Monthly Archives: October 2012

Oct 31 2012

Adewale Troutman: NewPublicHealth Q&A

Adewale Troutman, APHA Adewale Troutman, APHA

Adewale Troutman, MD, MPH, becomes president of the American Public Health Association today. Dr. Troutman is the former head of the Metro Louisville (Kentucky) Department of Health and Wellness, and is currently a professor of public health practice at the University of South Florida. NewPublicHealth spoke to him this week about his vision and mission.

NewPublicHealth: Are you hopeful about the future?

Dr. Troutman: I am always hopeful about the future, I have seen so much in the past. One of the sad stories that I often think about is as a kid seeing the cover of Jet Magazine and a picture of Emmett Till who was murdered in the South, accused of whistling at a white woman. That was a low point for me as a kid because I was a child and I was absolutely terrified that something like that might happen to me.  So much has happened since then. I mean I had a high school average of 69, my first semester at a community college was a .38. I didn’t know anything about school or college and yet here I stand today, many years later, with some five degrees, an emergency medicine physician, running health departments for the last 15 years now ascending to the presidency of this organization. You got to be hopeful with that kind of a background. So yes, I am very hopeful. 

NPH: What’s ahead for public health under your leadership?

Dr. Troutman: We are looking now and ahead at a definition of health that is much more than just going to the doctor’s office. Health is not health care.  Health care is a part of the spectrum of health and we need to look at it that way.

Together with non-traditional partners we are looking at social determinants -- the things that are responsible for the health of populations and you find things like housing, education, neighborhoods, urban blight, crime and punishment,  early childhood development, and social isolation. You have to be in partnership to address those issues because they are other people’s fields of specialization and we need to find a way to recognize that all of them act together synergistically to improve the health of a community. And a healthy community is a fair community. 

In my health department in Louisville for instance we reached out to Jobs for Justice.  Some asked if I was crazy, and I said no. Employment status is an integral part of the health of populations and communities. And there are people out there that have more of a history or more expertise in social justice, community organizing, policy development, than maybe we do. So why shouldn’t we be in an equal partnership with them? 

Oct 31 2012

Changing Social Norms on Risky Drinking

In observance of the twentieth anniversary of the Centers for Disease Control and Prevention’s Injury Prevention Center, yesterday’s sessions at the American Public Health Association meeting included a panel discussion on injury and violence prevention. The issue is critical, say experts, because despite ongoing efforts to prevent and reduce injuries in the U.S., they remain they remain the leading cause of death for children and adults between the ages of 1 and 44 years.

Yesterday’s panel, convened around the Injury Center’s theme for the year, "Celebrating the Past and Protecting the Future,” and included experts discussing the need to create new policies to reduce injuries, youth concussions and risky drinking among young adults.

NewPublicHealth spoke with Stephen W. Hargarten, MD, MPH, Professor and Chair of the Department of Emergency Medicine and director of the Injury Research Center at the Medical College of Wisconsin, who discussed risky drinking during yesterday’s discussion.

NewPublicHealth: You head a youth alcohol risk reduction project which you spoke about during an APHA panel yesterday. Tell us about its scope.

Dr. Hargarten: Our project in La Crosse County addresses risky alcohol use and abuse in young adults and those under age 20. We started the project in 2007 addressing the challenge of alcohol-related injuries and death among youth and precipitated by the death of a student who was severely intoxicated and who drowned in the Mississippi River. Our goal is to change the social norms of La Crosse County, which requires that we have community involvement. We have collaborations with the universities, the hospitals, with the public health community in the county, and we are changing the social norms by looking at risk factors among youth, at factors that make this a hostile environment for youth to be able to make good decisions when it comes to alcohol.

NPH: What are the specific actions you’ve taken?

Dr. Hargarten: We are looking at helping young adults make better choices about what they do and don’t do but more importantly I think it is an environmental intervention.  The environment for their deciding to drink alcohol is an important consideration for us to make when we are making the changes necessary. The ways that we are doing that include server training, making sure that colleges are creating a positive environment for the students to make good choices about what they do on weekends, as well as during the week. 

NPH: What information do you have so far on how well it’s working?

Dr. Hargarten: Our preliminary data suggests that we have fewer hospitalizations that are alcohol related for our youth, fewer emergency department visits and while we had seven alcohol-related drownings  in our community between 1999 and 2007, we have had only one such drowning since then. So we are hoping that we are making an impact in our community.

NPH: Is this replicable in other communities?

