
• Government Shutdown Disrupts Public Health Programs
• Government Shutdown Delays Approval for Cancer Patient's Much-Needed Drug
• Goodbye, government: shutdown affects science, the environment, and health

It has come to my attention that I do a lot of things. Actually, I was told I do too much and to stop taking on so many projects. That’s probably not going to happen. If anything, I’ll try to get my hands in a few more pots before I really feel maxed out, but it did make me realize that I need to relax more.

Ah, relaxing. Such a foreign concept. There are maybe 4 hours a year where I really just sit down, think about nothing, and feel relaxed. It’s hard to just sit there. There’s always something to think about, a new report to read, an email to respond to. We are all guilty of it. We are all trying to do more with less, and if there is a new, interesting project we hear about, we jump at the chance despite the 14 other half-finished projects that we are a part of.

Which gets me back to relaxing. It can’t be healthy to work this much. We are public health after all. If we are overworking ourselves, how can we tell other people not to overwork themselves? Some days we just need to take a deep breath, sit down, and relax.

So that’s what I’m going to do this weekend. I won’t just be sitting on a chair somewhere if that’s what you’re thinking. Maybe I’ll finish that project I started. Or clean out the garden. Or start raking the leaves. Or…No. I’m going to relax, somehow, maybe. So if you can’t reach me for a few hours this weekend, you know why.

I’ll start back up bright and early in the morning though. There are a couple more projects to get started.

Well, maybe. That’s our intention anyway, and I’m cautiously optimistic that there’s a good chance that we might possibly be able to find a way to eventually determine how to get there at some point in the not too distant future. (Have I got you hooked yet?)

There are some good ideas brewing, and if it is anything like the actual brewing process, we’ll create something that has good commentary, clear ideas, with some seasonal variations, and a palate-cleansing aftertaste.

We’ll talk to people about some current public health topics and ask some others how they got into the business to begin with. We’ll try to put some information up to help all those public health students out there, and maybe even have a guest blogger or 2 (Hey commissioner! You got a few minutes?).

But most of all, we want to put up information and insight that you want to hear, or I guess read in this instance. So leave a comment and tell me what you want (Please, it makes my job much easier). And maybe I’ll keep the shameless plugs to a minimum (2013 CPHA Annual Conference, 10/25/13, Don’t miss it!).

Oh, and the big disclaimer. Nothing written is intended to be the official viewpoints of CPHA. CPHA is not responsible for any content posted on the blog or in the comments section, and nothing written should be construed as CPHA supporting or opposing any position. Everything here is the complete responsibility of the poster. Or guest poster. Or the kid I get to do it for more who lives down the street. Anyway, you get the idea.

So comment away and let’s see what we can cook up.

I’m not going to give an eye-witness account. I wasn’t there when the bombs went off.

And while I can’t describe how the panic, confusion, and chaos must have felt, I can tell you how I felt that afternoon.

I got chills watching the news unfold about what happened. I walk down Bolyston Street on a regular basis. I’ve been in those stores and eaten at those restaurants. I get my hair cut a block away. The Boston Public Library is across the street from 1st bomb, and my bank is in the Prudential Building, across the street from the 2nd bomb.

It gives me chills just to type the words "bomb" and "Boston" in the same sentence.

Part of me is not surprised that something like this occurred. In the past few years, we have had shootings at movie theaters, schools, and places of worship. We have had threats or attacks in Times Square, at a Martin Luther King Day parade, and on board airplanes. It has happened in places that I can and cannot imagine. So, no, I’m not surprised it happened in Boston.

What has surprised me is how people around the city have reacted. Stories of people inviting total strangers to spend the night after Bolyston Street was cleared out. Stories of runners, exhausted after the Marathon, literally running to hospitals to donate blood. Seeing the video of how the first responders and bystanders didn’t hesitate or waiver to help the injured in what can only be described as chaos.  If Philadelphia is the City of Brotherly Love, Boston is your extended family. 

But still, from a day that was reserved for celebration: Patriot’s Day, the Boston Marathon, the anniversary Jackie Robinson broke the color barrier in baseball, and a walk-off win by the Red Sox, we now get a day of mourning and remembrance.

I wish I could give a stirring speech on how this demonstrates the importance of emergency preparedness or on how we shouldn’t cut public health budgets.  I wish I could give that rousing public health speech that will turn our sadness into motivation.  But I can't.  That’s not where my mind is at the moment.  My mind is in a decidedly un-public health place.

I'm not thinking about the city or the population.  I'm thinking of the individuals.  I'm thinking of the victims.  Of the Heros.  I'm thinking what would I have done if I was there.  And I'm thinking that it could have been me.