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04/03/2002 e e - New Hanover County Health Department Revenue and Expenditure Summaries for February 2002 Cumulative: 66.67% Month 8 of 12 Revenues 1~ qli 0\ \ Current ~r \ Prior Year Revenue Balance Earned Remainin % Budgeted Amount Revenue Earned Balance Remainin % Budgeted Amount Federal & Slate C Fees edicald edicald Max H Fees ealth Fees \. $~ $ 151,857 $ 399,751 $ 708.728 $ 190,305 $ 654,837 Expenditures Current Year Prior Year BUdgeted Amount Expended Amount Balance Remainin % Balance Remalnin % Budgeted Amount Expended Amount Revenue and Expenditure Summary For the Month of February 2002 9 f - e e NEW HANOVER COUNTY HEALTH DEPARTMENT BOARD OF HEALTH (BOH) APPROVED GRANT APPLICATION STATUS aJo~~ '''~''.MUM~tMiMMMHmHMMMbMMt:mnn~nmrmnmM di/ 11/7/01 Youth Tobacco Prevention proJect- Robert Woods Johnson Youth Center Teens Against Tobacco Use (TATU)-HeaRh Action Council of NC Health Carolinians- NC DHHS $350 $10,000 $11,800 $11,800 MMmMfM:U#~. .WmmMfmmm :~MmwmmthhMbH. ? ~f~~MMtmmrmm~M~~~~&mmMm@;~~MtmmmmmWt@@M}-~ 9/5/01 Family Assessment Coordination- March of Dimes Folic Acid Pro"ect- March of Dimes Safe Kids Coalition- State Farm"Good Nel hOO!" $16,500 $16,618 $16,500 . $3,000 $13,318 :Mmrmm~t@Wh~m~h~ 8/1/01 TB Elimination and Prevention - CDC, NCDHHD, DPH, TB Control P ram Teen Aids Prevention TAP CFMF $10,000 $45,500 $ 9200 $25 000 $800 $20,500 .M;m~H~@t<NW~~tt~ >: ~.~~<~RmmfmUmmWm~~WnM~~>~~~ ~~~m~*ummmmm~M~~%r hMtMdNbNl .tm@~mgM~~~~ HM~N~::.;.W:.J~\ ~~ .httmmmrm~~ 7/11/01 Diabetes Today - Diabetes Prevention & Control UnR, NCDHHS $10,000 Lose Weight Wilmington - Cepe Fear Memorial Foundetlon $10,000 . .t@JtN*MMFMW~M% 616/01 $25,050 $25 050 $28,060 $28,000 $2,060 Nl!ir<~ d~MW~~~UMHMrm~@~@@HW@g~Hk@MH~MmmmmdnmrHnp;m:mM~M~1-M1~~MM~~~~~M~~WMWN@m~~rmWH 4/4/01 $15,000 $15,000 $192,221 $192,221 ilii:iliiaW Safe Kids Traller-Sate Kids Sate CommunRIes- NC Govemo(s Hi hwa Saf . ""\f6i'iJ!QIOiliMlMil!l'^~ Intensive Home Visitation Program Ex anslon Grant - Smart Stert $96 000 $4,000 12/6/00 .~MHlt~~, .%~ h: '~~~f\>> .MmtW{:m~%d~k~~;.~t. ~~ ~mr r~W~~~{~iM~~M~Mimm:PM@ NkdM~m@\@r ::MMM m'Ab~~~ ~~#WWMMWr. 11/1/00 Childhood Asthma Management & Control Interventions- NC Department of HeaRh & Human Services, Division of Public HeaRh, WCH Section $12,715 ;~~}bgmk~~mdMWH<Ji~~mMfgN%tmWjM~~mM~mnmm@K:nml~m~:nnm:mmm~~l:H 1014/00 Cape Fear Memorial Foundstlon-Uce Eradication Pro ram $5,000 Healthy Carolinians- OffIce of HeaRhy Carolinians, Division of Public HeaRh, North Carolina Dept of HeaRh & Human Services $10,000 As of 3/19102 . NOTE: NolIIIcsIion received since last report. 32 $5,000 10/4/00 $10 000 , - e e NEW HANOVER COUNTY HEALTH DEPARTMENT BOARD OF HEALTH (BOH) APPROVED GRANT APPLICATION STATUS biifif'UO, ',' ammm llti'liiitl%dlmmmmml!ll@llmlmWmmmmwmmmmmmOl. "'''u~lijll n#AA\fI""g nS~rfiifmm!Oii).A March of Dimes- March at Dimes Birth Defects Foundation Eastem Carolina Chapter 812100 $52,000 $50,000 $2,000 $48,000 $48,000 mmunrmwwmwnmmm 7/12/00 Pendlna Grants 0 0% Funded Total Request 9 32% Partiallv Funded 12 43% Denied Total Request 7 25% Number of Grants ADDlled For 28 100% As of 3/19102 . NOTE: NolIlio..atiol, received since last repolt 33 ~ e e e NEW HANOVER COUNTY HEALTH DEPARTMENT 2029 SOUTH 17TH STREET WILMINGTON, NC 28401-4946 TELEPHONE (910) 343-6500, FAX (910) 341- 4146 -,.-.. ..,.......,...,. DAVID E RICE, MPH, M A Health Director LYNDA F SMITH, M P H Assistant Health Director March 20, 2002 To: New Hanover County Board of Health From: Cynthia W Hewett, Business Officerc)' Subject: New Medicaid Rates We recently received an email.alongwithalistingofthenewMedicaidrates.fromDennisE.Harrington.MPH.Chief of Local Health Services. These rates are retroactively effective February 1,2002. After reviewing this list, there are several of our current fees that need to be adjusted based on the newly adjusted Medicaid Rates. Code (Description of Service) Current Fee Charged New Medicaid Rate Proposed Fee to Charge A4260 (Norplant Kit) (* New code) $ 0.00 $ 390.00 $ 390.00 58301 (IUD Removal) $ 95.00 $ 96.89 $ 96.89 11975 (Insert Norplant) $504.90 $ 102.82 $ 102.82 :/J Ilf7;}- 117 i;)- - 1197f ~lllove l'''lurph:lu(} $ 197 11 .) IJ.I.~l ~ 111.9:: 11977 (RemovelReinsert Norplant) $ 553.00 $ 190.38 $ 190.38 54050 (Destruction/Lesion/Condyloma) $ 120.89 $ 134.04 $ 134.04 46900 (Destroy Anal Lesion) $ 162.26 $ 179.07 $ 179.07 "Your Health - Our Priority" 34 . " e Code (Description of Service) 96110 (Developmental T est/Limited) Current Fee Charged $ 168.00 New Medicaid Rate Proposed Fee to Charge $ 64 71 $ 121.00 The following services are currently being billed only to Medicaid. Our Nutrition Program is continuing to experience an increase in the number of private pay patients being referred to and seen in their program. We would like to begin billing private pay patients for these services. (Please note that private pay patients these services will be placed on a sliding fee scale and their charge will be adjusted based on their level of income). Code (Description of Service) Current Fee Current Medicaid Proposed Fee I Charged Rate to Charge 97802 (Initial Assess Med Nutr Therapy) $ 16.70(Medicaid Only) $ 16.70 $ 80.00 I e 97803 (Re-Assess Med Nutr Therapy- 15 min) $ 16.70(Medicaid Only) $ 1670 $ 18.00 97803 (Re-Assess Med Nutr Therapy- 30 min) $ 3340 (Medicaid Only) $ 33 40 $ 36.00 97803 (Re-Assess Med Nutr Therapy- 45 min) $ 50.10 (Medicaid Only) $ 50.10 $ 54.00 97803 (Re-Assess Med Nutr Therapy- 60 min) $ 66.80 (Medicaid Only) $ 66.80 $ 72.00 e 35 .f. , NEW HANOVER COUNTY HEALTH DEPARTMENT 2029 SOUTH 17111 STREET WILMINGTON, NC 28401-4946 TELEPHONE (910) 343-6500, FAX (910) 341-4146 e. Everywhere, Everyday. Evaybody. DAVIDE. RICE,M.P.H., M.A. March 19, 2002 LYNDA F. SMITII,M.P.A. Health Director Assistant Health Director To: New Hanover County Board of Health Through: David E. Rice, Health Director ~ J From: Janet McCumbee, Child Health Division { Regarding: Reclassification Request From: LPN (pT 02, Salary Range $30,347 - $46,550) To: Health Educator (PT 03, Salary Range $32,802 - $50,294) e This is a request for Board of Health approval to process a reclassification for Lorna Blackler's position. Lorna's position in the Child Health Division is presently classified as a Licensed Practical Nurse (LPN) in the Childhood Lead Poisoning Program. Several years ago, this position was full time, with a dual role of the above and WIC nurse. At the time of a vacancy, the Nutrition Division Director and I, with Human Resources approval, split the position to two part time positions. The Lead nurse position in Child Health became a halftime position. Lorna was hired as a LPN; however, she also has a Bachelor's degree and has always functioned at a higher level than the LPN class. As we have developed this position and monitored the needs of the Lead Program, we have changed the job description to reflect a Health Educator class. Several issues make this new Health Educator class a much better fit for the position. First, there is no need for any hands-on nursing functions in this position. We have a Lead Program Nurse as the program coordinator and she oversees all program work, including Lorna's duties. Secondly, we have found that the primary function of this job is Lead Poisoning health education, both to individuals and groups. Third, the position has integrated a great deal of environmental health knowledge to the home assessments, both for Lead hazards and for Asthma controL Lastly, Lorna has written several grants to increase our ability to provide Child Health services. The scope of these duties requires a Bachelor's degree. e I have had a discussion with Cathy Morgan in Human Resources, who advised me to pursue this reclassification, based on the new duties. Lorna has been functioning in this capacity for the last few years. The financial obligation is minimal Lorna is presently at the beginning salary of the LPN scale, PT02 - step 01 ($ 30,347). The position change to Health Educator, PT03 - step 01 ($32,802) would require $1228 additional doUars in salary per year (halftime). Uniform allowance ($500), only required for nurses, would be cnt. The total cost would then be $728 per year. Please allow me to pursue approval from Human Resources and the County Manager. Thank you. II '/jour -.lJealtk _ Our Priorit'! II 36 e New Hanover County POSITION DESCRIPTION QUESTIONNAIRE (PDQ) I. BACKGROUND (Please print clearly or type) (Help? - Click hera and hold mouse) Raason for completing this form: 0 New Position ~c1assification 0 Salary Upgrade Neme: Loma Blackler Date: February 18, 2002 Current Job Dept.: New Hanover County Phona: 343-6612 Title: Health Educator Health Department - Child Health Division Supervisor's Supervisor's Supervisor's Neme: Janet McCumbee, RN Title: Child Health Director Phone: 343-6559 Total Time In Normal Work Hours: Work Week: Part-Time Current position: Stert: 8:00am 2 Y ear(s); 1 Month(s) If "part-time", please indicate Rnlsh: 5:00pm number of hours/week: 20 Do hours very? No e II. POSITION SUMMARY (Help? - Click here and hold mouse) he primary purpose of the job is to review, communicate, and track lead testing results; educate Flients to encourage protocol compliance; provide ongoing follow-up prn to children under lead ~urveillance, including home visitation and referrals to WIC, PCPs, laboratories, and environmental llealth; provide health education to the community on lead poisoning and lead hazards. e 37 Page 1 New Hanover County 1\1 A. ORGANIZATION RELATIONSHIPS (Help? - Click here and hold mouse) e (1) Your Supervisor's Title (Reminder - Click here and hold mouse) Child Health Public Health Nurse Supervisor I I Your Title Health Educator I (2) (3) Coworkers: Other Positions that Positions that Report to You Report to Your (only those over which you have Number of People Per Position Maneger/Supervlsor full managerial/supervisory at Left [from (311 (Titles only; not names) authority. CSCs (nurses & social workers) n/a n/a Community Haalth Assistant e e Page 2 38 e e e New Hanover County 1\1 B. CONTACTS (Help? - Click here and hold mouse) Title and Unit of Organization Nature of Contact Lead Program Coordinator - Child Health Division consult and confer Medica' Office Assistant - Child Health Division consult, confer, refer Child Service Coordinators - Child Health Division confer and refer Laboratory Staff - internal and external confer and refer WIC Staff confer and refer Registered Sanitarians - Environmental Hlth. refer, accompany, schedule, exchange locallregional information of lead investigations Private Health Care Providers refer and confer for client flu Amigo Translating & Interpreting Service for interpreting in Spanish for non-English speaking lead clients Page 3 39 New Hanover County IV. ESSENTIAL DUTIES Essential Duties Decisions Required Frequency %of DWMQAO Time 1. Process questionnaires and lab What is appropriate D 15% reports by reviewing registration follow-up based on protocol information, test results, and client and judgement? history and determine testing follow-up. 2. Enter client/testing data & Analyzing existing data - D 15% maintain database. Chart client correcting or researching contacts and follow-up. any disparities. How to document accurately. 3. Communicate follow-up to What is appropriate D 10% clients with Class IIA and greater follow-up based on protocol test results and to Hispanic clients. and judgement? Which communication method(s) are needed to ensure future compliance? 4. Track clients under lead What is appropriate W 20% surveillance and provide follow-up follow-up based on protocol pm including client contact via and judgement? Which mail, telephone, face-to-face, home referrals are to be made? Is visitation. home visitation needed? 5. Screen and satisfy telephone Does a child need testing? Is D 10% calls, requests, and internal another type of referral communications regarding CLPPP. needed? . 6. Assist with grant writing and What data is needed in 0 10% budget preparation to include: . support of grant proposal? implementation of grants, provides What kinds of activities and data as required for compliance affiliations are needed to with grant guidelines, and accomplish grant goalS? completing reports. How to measure outcomes. How to report accurately. 7. Analyze Quarterly Lead Review and Research lead Q 5% Surveillance Report and testing history of clients/and verify/submit data to DENR. nonclients under surveillance Page 4 . e e 40 - e e New Hanover County to verify accuracy of report. S. Coordinate lead investigations Provide scheduling and 0 5% prn. accompanyment for mandatory/voluntary lead investigations 9. Attend meetings and/or present Educate others regarding 0 10% information representing Lead CLPPP and develop rapport Team that affect the department or for encountering various community . scenarios. 