Dr. Hargarten: Yes, I think that the whole issue of the way we have done this has really presented at-risk youth and abuse as a public health issue. It affects youth, it affects families, it affects the communities and it is important that it is framed that way.  And we have partners who are tavern owners, we have partners who are community leaders, we have partners in academics and those partnerships are critical in order to change social norms.

NPH: And, given the preliminary success that you are showing, do you think this can translate into public health interventions for other risky behaviors by young adults?  

Dr. Hargarten I absolutely do, because we see we are beginning to impact the issue. We are seeing fewer motor vehicle crash deaths that are alcohol related in our community. So, yes, I think it impacts the health of the community in broader ways than we initially had anticipated.

Oct 31 2012

Arguments For, and Against, a Tax on Sugar-Sweetened Beverages

Over the past few years, many cities and states have considered taxing sodas and other sugary beverages. At the American Public Health Association meeting, Judy Jou, a PhD candidate at the University of Minnesota School of Public Health, discussed a study in which she and her colleagues interviewed stakeholders about their views on a sugary beverage tax. The study was supported by a grant from the Robert Wood Johnson Foundation through its national Healthy Eating Research program.

Most of the eleven interviews were with public health advocates and policy-makers. These stakeholders indicated that the main arguments in favor of the tax revolve around health:

  • Sugary beverages contain large amounts of sugar and/or calories.
  • Sugary beverages are a major contributor to obesity and related health conditions, especially for children.
  • The revenue generated by a sugary beverage tax can be used to fund community health programs.

Some stakeholders said that visual representations of the sugar in these beverages were effective at communicating the first point. Stakeholders learned messaging ideas through personal networking, published documents, other sugary beverage tax efforts and—less frequently—testing from focus groups or surveys.

The most common messages used against sugary beverage taxes included:

  • Government is acting as a “nanny state” and is restricting personal choice.
  • These taxes would have a negative economic impact on businesses and workers.
  • Soda and other sugary beverages are unfairly targeted and are not the only cause of obesity.

Citizens in two California cities, Richmond and El Monte, will vote on sugary beverage taxes on Election Day next Tuesday. In both cities, the campaigns to defeat the taxes have much more funding than the campaigns to pass them. One big challenge identified by the stakeholders Jou and her team interviewed was the vast resources the beverage companies have to fight these tax efforts.

>>The Los Angeles Times recently reported on the effort to pass a sugary beverage tax in El Monte.

>>Learn more about how pricing strategies— both incentives and disincentives—can promote the purchase of healthier foods.

Oct 31 2012

Getting Kids Active: Physical Activity in Schools

Cleminson Elementary_4891

Get kids active now and often was the message at a session on childhood obesity at the American Public Health Association 2012 Annual Meeting in San Francisco.

"Students are not getting enough exercise," said Christina Economos as she opened the session, though "physical education develops skills." Childhood Obesity 180 created the Active School Acceleration Project, which works to promote exercise inside as well as outside of school.

The Active Schools Acceleration Project works to increase quality physical activity in schools to combat childhood obesity and to get the beneficial health, behavioral, and academic outcomes that follow. American children today experience far fewer daily opportunities for movement and exercise because there is a decreased emphasis on physical activity in schools.

Economos noted that physical education is often one of the first programs to go following school budget cuts. Their goal is to reverse the trend of childhood obesity, one generation at a time—the benefits of which, aside from healthier, longer lives, include improved academic performance in school. This makes childhood obesity prevention a priority for schools, despite strapped budgets.

Economos and her team developed a four-pronged process—to find innovation, identify best practices, support existing and start up new interventions, and make plans for long term sustainability. They looked at grassroots programs in local schools as well as established national movements. The result was an "American Idol" type contest to solicit entries that showcase best practices for encouraging vigorous physical activity among students.

The ultimate goal is to showcase the best approaches to physical activity in schools. Practitioners hope to influence school policy change on physical activity from the bottom up.

Oct 31 2012

Recommended Reading: Living and Learning at APHA

To follow is an excerpt of a blog post by Myra Parker, JD, PhD, is acting instructor at the Center for the Study of Health and Risk Behaviors at the University of Washington and a Robert Wood Johnson Foundation (RWJF) New Connections grantee, about her experiences at the APHA Annual Meeting.

I took my seven-year-old daughter to help me pick up my registration materials at the Moscone Center. I was thrilled to map the American Indian, Alaska Native and Native Hawaiian (AI/AN/NH) sessions and discover they are located in one of the central buildings this year! It’s terrific to be able to attend the general sessions AND those specific to my community, which has not always been the case with AI/AN/NH sessions held in off-site hotels last year in Washington, D.C.


I was excited to see the diversity of attendees across many different professional backgrounds and ethnic/cultural communities.