10.Provide community education What level of written M 5% on lead poisoning. material is appropriate? Who is the audience? Are displays or other visuals needed? Page 5 41 New Hanover County V. SUPERVISION GIVEN (Help? - Click here and hold mouse) Place an "X" if appllcabla X X X PHRASES I do not officially supervise other County employees (sign performance reviews). I evaluate and sign performance reviews of other regular (non-temporary) employees. I evaluate and sign performance reviews of part-time, temporary or contract employees. I instruct other employees in methods or procedures needed 1 to carry out their job (how to carry out their assigned duties). I make work assignments for others. I make hiring and hiring pay recommendations. I make hiring and hiring pay decisions. I recommend pay changes. I recommend termination for poor performance. I make termination decisions. I provide advice to peers that they must consider carefully before making a decision. Example: We function as a lead Team, collaborating and troubleshooting as situations arise. including developing and revising policies and procedures based on my role on the team. X I provide information to supervisors/management that they use in making a decision. Example: Based on my role on the team and my knowledge and experience. I advocate for clients and program policy. Page 6 - e e 42 - e e I New Hanover County VI. PROBLEM SOLVING (Help? - Click here and hold mouse) a. n advocating for the State's enhanced guidelines expanding the offer for lead nvestigation, I have forged a good rapport with our regional lead inspector, assisting him with scheduling and accompanying him on local lead investigations and outreach ttempts. b. n attempting to improve our tracking system, I have taken on the responsibility for our ead client's database. I have spent considerable time cleaning up the data base, updating pld charts and patient information, and developing a reporting system with Health IT Sta~ hat has greatly increased efficiency, improved accountability, increased compliance and ecreased caseload. VII. NATURE OF ASSIGNMENTS (Help? - Click here and hold mouse) 1. If I see tha need. I can change the following without my suparvisor's approval: Place an "X" ITEMS I CAN CHANGE EXAMPLE if applicable The objactives I am trying to achieve (Refer I have encouraged mandatory to page 1, Position Summary for the lead investigations objectives). unprecedented in the county based on information I obtained at a lead poisoning prevention seminar. X The means for achieving the objectives of my I have taken the initiative and . job (i.e., my work methods or procedures of changed forms and form my work plan). letters, developed a computer based tracking system and appt. reminder system, and taken responisbility for data entry . X The way assigned work methods are carried I work with a minimal level of Page 7 43 New Hanover County out (i.e., the order or frequency of my duties). direct supervision. I have revised and simplified most of the routine aspects of the program, developing and refining a system that has increased efficiency and standarized the program. . Give an example of how you have modified or developed new work methods to deal witt aw or unusual circumstances on your job. have revised forms and letters and standardized information to clients to include bilingual nformation to serve an ever increasing Hispanic more equitably. Our compliance rate has enefited by these changes.We save time and paper and appear more professional. Page 8 44 - e e - e e New Hanover County VIII. EQUIPMENT (Help? - Click here and hold mouse) List the equipment you regularly use on your job (Examples - Click here and hold mouse). List the duty number from Section IV - Essential Duties and the equipment you use to perform that duty. (Examples - Click here and hold mouse) DUTY EQUIPMENT USED computer and software, copy machine 1 computer and software 2 telephone, car, computer and software, copy machine, calculator 3 computer and software, telephone, fax, car 4 telephone, computer and software 5 shredder, computer and software 6 car, telephone, computer and software, fax 7 fax, telephone, computer and software, car 8 fax, telephone. computer and software. car 9 10 IX. WORKING CONDITIONS (Help? - Click here and hold mousel Piece en .X. if applicable CONDITION X Does Not Apply (Proceed to section X.) Hazardous physical conditions (mechanical parts, electrical currents, vibration, etc.) Atmospheric conditions (fumes, odors, dusts, gases, poor ventilation) Hazardous ma erials (chemicals, oil, etc.) Extreme temperatures Inadequate lighting Work space restricts movement Intense noise Travel Other: Please describe: Home visiting in some high crime areas and driving to and from emergency shelters during storms. x X X Page 9 45 New Hanover County X. EDUCATION AND EXPERII;NCE ~I. What minimum level of education do you believe is needed to satisfactorily parform your job? Not necessarily your own level of education or that which is currently stated in your job ~escriPtion). Select the laval that applies to your job. ~achelor' s degree . f "OTHER", please explain: "l. What field(s) should treining or degree be in? Health Education, Nursing, Social Work, ~ommunications in health related field ~). Are any state, fedaral or professional licenses or certificates 'squired by law 0' /lstuts to enter ffour job? (Examples. Click herel No f .Yes., please list: d). What minimum kinds of experience are needed to enter your job? Type of Experlance Minimum Time Required computer and typing skills 1 year(s) month(s) working with the public, preferably with a cross section of 1 year(sl month(s) the population, in the health care setting and homes health oriented or social service related experience 1 yaar(s) month(s) preparing reports, writing latters, developing presentations 1 year(s) month(s) year(s) month(s) . year(s) month(s) e e Page 10 46 I l.. il . e e . New Hanover County XI. REQUIRED KNOWLEDGE AND SKILL (Help? - Click here and hold mouse) a. Knowledge b. Knowledge Of: charting in health and medical records 1. medical terminology 2. lead poisoning and lead poisoning prevention 3. child health and development issues 4. anatomy and physiology 5. public health concepts and practices 6. community health and human services and resources 7. effective education/teaching methods and group dynamics 8. Skills Skillin: data entry 1. good written communication, charting 2. gathering and analyzing public health data 3. good verbal communication and interviewing 4. developing and delivering presentations 5. Essential Duty #(s) Essential Duty #(s) 2 3,4,6,9,10 1,4,6,7,9,10 3,4,5,9,10 6,9,10 basic office equipment skills - to include use of computer and various 1-10 6. software developing public health programs 7. 8. Page 11 6,9,10 47 ,. . e e , . ~ STRA TEGle PLANNING PRIORITIES March 26, 2002 Update e Access to health care (Issues #7, 11 & 5) + More at Four' The More at Four committee met last week and decided to try to get the at risk four year olds into classrooms by 3/25. There will be 18 placed at J.C. Roe and 18 at Headstart for the remainder of the school year Families will need to register by calling Smart Start (815-3731) this week. + Matemity Wellness Expo: Women's Health Care Division participated with the Matemity Wellness Expo on Saturday, 3/16/02 at the Coastline Convention Center Staff reported that the event was successful and it presented many opportunities to share about health department matemity and women's health services. + Vaccine availability impacting on services given. Some immunizations delayed and staff creating callback system for several vaccines. Loss of temporary position in Medical records impacts quality of services and efficiency in 5 divisions that use patient medical records. + In honor of National Children's Dental Health Month, the New Hanover County Dental Program, the North Carolina Oral Health Section, Cape Fear Community College, and the Wilmington TriCounty Dental Society sponsored "Seal Out 2002" "Seal Out 2002" was a local Dental Health initiative to prevent tooth decay by the increased use of Dental Sealants. "Seal Out 2002" took place at the Cape Fear Community College Dental Program on Friday, February 22, 2002. Local Dentists volunteered their time in order to supervise the placement of Dental Sealants by Dental Assisting and Dental Hygiene Students. In total, 45 local elementary students received 226 Dental Sealants, along with other services, free of charge. + II. Preventive services & lifestyle-related risks (Issues #12 & 15) + Bells for Remembrance: The Women's Health Care Division will be hosting a district BCCCP meeting for Bells for Remembrance - - - in memory of those who have lost loved ones to breast or cervical cancer Pink Ribbon Plus members are participating in the program. We were asked to be the hosts and share information about our successful Bells for Remembrance campaign to local churches in Wilmington last year. + Juvenile Crime Prevention Council: A Juvenile Crime Prevention Council Youth Continuum of Care - Focus Group Report has been received. This is a result of a grant from SEC. The report is in a notebook on the book shelf in front of Frances DeVane's office to be checked out, or you can pull it up on the web: http://www.secmh.org/DownloadslYCCFG It is rather lengthy and covers subjects such as violence, drugs, skipping school, etc. + Seal Out 2002: In honor of National Children's Dental Health Month, the New Hanover County Dental Program, the North Carolina Oral Health Section, Cape Fear Community College, and the Wilmington TriCounty Dental Society sponsored "Seal Out 2002" "Seal Out 2002" was a local Dental Health initiative to prevent tooth decay by the increased use of Dental Sealants. "Seal Out 2002" took place at the Cape Fear Community College Dental Program on Friday, February 22, 2002. Local Dentists volunteered their time in order to supervise the placement of Dental Sealants by Dental Assisting and Dental Hygiene Students. In total, over 45 local elementary students received Dental Sealants free of charge. + Diabetes Coalition: Trish Snyder will have the May 1 Board of Health Dept Focal on Diabetes Coalition Activities. (The Management Academy Report (Janet McCumbee) has been changed to the July 3 Board of Health Dept Focal. + TAP' Bridgette Jamison, one of our original TAP peer educators who continue to volunteer and provide leadership to the younger members of the group, received a New Hanover County Human Relations Award. Thanks to Jessica Nakell for nominating her I. e 1 ....- II ~ , + Hepatitis B Vaccines: Hepatitis B vaccines to 6th graders in public schools are completed for this year. Thanks to the nurses in Community Health for your assistance in getting this done. + Special Immunization Project: CDD will be focusing on special project to immunize Hispanics. Collaborating with Jr Sorosis (Courtney Wilson- contact) to promote immunizations among this population. + Outreach Program at Cure AIDS: As a result of a Region VII outreach program at Cure AIDS of Wilmington, sixty-five individuals had blood drawn for syphilis and HIV testing. The tests for syphilis performed in our laboratory may have yielded three new cases. The HIV testing is being performed at the State Laboratory + Diabetes Dinner Theater' is scheduled for March 28 at 5:30 PM in the Health Department Auditorium and will include an original play with the Rockin' Chair Players, a catered dinner and a health talk by endocrinologist Bryson Ley, MD. Chef Kevin Doyle, of JP Unique Catering, trained at the Culinary Institute in Hyde Park, New York. He will prepare the meal in consultation with Carol Bottoms, diabetes educator and nutritionist with the Health Department. "Dinner will be delicious, nutritious - and diabetes friendly," said Mr Doyle. The play, " A Touch of Sugar" is based on the myths and misinformation people have about diabetes. "Irs lighthearted and humorous - and designed to get people thinking and talking," said playwright and director Sylvia Cantor A question and answer session will follow the play and will be moderated by Dr Ley His talk, "Four Things Everyone with Diabetes Must Know" is geared to persons who have already been diagnosed with diabetes. The New Hanover County Diabetes Today Coalition sponsors the program. A $10 fee will cover the dinner and program. Registration is essential. Call 343-6758. + Smoke Free Bar' A1leigh's Restaurant will be designating one of its bars as 100% Smoke Freel This was voluntary, based on the results of a customer survey last Fall. + TB Screening: Report of facility's annual TB screening completed. NHCHD remains at very low risk as an employer as there were no skin test conversions among health care workers this year Thanks to staff for staying alert. Remember to "THINK TB" -+ STD/HIV staff working on project to provide effective preventive education to men having sex with men to reduce transmission of STDs and HIV among this population. + Several Child Health staff is working with Smart Start and the NHC Schools to get the More At Four Preschool Program up and running