My first session, since I am working on an evaluation of a tribal home visitation grant funded under the Affordable Care Act through the Administration for Children and Families, was Protecting the Health of Our Children and Families – Examples of Maternal and Child Health in Indigenous Communities. It was standing room only!! The first presenter focused on a national campaign to raise awareness about Sudden Infant Death Syndrome within AI/AN communities, entitled: Lessons from designing a campaign to address infant mortality among urban American Indians and Alaska Natives, by Shira P. Rutman, MPH and Crystal Tetrick, MPH. Being in Seattle and being Native, of course I am aware of the groundbreaking work done at the Urban Indian Health Institute based at the Seattle Indian Heallth Center. It was a treat to hear about one of their efforts and you can learn more here:

>>Read the full post over on RWJF's Human Capital blog.

Oct 31 2012

Public Health News Roundup: October 31

Missed Work by Smokers Costs Economy Billions
Smokers miss work more often than nonsmokers and costs their employers—and the economy—billions of dollars each year, according to a new study in the journal Addiction. Researchers analyzed studies covering approximately 71,000 public and private sector workers across the globe, finding that in the U.K. alone the average loss of an extra two or three days of work meant a loss of $2.25 billion in 2011. Smokers are 33 percent more likely to miss work than their nonsmoking coworkers. "Clearly the most important message for any individual's health is, 'Quit smoking,' but I think that message is pretty well out there," said Douglas Levy, a tobacco and public health researcher from the Harvard Medical School in Boston. "I think (the study) does point to the fact that this is something that doesn't just affect the individual, it affects the economy as well." Levy was not part of the study. Read more on tobacco.

Public Health Effects of Hurricane Sandy to Linger
As workers struggle to begin repairing the damage caused by Hurricane Sandy, officials are warning that the storm’s lingering effects will likely mean a variety of public health issues in the coming months. Immediate dangers include lack of electricity and the inability to access basic medical care—especially important for the elderly. Experts also expect long-term issues such as lack of clean drinking water and an increase in pollens, molds and other allergens. "Immunocompromised people and elderly people are probably at highest risk for complications from mold exposure and these are the people who should stay away from water-logged buildings, especially for prolonged periods of time," said Pavani Ram, MD, associate professor of social and preventive medicine at the University at Buffalo's School of Public Health and Health Professions, according to HealthDay. Read more on disasters.

Smoking, Being Overweight During Pregnancy Increase Odds of Overweight Kids
Mothers who are overweight and smoke during pregnancy are more likely to have overweight children, according to a new study in the journal Archives of Disease in Childhood. Researchers analyzed 30 studies looking at early-life health of approximately 200,000 people. The link between smoking and overweight children could be a sign of overall social and lifestyle risk factors, according to Stephen Weng, MD, of the U.K. Center for Tobacco Control Studies at the University of Nottingham. "Several risk factors for both overweight and obesity in childhood are identifiable during infancy," Weng and colleagues concluded in the report. "Future research needs to focus on whether it is clinically feasible for health care professionals to identify infants at greatest risk." The study also found that breastfeeding and late weaning reduced the likelihood of obesity. Read more on maternal and infant health.

Oct 31 2012

Engaging Partners and "Pillars of the Community"

West Oakland residents West Oakland residents

Back in 2003, officials from the city of Oakland approached the head of the Alameda County Public Health Department to figure out how to collaborate to tackle the growing problem of violence. They began working together, and with the community, to figure out what was going on. Through a series of rigorous, door-to-door community surveys and community forums, they discovered a complex web of interrelated community issues—as well as a number of powerful community assets and existing partnerships.

Alameda County public health officials presented at the APHA annual meeting on a session about the role of community partners in community-based public health.

Alameda is a county of opposites, according to Liz Maker, Evaluation Specialist at Alameda County Public Health Department—some very poor, some doing amazingly well and in some cases those sections are separated only by a block or a fence.

Sobrante Park youth activists Sobrante Park youth activists at a community-wide youth event that they coordinated

The City-County Neighborhood Initiative, a partnership between the Alameda County Public Health Department, the City of Oakland, neighborhood resident groups, community-based organizations, the Oakland Unified School District and the University of California, Berkeley, was created to empower residents and support grassroots efforts to create safer neighborhoods and reduce inequities. Partners include a homeowners association, a large community reform church, and local neighborhood committees.

Read more

Oct 30 2012

Built Environment and Public Health – Planning the Way Forward


Complete streets, mass transit and active communities were the buzzwords at a well-attended APHA session on Tuesday, dealing with the role of planning and built environment to improve health outcomes.