this school year 36 at risk children due to enter Kindergarten this fall will benefit from several months of preschool this year to prepare them for entering K in the fall. Our Health Check clinic will also try to accommodate the physicals needed to enter the program. + ACS officers will continue to transport adopted pets to local veterinarians for the surgical procedure in spite of decreased staff. + Judy Evonko and Jean McNeil went to Dorothy B. Johnson Elementary School to perform the rabies puppet show for several first graders. + Jean McNeil was featured in Critter Magazine after teaching the UNCW honors class on . Animals in Society" Dr Bob Weedon teaches adjunct professor at UNCW and area veterinarian the class. + Four pit bulls attacked an owner's two dogs in downtown Wilmington. Wilmington PD killed two of the attacking dogs. The incident spawned a barrage of media coverage in every area, including discussion to ban the pit bull breed from the city + III. Communication, education & marketing (promotion) (Issue #1 & 4 in part) + Diabetes Education Classes: The New Hanover County Diabetes Coalition presents Diabetes Education Classes on Wednesdays 3 - 5 PM, March 6, 13,20, and 27, 2002. A $10 fee includes all materials. Scholarships available. Register at 343-6758. + Bioterrorism: Emergency Response Plan was distributed to designated staff on March 4. The revised plan was also submitted to the State. Copies (without attachments) will be made available in the break rooms and at our web site address: ~ e e 2 I, . e http://www.co.nhcgov.comlHlTHlPDF/Emergency%20Response%20Plan.pdf + National Nutrition Month: In celebration of National Nutrition Month, a lunch and leam is scheduled for Wednesday, March 6, Noon-1 :00 on "The Joy of Soy" Susan Fellows, ECU dietetic intem, will present the latest research findings on the health benefits of soy Bring your lunch and beverage. There will be some taste testing of soy products. + league of Women Voters will sponsor presentation on Bioterrorism for community on March 21, 6:30pm in NHCHD Auditorium. Presentations by Fire Dept. Hazmat and NHCHD. Public invited. + Statewide Immunization logo: Thanks to those who participated in the opinion survey to select a new statewide Immunization logo. + IV. Facility utilization & Information technology (Issues #6 & 4 in part) + Web Site: Dave Rice requested the Management Team to review all parts of the NHCHD web site, including links, and send revisions to him by March 15. Now that our web site is online, we need to keep the web pages currentl + HIPM. Dave Rice distributed a copy of the February 20, 2002 State HIPM Consultant Activity Report to the Management Team. + GWI Help Desk: A brief overview of the new GWI helped Desk software was presented to Mgmt Team. A brief presentation will be given to staff on Thursday March 7 lunch -n-leam sessions will be provided for staff training. We will implement usage of the GWI Help Desk on Monday March 11th. + Changes to lGFS and GHRS: lGFS and GHRS is going to have a new look. We have not been provided with speCific dates as to when the change will take place- but the "green screens" will go away and be replaced with a "windows" look. As more information is available it will be passed onto staff. If needed, we will hold an in-house training session to familiarize staff with upcoming changes. + Tables: We are trying to repair the Wood Conference Room table. Please remember, this table should not be moved for any reason. Due the table in the break room being pushed around so much, the legs became wobbly and one broke. We need to keep it as stationary as possible once repaired. + PCMS: We will be installing an upgrade to the PCMS system on Wednesday evening (3/20/02). All as users must be signed off of the system by 5:00pm. Release notes are being distributed to staff today + AS400: The Operating System for the AS400 will be upgraded this weekend. The AS400 will be inaccessible for staff after 5:00pm on Friday (3/22) until we open for business on Monday (3125) morning. All AS400 users must be signed off of the system by 5:00pm on Friday (3122). + Fire Prevention: Fire Prevention experts will conduct a walk-through of the NHCHD facility (17th Street) on March 21 at9 am. A fire truck will arrive and 7to 8 firemen will be in the building for a "Pre Fire Plan" This will not be a fire drill. + Clinical space downstairs not available to expand any CDD clinic services as result of Child Health clinical space moving downstairs to accommodate regional Bioterrorism team. Staff identifies need to increase CDD clinical services. + ACS met with other county representatives to discuss a possible change to a different statement billing company Free set-ups will enable employees to view potential samples prior to signing a contract with the company ACS will determine feasibility of sending all notices through the new company to better utilize staff time. + V. Water quality, storm water management & drainage; & Air quality (Issues #3 & 8) + Controlling Eagle Island mosquitoes is an unremitting biological as well as mechanical challen!le. Where on the typical breeding site, !letting rid of standing water is central, the ~ e 3 ,- . - . . ecology of drying mud flats sometimes dictates paradoxical action. For select species, the mud itself provides the ideal media to begin the propagation cycle. Migratory Ochlerotatus sollicitans refrain from depositing eggs in water, but instead seek drying mud. With apt conditions, it is thus more effective to maintain a flooded site where minnows, natural mosquito predators, thrive and provide adequate control through a natural sequence of life and death. Weirs are constructed on large capacity spoil deposition sites such as Eagle Island as a part of the water management system and allow either drying or flooding of these sites. Vector Control Program staff and US Army Corps Of Engineers representatives monitor these structures to assure proper function and maintain desired control measures. .. Environmental Health Specialists are working with the developer of a project off Holly Shelter Road to design wastewater systems that will accommodate the proposed use and rely on the natural site conditions for treatment and disposal of wastewater Parcels will be divided and sold for the construction of small commercial ventures. Five large wastewater collections, treatment and disposal systems with capacity to daily process 2500 gallons each (or a total 10,000 gallons per day site capacity) will be constructed on common areas of the property Locations for the wastewater systems are distinguished by soil profiles conducive to the biological and chemical processes that render wastewater free of human pathogens. .. Vector Control Program staff have recently worked with the USDA field consultant to alleviate serious drainage issues attributed to growing beaver populations at three separate locations. A natural basin between Lennon Drive and the Target shopping complex was discovered to sustain a large colony after a major sewer overflow behind the apartment buildings. Periodic flooding of Prince George Creek in the areas of Blue Clay and Parmele Roads brought attention to another well-established colony Telfair Creek runs through The Cape off Carolina Beach Road and contributes to water management issues for the golf course and residential areas of the development as a result of being a favorable habitat for these aquatic rodents. .. VI. Emerging health risks (Issue #13) .. IAa Courthouse: Staff has received inquiries about the indoor air quality issue at the courthouse. Dianne Harvell has communicated these to Mike Winebar Mike secured an OSHA evaluation that generated a referral to DHHS. Subsequently, a DHHS industrial hygienist evaluated the facility Media contacts last week suggested an effort to get details of the forthcoming report from these agencies; however, we had to advise that we had no information at the present time. .. Bioterrorism: A letter was sent supporting the North Carolina Division of Public Health's Center for Disease Control grant application for supplemental funding of "Public Health Preparedness and Response for Bioterrorism" (The Health Directors in the 7 host Public Health Bioterrorism Team Counties were asked by the North Carolina Department of Health and Human Services to send a letter of support.) The goal in receiving the grant funds is to upgrade our state and local public health systems in preparedness/response related to Bioterrorism, outbreaks of disease, and other public health threats/emergencies. .. Bioterrorism: Weekly conference call with host Health Departments for the Public Health Bioterrorism Teams was held on March 18. The NC Center for Public Health Preparedness is working with the State to include additional epidemiology capacity to the 7 teams. .. VII. Population growth & diversity (Issue #2) .. Spanish Radio Station: Janet McCumbee will be working with a group, headed by Alan Swart, who will be formulating some PSAs to be put on the Spanish radio station. These will be health and safety messages. She will be calling on other staff in several divisions to assist with these. ~ e e 4 ': ~ - e e + Interpreter working in TB program one day per week with good results. contacting Hispanics to start on preventive medicine for TB infection (to reduce likelihood of progression to TB disease). + VIII. Discontinued services picked up by Health Department (Issue #9) + Discussion with Cape Fear Chapter of American Red Cross to seek funding for Teen AIDS Prevention Program + IX. Staff Development & continuing education (Issue # 14) + Medical Consultant: Dr Rhyne's Contract is effective as the Medical Consultant to the Board of Health. (We are waiting for paperwork to have her effective as Physician Extender Back-up. + A preliminary list of staff that may be interested in attending Bioterrorism Conference, April 12, SunSpree, Wrightsville Beach-was sent to Barb Bissett at New Hanover Regional Health Network for invitations to respond. Management Team were asked to send an e-mail with names of other staff who may be interested in attending to Lynda Smith so these names could be included. + On April 12, a conference entitled "Consequences ofTerrorism: Regional Medical Response Training for a Nuclear, Biological or Chemical Attack" will be held at the Holiday Inn SunSpree in Wrightsville Beach. Attendance will be limited. Health Department will be informed shortly regarding the number of staff that can attend. + Staff Appreciation Luncheon: NHCBH Executive Committee graciously agreed to continue the Staff Appreciation Luncheon. It will be held on April 11 Frances DeVane reviewed the tasks with the Management Team: Groceries - Environmental Health, Tables/DecorationslTable Clothes, Grill, Cooks, Other Assignments, Property Management. + Dave Rice met with Dr Schleupner to screen the physician epidemiologist candidates. To date, five candidates have applied. In addition, the nurse epidemiologist and industrial hygienist positions have been advertised. + New OSHA requirement that all staff must use needle stick protection devices will significantly impact budgets since approximately 22,000 needles used per year and cost for new needles with protection devices is 411% increase over current price (effective immediately). Travel restrictions seriously impacting ability to attend continuing education and staff development. + Several of ACS staff took advantage of the HR class on business writing. Information leamed will be utilized to re-format the pre-citation letter and the citation. + X. Evaluation of services (Issue #16) + Bioterrorism: NHCHD BTL Team met February 25-26 to complete our Revised Emergency Response Plan. The revised plan will be submitted to the state by March 8, 2002. When finalized, the plan will be distributed as per usual to Emergency Policy holders. Meeting with NHHN and SEMH was held on February 25. + Community Child Protection Team: On 2/21, Janet McCumbee participated in a Community Child Protection Team death review at DSS, initiated by the state. The state DSS requires these reviews when a child who dies has been under DSS investigation for abuse and neglect. In this situation, the family had been under DSS protective services in 3 counties over a period of several years. The state review coordinator will summarize the conclusions and recommendations of the group for future prevention of child deaths. A review will be held next month on a second case. + Temporary Food Facility Rules: The BOH Environmental Health Committee held a public hearin!l to receive inout on prooosed chan!les to these rules Wednesdav, Februarv 20, 2002. 5 . No one appeared to speak before the EH Committee. The BOH Executive Committee will consider the proposed changes on Tuesday, February 26, 2002 and by the BOH at their next monthly meeting on March 6, 2002. .. Policy Team: Discussed a draft of the Mail Handling policy It will be distributed to Staff by email for input to your Division Director .. HIPAA. Dave Rice and Cindy Hewett will meet with NHC Administration and other Department Heads to discuss HIPAA on March 6. .. CPT Rates and Fee Policy Updates: Nursing, Lab and W1C Directors were provided with a copy of our CPT codes and rates that are currently being used here at the Health Department, as well as the new Medicaid Rates that were effective 2/1/02. Some of our in-house rates will need to be adjusted due to the new Medicaid rates. Division Directors will discuss their proposed rates with their Multidisciplinary Committee Representatives and return their proposed rates to Cindy Hewett by Friday, March 15th. Proposed rate changes will be presented to the BOH for approval at the April 2002 meeting. .. Medical Records: Medical Records will be closing at 5pm daily due to staffing shortage. Other changes may be forthcoming as staff struggles to provide services to the programs. Thanks for your cooperation. .. Policy Team: Discussed NHCHD employee's orientation checklist. Management Team will review the process on March 12. .. Vaccine Shortage: New requirement for varicella vaccine: children at 12 months of age on April 1 ,2002, will be not be out of compliance for varicella vaccine until November 1, 2002. Shortage of varicella vaccine delays implementation of requirement. .. Policy Team: Reviewed Health Department Human Resources Representative NHCHD employee's orientation checklist. Several changes were recommended. The checklist will be revised and will be considered for inclusion in Policy and Procedures Manuel. .. Ground Rule for Health Department Monthly Staff Meeting: Cell phones/pagers, etc. must be turned off or put on vibration mode during the staff meeting to reduce distractions to other staff. Under no circumstance should a staff member answer a call and carry on a conversation in the auditorium while the meeting is going on. If you must receive or make a call, leave the auditorium and step outside the building or into another hallway so staff in the auditorium cannot hear your conversation. (This happened 4 or 5 times during the March staff meeting and was disruptive to others in the meeting.) .. Medical Records: Five Division Directors met to try to increase coverage for Medical Records. All programs affected are asked to be patient and flexible as level of service diminishes and changes are affecting many staff. Discussion continues. .. Policy and Procedures: Discussed NHCHD employee's orientation checklist. The checklist was approved and a general orientation policy was recommended to the Policy Team for development. Mail Handling policy was discussed. Management Team will continue its discussion on Marcy 26. .. ACS clerical staff is in process of evaluating methods of data entry for licensing and upkeep of the program. Budget constraints may cause a decline in revenue, since they have not been approved to do overtime work to keep licensing current. .. ACS staff discussed methods to cover essential functions of our division after leaming of the permanent loss of the second officer position that has been on hold for six months. .. - e e 6 ) e March 2002 New Hanover County Health Department Influenza-Like Illness - the Worst May be Over e As of the March 6, 2002 report, influenza-like illness as reported from the state's 38 sentinel sites seems to be on the decline. Peak activity occurred in the second and third weeks of February. One hundred thirty- four isolates have been submitted to the state lab from sentinel sites, and only one virus type, A1H3N2, has been identified. Information gathered from these sentinel sites has helped monitor strains and their spread in the state, and would serve to identify new strains with pandemic poten- tial, as well as determine if antiviral drugs at our disposal would be useful in treatment. CONTENTS Live-Virus Vac. ....2 e Pertussis ............... 2 Stats......................2 ThinkTB When Considering Remicade Therapy I nfliximab (Remicade) is a humanized antibody used in the treatment of ehron's disease and rheumatoid ar- thritis. Studies show a four-fold increase in the development of TB dis- ease in patients taking Remicade, probably due to its suppression of the immune system. Cases Reported Soon after its use began in 1998, cases of TB began to be reported through the MedWatch reporting system of the FDA. Through May 29, 200 I, 70 cases of TB as- sociated with Infliximab treatment were reported. TB developed after three or fewer treatments in 48 of those 70 patients. Forty patients had extrapul- monary disease. Sixty-four of the 70 cases were from countries with low incidence rates of TB. New Recommendation Because active TB disease has developed so soon after initiation of treatment, the recommendation now is for Betsy Summey, FNP, 343-6531 patients being considered for Remicade treatment to be given a TB skin test and if positive, complete treatment for latent TB infection before Remicade therapy is begun. !: .. .' , Immunosuppressant drug therapy--whether it be long term steroid use, antineo- plastic agents, or others- has long been considered a risk factor for progression of latent TB infection to TB dis- ease. Evaluation and treatment of latent TB infection is appropriate for patients being placed on any immunosuppres- sive agent. Immunization News Varicella Required Effective April I, 1001, all children bom on or after April 1,1001 will be re- quired to have one dose of varicella vaccine before age 19 months. (Continued) 2 Although not required, chil- ACIP now recommends cine beginning in the late e dren born on or after July I, that if two parenteral Iive- 1940s, pertussis continues to 1994 and prior to April I, 200 I virus vaccines occur in the U.S. Since a his- are still recommended to have are administered toric low incidence in 1976, the vaccine. less than 30 days incidence has increased in apart, the vac- cycles, peaking every three A shortage in varicella vaccine cine given second to four years. Researchers production may delay some should not be have compared data from children getting the vaccine; counted as valid 1997-2000 to that of 1994-96 however, the shortage is ex- and should be repeated at and found pertussis incidence - pected to be resolved by late least four weeks later. increased 60% among adults spring or early summer. and II % among infants. A study recently published in Non-Simultaneous MMWR found that children Infants too young to have com- Administration of who received varicella vaccine pleted the three-dose series Live-Virus less than 30 days after MMR _w",,~pe-[J vaccine had a 2.5-fold in- cially at risk. but _ Vaccines creased risk of breakthrough their infection varicella disease, that is suggests also, Since 1983, the Advisory varicella disease in a vaccinated that pertussis cir- eommittee on Immuniza. person. culation in general has oc- tion Practices (AeIP) has rec- curred. The transmission to ommended that live-virus vac- Pertussis infants may also guide policy cines be administered on the decisions to be made in the same day or at least 30 days Persists future regarding use of acellu- e apart. What has not been ad- lar vaccine in persons seven dressed was the action needed DesPite the widespread years and older. if this did not occur. usage of pertussis vac- Communicable Disease Statistics New Hanover County July 1, 2001 - February 28, 2002 AIDS .......................... 26 Campylobacter ......... 10 Chlamydia............... 344 E. coli 0157:H7............ 0 Gonorrhea............... 209 Hepatitis A.................. 3 Hepatitis B (acute) ..... 5 Hepatitis B (carrier).. 11 Hepatitis C (acute) ..... 2 HIV Infection ....................33 Lyme Disease ....................0 Pertussis ............................1 Rky. Mt. Spotted Fever....10 Salmonellosis ..................74 Shigellosis .........................3 Strep, Group A Invasive....1 Syphilis ............................24 Tuberculosis ......................8 'e 1Jnitf'd"'VC! Stan" National Association of Local Boards of Health .".".,. .. ,r- "--- Published for Members of Local Boards of Health President's Message Phil Lyons New Years' greetings to all NALBOH friends and associates. As I begin my term as President of NALBOH for 2002, I want to thank all of those who contributed in the past to make NALBOH the vibrant organization it is today and ask for your support to help it continue to grow and develop into a strong partner in the public health community. I have served on a local board of health in Utah for eleven years and have seen first-hand all of the good services that are provided C'l a community through local boards. Many of these are unique. ~e must work together and share ideas to help strengthen our local boards. My home is in Heber City, a small town in Wasatch County, Utah. It is Utah's privilege (or curse) to be host to the 2002 Olympic Winter Games. I serve on our local Olympic Committee working mostly with food vendors. The Olympics have had a huge impact on all the services provided by our state. It is hard for me to even comprehend all the work and planning it takes to put on such an event. One example: 10,000 port-a-potties to set up, service daily and then haul the waste away. In my next President's Message, I'll report the results. During the first part of October, Marie Fallon, NALBOH's Executive Director and I attended the Seminar for Non-Profit Board Chairs and CEOs held in Boston, MA. We had the opportunity to work on case studies and learned problem solving methods. After each session, we worked together on issues that had been presented. It was very helpful to work with heads of other boards and share the problems we each face. We both felt the seminar was very heipful. We hope to be able to use the things we leamed to help make NALBOH a more effective and efficient organization. In December, Marie and I attended a Health Officers' orientation at CDC in Atlanta. We had the opportunity to interact with ASll-iO's r 1d NACCHO's Executive Directors as well as many of the rectors of CDC. It was encouraging to work with others who ~ -share the same concerns about health issues as NALBOH. Paul Halverson, Director, CDC-Public Health Program Planning Office, Continued on Page 2 1 1- .... .. February 2002 The Public Health Role in Fighting Terrorism By Ann Dietrich, L. Cheryl Runyon and Martha King Submitted by Vaughn Upshaw, OrPH, NALBOH Emeritus Board Member The nation's fears that terrorists might use anthrax, smallpox, or chemical, nuclear and radiological weapons have splashed public health issues across headlines with stark new urgency. Lawmakers face the challenge of ensuring that their state's public health system and laws are up-to-date and can serve the public well in the event of another terrorist attack. These are the same public health laws that help states guard against naturally occurring threats, such as influenza, measles, West Nile virus, Hantavirus, toxic substance spills, and natural disasters such as hurricanes, fires and floods. Public health systems help prevent disease and injury, protect against environmental hazards, promote healthy behaviors, respond to disasters, and help ensure access to health services. These systems were built to counter naturally occurring events. But the additional threats posed by deliberate actions to unleash infectious or other deadly agents on unsuspecting populations are now very real. An effective public health system includes strong state and local health departments, highly trained professionals, sophisticated disease monitoring and reporting systems, up-to-date laboratories, electronic information systems to communicate rapidly with other emergency responders, resources to treat victims (such as adequate medicines and vaccines), and tools to prevent the spread of disease (such as the ability to isolate contagious or contaminated people). But according to the Centers for Disease Control and Prevention (CDC), most state and local public health agencies are not fully prepared to serve as the first line of defense against terrorism and other public health threats. Many systems lack some of the key components identified as necessary to respond adequately to natural or man-made threats. State Actions Many states have public health laws that predate modern threats and civil rights advances. For example, Massachusetts Senator Richard Moore notes that his state's quarantine law still carries a 1940s-era fine of $10 per violation. Many state laws give broad authority for emergency powers without specifying important details. Emergency health powers in some cases have been revised on a piecemeai basis over the decades, embedding provisions in different sections of statutes, and may be inconsistent or ambiguous. Continued on Page 2 , " NALBOH NewsBrief February 2002 President's Messaee...