Several presenters took turns describing physical activity, public transportation and urban planning in different areas of the United States and how policies implementing these strategies can improve the public’s health.

Mary Thomas, of the San Antonio Metropolitan Health District, noted that 1 out of every 3 children, and 2 out of every 3 adults in her city are obese – which was one of the reasons San Antonio decided to implement a Complete Streets policy to promote healthy living and safe mobility.

Thomas noted that the implementation of the Complete Streets policy required collaboration on a larger scale than the city had ever seen: “We used an interagency work group, with every group from the Public Work Departments, to the Office of Environmental Policy, to Parks & Rec, to the Office of Historic Preservation. There was a lot of collaboration. This was probably the first time all these groups had come together in San Antonio.”

Read more

Oct 30 2012

Public Health to Public: In an Emergency, Heed the Warnings to Evacuate

While post-tropical-cyclone storm Sandy is still packing some punches in several states, other communities are beginning to clean up, and unearth the lessons learned. One critical lesson: how to get more people to pay attention to evacuation warnings in the next emergency. Many city and state leaders urged community members to heed warnings to evacuate before Sandy hit, to help protect themselves and reduce the risk for first responders. Yet at least hundreds of people, likely more, stayed at home to ride out the storm. Some died and others had to be rescued in in dangerous situations, or after suffering through the worst of the storm. NewPublicHealth asked James G. Hodge, Jr., J.D., LL.M, Director, and Network for Public Health Law, Western Region, about the legal issues surrounding orders to evacuate in an emergency.

NewPublicHealth: Are there laws that require people to heed orders to evacuate? 

James Hodge: Yes, many states’ emergency laws include authorization for mandatory evacuations of affected zones, but enforcement is tough to accomplish. As a result, evacuation orders may be issued, but citizens may choose not to follow them.

NPH: And are there legal consequences for people who don't heed the orders? 

James Hodge: Yes, in some instances. Not only may they place themselves in peril, government may not be legally obligated to rescue affected citizens who remained in place especially if conditions will not allow for safe and effective response efforts. Issues like these arise in nearly every disaster with advance warnings, including hurricanes, floods, and wildfires. Regrettably, some citizens who choose to remain in harm’s way may be negatively impacted. This is a terrible and avoidable consequence of major disasters. Ultimately, governmental efforts to force evacuations, however, are resisted by a minority of persons who are unwilling to leave for varied reasons. Emergency responders and public health authorities seek to assist them to protect their life and health, but are not legally obligated to do so when conditions do not allow for their own safety.

NPH: What’s your best public health guidance for people facing emergencies such as hurricanes?

James Hodge: When authorities issue an order to evacuate, do it! The risks you take in the face of these disasters are too great not to. Safe and effective evacuation is your best option.

Oct 30 2012

How to Help Parks Help City Residents


City parks can be a cost-free venue for people of all ages and backgrounds to be physically active. Two presenters at the American Public Health Association meeting discussed programs to increase physical activity opportunities in city parks during a session on Tuesday afternoon. The two projects were funded by Communities Putting Prevention to Work grants and focused on neighborhoods that have a high proportion of low-income and minority residents.

Adam B. Becker, PhD, MPH, from Lurie Children's Hospital, spoke about the work the Consortium to Lower Obesity in Chicago Children (CLOCC) undertook to increase walking access to parks. Members of 10 community-based organizations were trained to assess barriers to park access using the Neighborhood Walkability Assessment Tool.  The tool included analyses of possible recommendations to overcome any identified obstacles to walking.

CLOCC also created a guide to be used by city planners and engineers when deciding how to improve the walkability of local streets. The guide included suggestions such as improving sidewalks and installing pedestrian countdown timers and pedestrian islands in streets. Dr. Becker said that the city agencies are excited to have better data to help them identify walkabilty problems and prioritize solutions.

In the second presentation, Mary Thomas, MPH, from the San Antonio Metropolitan Health District, described a program that installed outdoor fitness equipment for use by community members in city parks. The goal of this program was to increase park use, and to increase physical activity among residents when they use parks.

In a partnership with the Parks and Recreation Department, fitness equipment was installed in 28 San Antonio parks, and the project was publicized using flyers and newspapers. A survey of park users showed that 54 percent spent more time in the park after the installation of fitness equipment, and most said that the equipment was user friendly and had clear instructions.

Park users identified the lack of water fountains and shade as the biggest barriers to using the fitness equipment more often.  And, it should be noted that 88 percent of park users traveled to the park by car. San Antonio and Chicago clearly have the opportunity to learn from each other’s efforts.