(Continuedfrom Page 1) and his associates went to great lengths to make the workshop a success. While in Atlanta, we had time to meet with Anthony San- tarsiero, our liaison from CDC. Tony has been a very important part of NALBOH this past year and his insight on health issues will be very beneficial to the organization in the coming year. The world that we now live in has changed a great deal in the past several months. It is an exciting as well as a challenging time to be Involved in public health. As local boards of health members, we will need to be better prepared to meet the challenges that lie ahead. It will become very important for every board member to be prepared to make a positive influence on his or her board. In the past NALBOH has been able to help with several board training instruments. In the future, with your help, we will become more involved in developing training aids that will help you to have successful local boards of health. It is my personal goal for the year 2002 to do my best to address as many of your concerns as possible. Please let those of us who serve as your national leaders know the areas about which you are concerned. I know that local board members are the individuals who will even- tually make the programs work. It is our desire to do all we can to help you be successful. 0 President President-Elect Secretaryrrreasurer Past President NALDO" Officers Phil Lyons (UT) Ken Hartke (IL) Stephen Papenberg (NJ) Harvey A. Wallace (Ml) North Atlantic Mid Atlantic East Great Lakes Southeast Midwest West West Great Lakes State Affiliate State Affiliate NALBOH Trustees Shepard Cohen (MA) India Hosch (WV) Jim Recchio (OH) J. Frederick Agel (GA) Larry Hudkins (NE) Connie Tatton (UT) Rebecca Wurtz (IL) Barbie VanderBoegh (10) Ronald Burger (GA) NALBOH Staff Marie M. Fallon, MHSA Executive Director Director of Liaison & Governmental Relations Tobacco Control Consultant Project Director~ Training Project Coordinator Membership Coordinator! Publications NewsDrielEditor Edwin "Ted" Pratt, Jr.. MPA Rebecca Edwards, MPH Sarah Chard, PhD Jennifer M. O'Brien, MPH Grace Serrato Fleming Fallon. MD, DrPH Requests for Articles and Meeting Announcements NALBOH would like to receive announcements and articles for future issues of the NewsBrief. If you have a topic that would be of interest to other local boards of health, please let us know. We are also interested in publishing upcoming conference announcements and meeting dates. The next publication deadline iSAprill0, 2002 Please mail your articles andlor announcements to NALBOH at 1840 East Gypsy Lane Road, Bowling Green, OH 43402. Or .,:ax to (419) 352-6278, or emaii us at <nalboh@nalboh.org> 0 Page 2 --- -~~~ PH Role In Fighting Terrorlsm...(Continued from Page 1) A number of legislatures and state agencies are beginning to look at the capacity of their state public health systems. In 2000, Colorado enacted legislation that creates an emergency epidem- ic response committee to advise the governor about reasonablr'\\ and appropriate measures to reduce or prevent the spread of W disease, agent or toxin, and to protect the public's health. The committee will develop a supplement to the state's disaster plan, which will outline the public health responses to acts of bioter- rorism, pandemic influenza and epidemics caused by novel and highly fatal infectious agents. Federal Actions The Public Health Improvement Act of 2000 is the first federal program aimed at helping the nation's state and local health departments respond to health threats like drug resistant diseases and terrorist attacks. The act authorizes grants to state and local health departments to update laboratories, improve electronic information networks and emergency response systems, and train staff. It also establishes publiC health standards for states to measure their performance. Also, in an effort to help states examine their own public health emergency preparedness, CDC requested legal experts at the Center for Law and the Public's Health (at Johns Hopkins and Georgetown Universities) to draft a model state emergency health powers act (MSEHPA). Copies of the act are available on line at: <http://www.publichealthlaw.net/> The final product is intended to help states review their own statutes for key elements to prepare them for possible terrorist attacks or other public health emergencies. A related effort is being sponsored through the Kellogg an) Robert Wood Johnson Foundation's Turning Point progranl The Turning Point Public Health Statute Modernizatio' National Collaborative is working to strengthen the legal framework for public health by developing a model state publiC health act. This Collaborative is made up of representatives from five Turning Point States (AK, OR, NE, WI, CO), the CDC, HRSA, APHA, the National Conference of State Legislators, National Governors Association, NACCHO, NALBOH, National Association of Counties, National Indian Health Board, and National Congress of American Indians. This group has outlined and begun work on a model public health statute and copies of the draft are available at <http://www.hss.state.ak.us/DPH/aphip/collabpubs.htm > Boards of health need to be familiar with both the Model State Emergency Health Powers Act and the Model Public Health Statute because these laws provide a useful framework for understanding critical public health responsibilities at the state and local levels. Local boar-d members might find these models useful as they review and advocate for legislation at the state level To learn more about the model acts, plan on attending the session at the upcoming NALBOH Annual Conference. See page 9 for more Information. 0 The NALBOH NewsBrief is published by the National Association of Local Boards of Health 1840 East Gypsy Lane Road Bowling Green, OR 43402 Phone: (419) 353-7714 Fax: (419) 352-6278 Email: <..nalboh@nalboh.org> Website: <www.nalboh.org> ~ \ J The pmductionand distribution of this puhlicalion are supporte dbyfundsfromthcCcntcn;of Disease Control and Prevention. NALBOH NewsBrief Report from Washington Edwin "Ted" Pratt, Jr., MPA Director of Liaison and Governmental Relations o . I I I am writing this report on Friday, January 25th Congress has been back in town for a week, the news is full of Enron, and a great deai is going on that is of great importance to boards of health and the local public health system The Department of Health and Human Services today released detailed information on the process that will be used to distribute the over $1 billion in bioterrorism funding designated for the states to help prepare their public health infrastructures to respond in the event of a bioterrorism attack. (You can track the latest DHHS press releases and fact sheets on the Internet at <www.hhs.gov/ news>). There were reports today that the President's budget for 2003 will nearly double the funding for homeland security to $37.7 billion with the President indicating he will use part of these funds to improve the nation's public health system. At the National Health Poiicy Conference last week here in Washington, I asked how likely would federal support for public health infrastructure improvements be substained at the local level so that locai governments could make long-term commitments to improvements in staffing levels, training, and capital investment. Dean Rosen, senior aid to Senator Bill Frist (R-TN) and the lead minority staff to the Senate Subcommittee on Public Health on which the senator serves, insisted that there would be a multi-year, sustained commitment that local governments could count on. Oow, if I can be forgiven a run of cliches here, it is certainly wise not to count your chickens before they hatch, but do not forget that an ounce of preparation is worth a pound of catch-up (sorry) and that good fortune is usually when preparation meets opportunity. So with all this money getting set to flow down into the states directly through grants, or indirectly through various federal agency programs, iocal public health needs to get prepared. We must be prepared to participate in state pianning; prepared to effectively advocate for enhanced resources at the local level; prepared to use those new resources wisely and effectively; and prepared to account for the use of those resources by being abie to document improved capacity and capability. So how do we assure such preparedness? The National Public Health Performance Standards Program (NPHPSP) Summit at which national implementation was to be announced was scheduled to take place on February 4th. It was cancelled because the President scheduled his formal budget announcement for that day. After years of work by literally hundreds of public health professionals, academics, federal and state agency personnel, and local board of health members, we are ready to roll out the State, Local, and Governance Instruments for use by their respective public health systems and agencies to provide for assessment and quality improvement. They are, in fact, the perfect tools for being sure that your board, your health department, your r"~cal and state public health system are prepared to develop, "- npiement and review the best policies and programs to put these new resources to work! And that's not all. Going through the Performance Standards process will help board of health members better appreciate _______ _ February 2002 and perform their responsibilities. Nothing was harder, I found out during my near decade on a board of health, than comprehending the entire universe of my board's responsibilities. I am certain this is a common experience for other board of health members across the country. Trying to expand from the day-to-day experience of regulatory and administrative activity to a holistic view of the local public health system in order to develop policies that would enhance the health status of the community I had been elected to serve was just about impossible without some well thought out method. At the time I served on a board of health, I was unaware of a methodology that could help me. It was only in 1992, at the end of my service on a local board of health, and as a direct result of my involvement in NALBOH, that I became aware of APEX/PH, the first of the National Association of County and City Health Officials' (NACCHO) local public health system self-assessment instruments. Now, as more resources are set to flow through the states to local and regional agencies to strengthen preparedness and capability for confronting and responding to terrorist assault, local governments are going to be called on to demonstrate the ability of their institutions to respond effectiveiy to these new challenges. It is my firm belief that these institutions, which include local boards of health, have the potential to provide the most effective responses. However, they must go through an organized and inclusive process of assessment, policy development, and assurance of implementation that considers the entire local public health system. Going through the Governance Instrument itself, and supporting your local heaith department's use of the Local Instrument will take only a few weeks, and will go a long way toward preparing for the development, implementation and review of poiicies that will keep your board of health a relevant and critical partner in the forthcoming national effort to build a homeland defense and rebuild the public health infrastructure. You can review and download the Governance Instrument at the NALBOH website <www.nalboh.org> and the Local Instrument at the NACCHO website <www.naccho.org> There is also the State Instrument that you should insist that your state's health department use to assess its performance, which can be found on the Association of State and Territorial Heaith Officials (ASTHO) website <www.astho.org> There is a Glossary common to all three instruments with many resources listed. And, as always, the NALBOH staff is ready to assist you in any way as your board embarks on this important process. Good luck and good health (remember, good luck is when preparation meets opportunity). P.s. While you are at the NACCHO website, check out MAPP (Mobilizing for Action Through Planning and Partnership). 0 Check out our Website! <www.nalboh.org> If you have not checked out our website, then now is the time. Our website has really expanded. We are trying to meet the needs of all NALBOH members. We welcome suggestions on how to improve our site. E-mail your feedback to <nalboh@nalboh.org> Remember, our goal is to assist local boards in providing up to date information and training. 0 --~_._._..._........._.......- -. Page 3 NALBOHNewsBrief February 20.0.zJ National Association of Local Boards of Health Your NALBOH Representatives ...........:,'": .",..",. ~ Q), President-Elect 530 NE Glen Oak Avenue Peoria, IL 61637 Phone: (309) 655-2261, Fax: (309) 655-2967 E-mail: <ken.n.hartke@osfhealthcare.org> REGIONS .. -'.. .-... . North Atlantic II Mid Atlantic . Southeast . East Great lakes . West Great lake~ . Midwest . West . .m Harvey A. Wallace Past President 1401 Presque Isle Avenue Marquette, MI 49855 Phone: (906) 227-1135; Fax: (906) 227-2181 E-mail: <hwallace@nmu.edu> l Stephen Papenberg Secretary/Treasurer 210 North Main Street Pennington, NJ 08534 Phone: (732) 329-4000 ext. 237; Fax: (732) 329-0627 E-mail: <spapenbe@twp.south-brunswick.nj.us> ~ ......- J Page 4 --- , ' NALBOH NewsBrief February ~ c) . J. Frederick Agel Southeastern Regional Trustee 3643 Doroco Drive, NE Atlanta, GA 30340 Phone: (770) 939-4320; Fax: (770) 939-9978 E-mail: <jageI31035@aol.com> r , i I ,.,,'-~ . it -ti"" < , ~ ': ',-. ~ :,' '-r ~_'" '.,':. t .\, t'.;"'i -/.;.' 1J ~i\t'~') ", ,', ;;;'1/, [, \' ~j. "i", ',~, : ~ '. ',V-.\ . l~' \r \ o :x 1- Shepard Cohen North Atlantic Regional Trustee 39 Cartwright Road Wellesey, MA 02482 Phone: (781) 237-9852; Fax: (781) 235-145S E-mail: <shepcohen@aol.com> Larry Hudkins Midwest Regional Trustee 2 County-City Building, 555 South 10th Street Lincoln, NE 68508 Phone: (402) 441-7447; Fax: (402) 441-6301 Jim Recchio East Great Lakes Regional Trustee 2412 Fontana Street, N.W., Suite 350 Massillon, OH 44646 Phone: (330) 454-5698; Fax: (330) 4S4-8550 E-mail: <jimrecc@aol.com> Connie Tatton West Regional Trustee Box 303 Midway, UT 84049 Phone: (43S) 654-2416; Fax: (435) 654-2416 Email: <ctatton@juno.com> (, ?- A.. \ A. Barbie VanderBoegh State Affiliate 17447 Batt Corner Road Wilder, ID 83676 Phone: (208) 337-3486, Fax: (208) 337-3486 E-mail: <barbie_vb@hotmail.com> National Office 1840 East Gypsy Lane Bowling Green, OH 43402 Ph: (419) 353-7714; Fax: (419) 352-6278 Website: <www.nalboh.org> E-mail: <nalboh@nalboh.org> Washington DC Office 1350 Connecticut Avenue, NW, Suite 850 Washington, DC 20036 Ph: (202) 223-4034; Fax: (202) 223-4035 E-mail: <nalbohdc@olg.com> Page 5 I r NALBOH NewsBrief - ----'-"-1 February 2002 i -' Model State Emergency Health Powers Act (EHPA) Draft Comments Review Meeting Ted Pratt met to review comments submitted by various organizations and to discuss next steps in developing a revised draft for use by state legislators in the upcoming 2002 sessions. This is the first time we have worked directly with the National Association of Attorneys General (NMG) and the National Council of State Legislators (NCSL). NALBOH looks forward to building new partnerships with them. 0 National Public Health Performance Standards and Local System Improvement Plans: The Texas Evaluation Pilot Harvey Wallace, Past President, NALBOH, participated with Paul Halverson, CDCjPHPPO and Patrick Libbey, President, NACCHO, presenting their "Observations and Thoughts on NPS." The meeting was in Austin, TX on January 8-9 and was sponsored by the Texas Association of Local Health Officials and the Texas Health Department. 0 Council on Linkages J. Frederick Agel attended the Council on Linkages where the Core Competencies were discussed. Competency examples can be found at <www.trainingfinder.orgj competenciesjlist.htm> Fred presented NALBOH's organizational update at this meeting to encourage other organizations and to set an example. Also discussed was the Institute of Medicine scope on training and framework as well as bioterrorism and how the council on linkages could play an important role as a convener of information. 0 ENACT Legislative Committee Meets in Washington, DC ENACT is now Partners for Effective Tobacco Policy. ENACT's Legislative Committee provides the direction for the organization. NALBOH is a full participant in this committee. Campaign for Tobacco-Free Kids is developing a grassroots effort to support the GanskejDingelljWaxman-FDA Authority to Regulate Tobacco bill (HR 1097). The Partners have been working with Senators Durbin, Kennedy and Harkins about developing a bill to control new tobacco products. 0 Task Force on Community Prevention J. Frederick Agel represented NALBOH at this meeting to discuss studies demonstrasting the benefit of Sexuality Education. Also reviewed were The Cancer Chapter and the Physical Activity Chapter. The Childhood Visitation section concluded that there was sufficient evidence to recommend the positive effect of professional home visitations and improved outcomes with longer program durations. This Task Force has been in existance for six years. It is now expected that the community prevention book will be available in 2003. 0 ~~e~_ ~ ~ 0~ :"';::J~ IJIQ' ,,~ ~~~'I'I ,~ Welcome to the Board Doctor, a new column that was suggested by NALBOH members. Many board members have questions about board procedures and responsibilities. Now board members can submit questions and have various experts respond Unless specifically requested, all names and locations will be kept confidential. Dear Board Doctor, I'm a relatively new member of our local board of health and have been attending monthly meetings for almost a year, but I'm unclear about the board's role in personnel matters. At our last meeting, one of the board members wanted to review the perfonmance of a health department employee. Evidently, the board member had received a complaint about the employee from a citizen and he felt the need to act to correct the situation. Other board members said that they too had heard complaints and began asking for details of the employee's duties, past performance, and options for disciplinary action. The health director seemed uncomfortabie during this discussion and repeatedly said that she was aware of the situation and was handling it. Still members of the board pressed her for details. I'm wondering what the board's responsibility is in this situation. Can you help? Signed, New and Confused OJ Dear New and Confused, It appears that your entire board is unclear about its authority for personnel issues. In most cases, the board is responsible for only one employee, the health director, and the health director is responsible for all other personnel. When a board gets involved in personnel issues below the director level, it is micro-managing. The board should step back to focus on questions of policy. For example, does the board have a policy on customer service? If not, then it would be appropriate for the board to adopt a policy that states, "All health department customers will be treated with respect and dignity," or, "All customer inquiries will receive a response within 24 hours or by the next work day." It is inappropriate for the board to evaluate an employee's performance other than the health director's. The health director could help board members by reminding them of her responsibility for employee performance, and referring to existing policies that she's following. She might also suggest gaps in the policies where the board could provide additional guidance. Please submit your questions to The Board Doctor by emailing them to <nalboh@nalboh.org> or visit the Board Doctor" website at <www.nalboh.orgjboarddrjbddr.htm> \ -.../ The opinions expressed are those of experts and do not represent official NALBOH position. 0 NALBOH NewsBri"r A Look At NALBOH Membership New NALBOH Memberships in 2002 NALBOH extends a very warm welcome to the following new members. We look forward to your involvement and hope to see ail of you at the NALBOH conference in New Orleans, LA, July 10-13, 2002. Colorado Saguache County Board of Health - Center, CO Connecticut Chesprocott Health Dist. Brd of Directors - Cheshire, CT Georgia Catoosa County Board of Health - Ringgold, GA Hart County Board of Health - Hartwell, GA Stephens County Board of Health - Toccoa, GA Iowa Dickinson County Board of Health - Spirit Lake, IA Hamilton County Board of Health - Webster City, 1A Illinois Adams County Board of Health - Quincy, IL Henry County Board of Health - Kewanee, IL Jackson County Board of Health - Murphysboro, IL Kendall County Board of Health - Yorkville, IL Madison County Board of Health - Edwardsville, IL Mason County Board of Health - Havanna, IL Pike County Board of Health - Pittsfield, IL Scott County Board of Health - Winchester, IL D Stark County Board of Health - Gary, IL r ndiana " Gary City Board of Health - Gary, IN Kentucky Oldham County Board of Health - laGrange, KY Massachusetts East Brookfield Board of Health - East Brookfield, MA Essex Board of Health - Essex, MA Monterey Board of Health - Monterey, MA Sunderland Board of Health - Sunderland, MA Minnesota Cass-Todd-Wadena-Morrison CHS - Walker, MN Dakota Cnty Community Hlth Board - South St. Paul, MN Kandiyohi Cnty Community Hlth Board - Willmar, MN Missouri Ralls County Board of Health - New London, MO Montana Missoula City-County Board of Health - Missoula, MT North Dakota Ransom County Public Health Board - Lisbon, ND New Hampshire Deerfield Board of Health - Deerfield, NH Farmington Board of Health - Farmingham, NH Holderness Board of Health - Plymouth, NH Milford Board of Health - Milford, NH Newmarket Board of Health - Newmarket, NH Oklahoma Haskell County Board of Health - Stigler, OK Woodward County Board of Health - Woodward, OK (,Oregon \... / Multnomah Cnty Board of CommjHealth - Portland, OR -- Pennsylvania Hanover Township Board of Health - Wilkes Barre, PA Texas Galveston County Board of Health - La Margue, TX 0 - - -:::::I ______ _ __ ______ February 2002 I ~~;= ~Q: Jennifer M. O'Brien, MPH @ Our discussion of technology and the ::t-: Internet is going to focus on a very :.......... 19 timely issue - disaster recovery plans. As a board of health member, you have a responsibility to ensure that there are plans and procedures for emergencies, which traditionally included plans in the event of fire, tornado, or power failure. The escalating use of and reliance on technology makes it equally important that your local public health agency develop a plan for major technological failures as well. Before beginning with a disaster recovery plan, make sure the local publiC health agency (LPHA) has a daily operating plan for technology. This plan should include information about how information and data are backed up (e.g. to a tape or other device), how often the back up tested, what the procedures are for reporting problems, and who is responsible for repairing the problem or contacting the vendor who supplies network support. Once a daily operating plan is in place, elements from it will help in the creation of a disaster recovery plan which is to be used during major technological breakdowns. These emergency plans have three phases. The first phase includes the plans and procedures for operating the LPHA until the problem is resolved. For example, let's say that the network at the LPHA is broken and it will take four days for the parts to arrive and to fix the problem. The plan should detail what is needed for the LPHA to be functional until the repair is completed. This might include a list of backup equipment needed or procedures for manually recording information. The second phase of the plan should address the measures needed to make the network fully operational once the hardware problem is fixed. Returning to our example, this plan should detail how the recovery of information will occur, who is responsible and how manually recorded data will be added to the system. The last phase should include an evaluation of the breakdown and its solution. This may include procedures for reevaluating service contracts or improving the daily operating plan of the LPHA. This step allows a continuous improvement process to occur SO that valuable lessons are not lost. Board of health members do not need to understand the technical details of the plan. The board's function Is to ensure that there is a well-tested plan, that the plan is used during an emergency, and that there is an evaluation of the plan once the problem is resolved. Therefore, your role as a board of health member is not to develop the plan or to know what would be needed to create such a plan. Your role is to ask the health officer for a plan, to allocate funds to support the development of a plan, and to help evaluate the implementation and management of the plan. If your board of health has a disaster recovery plan and you would be willing to share it with other board members, please mall a copy to Jennifer O'Brien at <jennifer@nalboh.org> or to 1840 East Gypsy Lane, Bowling Green, OH 43402. If you would like to share how a disaster recovery plan would have helped your LPHA during a recent crisis, submit a story online at <www.nalboh.org/projectsjtechtips/techtips.htm > 0 u.___ ~____~ Page 7 -....-..-..-...-..-..-..--..----..---.--.- NALBOH New.Brief Injury and Violence Prevention Resource Round-up Looking for guidelines, reliable information, best practices, and resources to prevent injuries and violence in your community? These web sites put it all at your fingertips. CDC Recommends...Prevention Guideline's System <www.phppo.cdc.gov/cdcRecommendS/AdvSearchV.asp> Searchable database lets you find guidelines, recommendations, and other documents approved by the CDC for the prevention of injuries and disabilities. Search by keyword, phrase (e.g., motor vehicle, unintentional injuries), or date. Center for Injury Research and Policy <www.jhsph.edu/reserach/centers/clrp> The Center's mission "is to use a public health approach to understand injuries and reduce their occurrence, severity and consequence." Table of Contents contains links to publication; faculty and staff; current research; education and training; community services; and links to other sites. Healthfinder@ - Healthy People 2010 Topics <www.health.gov/healthypeoplefhealthfinder/> A Healthy People 2010 interface for the U.S. government gateway to reliable health information and resources. Searchable Healthfinder@ topics are organized by Healthy People 2010 focus areas, including "Injury and Violence Prevention." Injury Control Resource Information Network <www.injurycontrol.com/icrin> This site contains a list of key Internet accessible resources related to the field of injury research and control, including publications, data standards, injury data & statistics, injury research centers, software and related research tools, discussion groups, grant opportunities, and recent research. MEDUNEplus, National Ubrary of Medicine <www.nlm.nih.gov/medlinepluS/> Provides access to well-organized news, research, laws/policies, and publications on dozens of injury and violence prevention topics. Use the "Search MEDUNE" link to find recent journal articles published on your topic of interest. National Center for Injury Prevention and Control (CDC) Profiles: <www.cdc.gov/ndpc/StateProfiIeS/index.htrn> Publications: <www.cdc.gov/ncipc/pub-res/pubs.htrn> Provides state injury profiles containing maps and tables of injury deaths and death rates for each state, including intentional and unintentional injuries. The profiles also include descriptions of CDC-sponsored injury prevention programs and research activities in each state. Download or order Center-produced publications, such as Best Practices of Youth Violence Prevention. National Guideline Oearinghouse <www.guideline.gov/index.asp> Search by keyword to find evidence-based clinical practice guidelines and related documents (e.g., association position statements) that may be useful tools to engage health care partners in promoting effective violence and injury prevention practices. Resources axnpiled by the Public Health Foundation, <www.phf.org>, 202-898-5600. 0 February 2~ Tobacco Use in Film and Television By V Michael Barkett, MD, FACS, FACG President, Colorado State Board of Health At the Colorado State Board of Health's April 2001 meeting ~ discussed the issue of the entertainment industry's portrayal';;,ff'{ smoking and its impact on children and teens. The purpose of this letter is to determine the National Association of Local Boards of Health's (NALBOH) previous involvement in this issue and to offer our support to any efforts to discourage the positive portrayal of tobacco use in film and teievision. Earlier this year, researchers at Dartmouth Medical School I published a study concerning tobacco use in movies. Based on viewing the top twenty-five films for each year from 1988 to I 1997, the researchers found that of the two hundred fifty films they watched, approximately 85% contained tobacco use. Twenty-eight percent of the films, including one in five children's movies, showed cigarette brand logos. Additionally, the study found that Marlboro is the brand shown most frequently in the movies. Not surprisingly, 54.S% of smokers between the ages of twelve and seventeen smoke Marlboro. Colorado recently received the results from its first-ever statewide survey of youth tobacco use and discovered some rather alarming findings. The survey was completed by 3,546 students in forty-one middle schools and forty-nine high schools throughout the state and showed that 39.4% of the state's sixth to eighth graders reported having used tobacco products. Additionally, of this middle school age group, 28% said that they had tried cigarettes before the age of eleven. Two in three high school students have tried cigarettes and 25.3% repo~ ') being current smokers. These statistics are particularly disturbin9d j because research demonstrates that the younger a person is when he or she first tries smoking, the higher are the chances of becoming a regular smoker. With studies indicating that the tobacco used by an adolescent's favorite actor is associated with the adolescent's smoking behavior and evidence that children are using tobacco at very young ages, we believe it is important to send a strong message to the entertainment industry that smoking in film and television negatively impacts the health of our children. 0 Wanted: Board of Health Members Interested in Tobacco Control and Prevention If you have a success story to share, are currently addressing tobacco control and prevention in your community, are interested in receiving more information about tobacco control and prevention, or would like a complimentary copy of the National Institute of Health's "Monograph ll-State and Local Legislative Action to Reduce Tobacco Use," please contact Rebecca Edwards by phone (419) 353-7714 or email ,"" at <rebecca@naiboh.org> 0 \ ..( ~e8 ~ ~~.aOH New,!rief , ((l NALBOH CONFERENCE HIGHLIGHTS ~o National Association of Local Boards of Health 1840 East Gypsy Lane Road Bowling Green, OH 43402 i C' 'hone: (419) 353-7714 . ax: (419) 352-6278 E-mail: <nalboh@nalboh.org> Webs;te: <www.nalboh.org> February 2002 NALBOH's 10th Annual Conference The Foundation of Local Public Health: Boards of Health, Health Departments, and Health Officers July 10-13, 2002 The Astor Crowne Plaza Hotel New Orleans, Louisiana Co-located with the National Association of County and City Health Officials Conference Highlights . Tools for Effective Governance · Emergency Response Planning · Grant Writing · Public Health Law · Fundamentals of Epidemiology · Land Use Planning · Environmental Health Issues · Strategies for Tobacco Control · Sustainable Community Programs and Healthcare Services AND MUCH MORE Check our website for conference updates and conference registration information at <www.nalboh.org> Page 9 I , li:ALBOHNe:~if- --=~-=--=--___-==::_-==-- IL TOBACCO-FREE U~ II ................................ . Join Other Local Board of Health Members for · · Tobacxlo Control Conference Call · . . . . . Monday: May 13. 2002 . · 12 noon-1:oo p.rn. Eastern Time · . . . . . Toll-free bridge number HlOQ-713-1971 and . . conference code #430064 · . . : NALBOH will moderate discussions on various tobacco use : . prevention and control issues relevant to local boards ot health. . ................................ Boards of Health as Venues for Clean Indoor Air Policy Making Joanna V. Dear/ave, BA Stanton A. Glantz, PhD American Journal of Public Health For the complete article see February 2002, Volume 92, Number 2 In the United States, many states and localities have boards of health that can issue regulations to protect public health independent of legislative approval. Most health boards are designed to be insulated from the political pressures experienced by legislators, and often the regulations they issue must be based solely on health considerations. Most boards are appointed for fixed terms (only 29% of boards have elected members), so members are generally not subject to reelection concerns or susceptible to the influence of campaign contributions. These facts, combined with the overwhelming evidence that secondhand smoke causes disease in nonsmokers, make health boards a logical venue to issue tobacco control measures. There are three main strategies the tobacco industry uses against health board smoking regulations: "accommodation" (public relations campaign to accommodate smokers in public places), legislative intervention, and litigation. (These strategies are in addition to the industry's overarching strategy of state preemption, which removes the authority of local governmental bodies to issue tobacco control policies.) Although boards of health are designed to be insulated from political pressures, the industry, in certain of its strategies, relies on politics to oppose health board regulations. In the present article, we examine the tobacco industry's strategies and provide case studies. Despite Industry opposition, some boards of health have successfully passed and defended regulations repealed, amended, or weakened. Successful regulation of secondhand smoke by a board of health requires that the board acquire the public support neccessary to withstand the political attack that the tobacco industry will mount, derive its authority from a statute and associated case law that permit it to withstand a legal challenge by the tobacco industry, and carefully craft the regulation in anticipation of such a challenge. 0 Model Ordinances Modei Tobacco Control Ordinances are available for interest- ed board of health members by contacting NALBOH at '" (419) 353-7714 or via e-mail at <rebecca@nalboh.org> y Page 10 . ~- February 2002 - Examples of Tobacco Control Policies Eliminate Exposure to Second Hand Smoke II"\;~ o Smokefree policies in public buildings and private worksites~JiI including restricting smoking to no closer than 50 feet of entryways into public building and private worksites. o Smokefree policies in restaurants, bars, bowling alleys, malls, movie theaters. . Smoke free policies in casinos. o Smokefree policies in outdoor public areas, parks, amusement areas, ball fields. o Smokefree campuses at local hopitals and medical centers. o Educate people about the health hazards of smoking in homes and cars and encourage smokefnee environments. o Eliminate smoking on city sidewalks and beaches. Promote Cessation o Health care systems will incorporate provider reminders to ask all patients about their tobacco use. o Ensure that Medicaid covers comprehensive cessation services and nicotine replacement therapy. o Health insurance companies and major employers will cover cessation services and National Replacement Therapy for all plan members. o Implement patient telephone support services for cessation, including counseling and medication for the uninsured. o Increase the unit price for tobacco products. o Reduce health insurance rates for non-smokers. OJ o Increase tax on all forms of tobacco products and earmark proceeds for tobacco prevention and control programs. o Require licensing of retailers who sell tobacco products and revocation of their licenses if they sell to minors. The following are components of a model retailer licensing ordinance. o Institute graduated penalties so that retailers are held accountable for their violations of the law. o Hold business owners responsible for violations, not emloyees. o Use civil penalties to quickly process violations. o Disallow affirmative defenses for violations. o Designate the local health department, not law enforcement, as the enforcement agency. o Incorporate a funding mechanism for enforcement into the ordinance, i.e. license fees and fines are earmarked for enforcement. . Post signs. o Conduct compliance checks. o Collect compliance data and report annually to the community. o Ban the sale of tobacco products through vending machines. o Require all tobacco products to be placed behind the counter. o Eliminate tobacco advertising in newspapers and magazines. o Eliminate point of purchase advertising. r\,\ \ \ Schoof Health Policies VJ:.J o School policy for a tobacco-free environment that is 24 hours/7 days per week, all facilities, activites, and vehicles. o Work with schools to provide tobacco-use prevention Prevention Youth Access Restrictions \ NALBOHNewsBriif education in grades K-12 with intensive instructions in junior high or middle school that are reinforced in high school. CIdentifying and Eliminating Disparities '. : 'The following are not policies, but are appropriate activities to deliver messages to specific population groups and develop leadership that would lead to involvement in policy change. . Use data to identify health disparities in tobacco use. . Convene broad-based, representative committee to develop, plan and select targeted group(s) for interventions. . Develop leadership from within the targeted group(s) to advocate for public policy and systems change to address tobacco issues. . Support development of culturally appropriate infrastructure and provide resources for initiatives to reach specific populations. . Design and implement mass media campaigns geared to the identified group's interests, attitudes, expectations, and norms utilizing appropriate media channels. I Preemption . Repeal existing preemption laws that prevent local communities from enacting ordinances restricting the use, sale, distribution and price of tobacco products. . Working with partners, monitor legislation for preemptive language. . Educate the community about what preemption is and how it impacts the community. I I ( /"':.Examples of Activites that Move Toward and \..)Support Policy . Work with and support community-based and statewide coalitions that are diverse, inclusive and representative of the community. . Deveiop working partnerships with other programs and agencies such as ALA, AHA, ACS, Smokeless States, state and local health professional organizations, state and local youth organizations, etc. . Implement mass media communication campaigns to educate the community about the constituents and health hazards of secondhand smoke. . Conduct mass media campaigns to encourage cessation and inform smokers of cessation services such as a telephone support line. . Conduct campaigns to educate the community about the constituents of and ingredients In tobacco and cigarette smoke. . Monitor the community for compliance with Master Settlement Agreement provisions and report violations to the Attorney General office for enforcement. . Conduct education campaigns to inform the community of industry efforts to promote tobacco use and encourage smoking uptake among children and college-age people. . Support and enhance Involvement of parents, mass media, community organizations, or other elements of an adolescent's social enviornment. Work with schools to provide program-specific training for teachers. Work with schools to involve parents and families in support of school-based programs to prevent tobacco use. . Work with schools to support cessation efforts among students and all school staff who use tobacco. c: . . n__-=-=~~~~~~~~_-~F~~ 2~2 j Work with youth groups to survey tobacco advertising at point of purchase. Work with youth groups to determine tobacco product placement in stores, i.e. behind the counter to discourage shoplifting, etc. Work with youth groups to monitor tobacco advertising in magazines with a high youth readership and report findings to the magazine, the public and the state attorney general. Work with school personnel and parent groups to ensure that advertising restrictions created as a result of the Master Settlement Agreement are adhered to and report violations to the Attorney General for enforcement. Monitor enforcement of existing policies and report violations to appropriate enforcement agency. Hold editorial board meetings with state and local news papers to educate the editorial staff on tobacco issues including the need for comprehensive programs and adequate funding levels, tobacco control policies to reduce use among adults and youth, smokefree environments, etc. Develop relationships with local reporters, including health, business, political, and sport reporters. Work with reporters on local coverage of tobacco issues. Collect, analyze and diseminate data on tobacco issues to community, decision makers and media. . . . . . . . Note: The above list of policies and supporting activities is not aI/ inclusive. CJ Request for New Bylaws, Regulations &. Ordinances In May, NAlBOH and the American Nonsmokers' Rights Foundation (ANR Foundation) will be sending a joint letter to all local boards of health requesting any new bylaws, regulations and/ or ordinances relating to tobacco use prevention and control. Please watch for the letter and respond to ANRF with any information not already listed for your community. Since this partnership began, NAlBOH has been able to help greatly increase the number of bylaws, regulations and ordinances on record in the local database housed at ANRF. The database is used to track local activity, to assist state program managers in surveillance, planning, evaluation and much more. 0 CALL FOR ABSTRACTS 2002 National Conference on Tobacco or Health November 19-21, 2002 Hilton, San Francisco Abstracts accepted online from February 1 to March 25, 2002. Submit your abstract online at <www.tobaccocontrolconference.org> The 2002 National Conference is looking for presentations and workshops that will provide current scientific and practical information on effective tobacoo control strategies and developments. All abstracts must be submitted online. ~ / ~._..._..._....._._.._........_..- --.'1 -----~--~~., --- ~ --- ~ I I NALBOH NewsBrl.! -~ - February 2002 I ................................................................... : Nomination Form : ~ for NALBOH Recognition Awards b : [ Submission Deadline: June 1, 2002 ]1: - - : [] Rev. Everett I. Hageman Award : _ This award, named for one of the founding members of NALBOH, is the most prestigious award given to a- - - _ current or past board of health member who has demonstrated outstanding leadership to a board of health - : and commitment to and enthusiasm for local public health. : : 0 State of Local Health Officer/Commissioner/Director Award : - This award is given to a current state or local health official who has: (1) Contributed significantly to state or- : local public health; (2) Contributed to the training, support and strength of a Local Board of Health or State : Association of Local Boards of Health. - : [] Legislator of the Year Award - This award is given to a national leader who: (1) Is currently serving in the United States Congress; (2) Has - _ shown outstanding leadership in promoting public health; (3) Has sponsored or contributed significantly to bills : championing public health issues. : [] Regional Trustee Award - This award is given at the sole discretion of the Regional Trustee of NALBOH to a current or past Local Board - _ of Health member who has donated significant time and energy in supporting state andjor local public health - . _ Issues. - - - - - - - - - - - - - - - - : Examples of Public Health Enthusiasm: - - - - - _ Involvement in Other CommuntiyjState/National Activities: - - - - - - - - - - - - Nominee's Name: Address: Home Phone: Department/Board of Health: Offices 80. Committee Positions: Legislative or Department/Board of Health Service: Outstanding Achievements: Occupation: Work Phone: :1) - - - - - - - - - - Nominator's Name 80. Title: Address: Daytime Phone: \]) , - - - - - ._-P:~:~2-~-~--- --- ---~-~- - ---.---.-.-.-.- ---------.------- -----.- - -~--------~------ - - -.-.--- - -----.--- - - - _._.---1 Please attiJch other pertinent information as necessary (two-page limit). Send nomination form to: National Association of Local Boards of Health 1840 East Gypsy Lane Road Bowling Green, OH 43402 Fax: (419) 352-6278 "- I NALBOHNewsBrief February ~ ................................................................... Candidate Name: Return By June 1, 2002 : Position for Nomination: · . o President-Elect 0 Southeast Trustee · o Secretary/Treasurer 0 West Great Lakes Trustee : o Mid Atlantic Trustee 0 State Affiliate · . . . . . . . . . . . . . . . . . . . . 2002 NALBOH Officers and Trustees c . . . . . . . Occupation: Address: Daytime phone: Education/ Degrees: On what board of health do you serve: Years served: _ Offices held (board of health, state, national): . . . Is your board of health a member of NALBOH? Yes No . · Specific skills: . . . Contributions made to local public health and community: . a~, I,' iI . . . . . . . . . . . . Daytime phone: . . . . . . . . . . . . Nominated by (optional): Address: . . . . . . . Please attach curriculum vitae or resume if appropriate, mail or fax to National Association of Locai Boards of Health 1840 East Gypsy Lane Road, Bowling Green, OH 43402 at (419) 352-6278 C' . , .:;' . . . . ................................................................... Page13 I r------ : NALBOH NewsBrief t February 2002 NALBOH Needs You! ] NALBOH's annual conference success rests in the participation of its members. Below is a list of opportunities for you to participat~ in the conference and share your successes and challenges. Please indicate which area you have an interest in by checking the bd,-_J/ and completing the information below. Fax (419) 352-6278 or mail to NALBOH, 1840 East Gypsy Lane Road, Bowling Green, OH 43402. Please retLJrn youL response no later than April 15, 2002. Thank you for your support. o Annual Conference Best of the Boards Presentation The Best of Boards session serves as an informal forum for board members to discuss innovative community programs or their board success stories. Participants are provided with a table to display a poster describing the program and/or to distribute sample materials; time is also designated for participants to present their projects, followed by a casual question and answer period. o Annual Conference Tobacco Control Poster Session The tobacco use prevention and control poster session allows boards to share their strategies for preventing and controlling tobacco use. Participants are given space to display a poster describing their local activities and time is allotted in the pro- gram for conference attendees to view and discuss the posters one-an-one. o Access to Care Addressing access to dental and health care services is a major issue for many boards of health. NALBOH would like to hear board members' approaches to increasing access to care for a session on sustaining community health programs. Please call or email the NALBOH office if you have information to share. o Land Use Planning What are the challenges to addressing urban sprawl in your community? What tips do you have for successful land use planning? NALBOH seeks real life examples to discuss a session on urban sprawl and land use planning. Please call or emall the NALBOH office with your experiences. o Other Successes or Challenges You Would Like to Share o Name Board of Healtfl Address Phone Fax E-mail ~------------------------------------------------------------------, I Application for Membership I : Board of Health/Organization/Name: I Address: I City' State: Zip Code: I I Phone: Fax: E-mail: I Contact Person: Title: I Check type of Membership: : 0 Institutional ($120) Any local board of health or other governing body that oversees local public health services or programs I ($95) A local board of health that is a member of its state association I 0 Affiliate ($300) State associations of local boards of health o Associate ($60) Any individual committed to NALBOH's goals and objectives o Retired ($12) Any former member of a board of health, state board of health, local governing body, state, territorial or tribal board of health o Sponsor ($60) A non-profit organization, agency or corporation committed to NALBOH's goals and objectives ($300) A for-profit organization, agency or corporation committed to NALBOH's goals and objectives J o Student ($20) Any full time student committed to NALBOH's goals and objectives . _ I I Date: I Membership Year' 2002 I Mail this portion, along with payment of dues to: NALBOH, 1840 East Gypsy Lane Road, Bowling Green, OH 43402 I I Page 14 -----------------------------------------------------------------_/ , ~--~ ~~bru-;'~ 2002 ! NALBOH NewsBrief ilia. Your Ca!lellda!f'! I Association of Maternal and Child Health Programs C~, 2002 Annual Meeting Maternal and Child Health: Partnering for Healthy Families and Communities March 2-6, 2002 Arlington, VA For more information, contact the Association of Maternal and Child Health Programs (AMCHP) at (202) 775-0436 or visit <www,amchp.org> ----, National Kick Butts Day 2002 April 3, 2002 i The nation's largest initiative to protect children from tobacco addiction and exposure to secondhand smoke. Your Board may get a free Planning Activity Guide. Contact the National Campaign Dr Tobacco-Free Kids at (888) 839-3869 or vist < www.kickbuttsday.org> J - 3rd Annual Ned E. Baker Lecture in Public Health The Changing Roles of Local Boards of Health: From Service Provision to Assurance Featured Speaker: Susan Scrimshaw, PhD Dean, School of Public Health University of Illinois at Chicago Friday, April 5, 2002 1:00 p.m. Eastern Time , , , MARK " YOUR 1 CALENDA~J c.. This lecture will be broadcast by satellite for local boards of health throughout the country! Visit <www.nalboh.org> for more information or call NALBOH at (419) 353-7714 National Environmental Health Association 66th Annual Educational Conference June 30-July 3, 2002 Minneapolis, MN For more information, visit <www.neha.org> or call NEHA at (303) 756-9090 -1 i I ~ NALBOH's 10th Annual Conference The Foundation of Local Public Health: Boards of Health, Health Departments, and Health Officers July 10-13, 2002 The Astor Crowne Plaza Hotel New Orleans, Louisiana Co-located with the National Association of County and City Health Officials For more information, visit <www.nalboh.org> or call NALBOH at (419) 353-7714 ~ c; NACCHO's Annual 2002 Conference Working in a Changed World Strengthening Public Health Preparedness July 10-13, 2002 Ritz-Carlton New Orleans Co-located with the National Association of Local Boards of Health For more information, visit <www,naccho,org> or call NACCHO at (202) 783-5550 Page 15 J (NALBOH'S 10th Al1nual Co~feren~~] o National Association of Local Boards of Health 1840 East Gypsy Lane Road Bowling Green, OH 43402 E-mail: <nalboh@nalboh.org> Website: <www.nalboh.org> The Foundation of Local Public Health: Boards of Health, Health Departments, and Health Officers July 10-13, 2002 The Astor Crowne Plaza Hotel New Orleans, Louisiana Co-located with the National Association of County and City Health Officials For more information contact the NALIDH office by phone: (419) 353-7714; fax: (419) 352-6278 e-mail: <nalboh@nalboh.org>, or vis~ our webs~e at <www.nalboh.org> o NON PROFIT ORG. u.s. Postage PI'JD Bowling Green, OH Permit No.4 7 ~