Health 2015 | Spring

HEALTH SOUTHWEST UTAH PUBLIC HEALTH FOUNDATION S P R I N G / S U M M E R 2 015

M O D E R AT I O N

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Avo i d i n g ex t r e m e s i n health practices

MEASLES

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Yo u r q u e s t i o n s a n sw e r e d

S U N SA F E T Y

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P ro t e c t i o n i n f o r m a t i o n and health benifits

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APRIL IS INFANT IMMUNIZATION MONTH Are your little ones up to date on immunizations? Check out the article on page12. Also, Utah has updated vaccine requirements for students going into kindergarten and 7th grade (visit swuhealth.org for details)

FAMILY RUN BREATHE EASY 5K AND KIDS RUN Saturday April 25, 2015 Confluence Park, St. George, Utah (1850 S. Convention Center Dr.) Go to BreatheEasy5k.org to register!

INTERNATIONAL TRAVEL CLINIC Planning overseas travel this summer? Visit the International Travel Clinic now to make sure you’re all set with vaccines, medications, and information specific to your destination. Available in Washington, Iron, and Kane counties (see page 31 for locations). Reduced rates for missionaries, humanitarian travel, and groups.

PLAY UNPLUGGED Starts right after school ends! Kids can ditch electronics and do fun activities sponsored by local businesses, then visit those locations to collect badges! This popular program will be returning to Cedar City this summer and will debut in Kanab. Visit weplayunplugged.com for details

NEED HELP TO STOP SMOKING? For FREE support and resources to quit the tobacco habit, visit waytoquit.org or call 1-800-QUITNOW

LOW-COST HEALTH SCREENINGS HEMATOCRIT

$15 ANEMIA

LIPID PANEL

$35 CHOLESTEROL

A1C

$25 BLOOD SUGAR

PT-INR

$25 BLOOD-CLOT TING

@SWUPHD offices in St. George, Cedar City, and Kanab (see page 31 for addresses)

PRE VE NT

PAST & PRESENT

6 FRONTIERS IN PUBLIC HEALTH From contagious disease to chronic illness

by David Blodgett, MD, MPH COMMON SENSE

8 THE CASE FOR MODERATION

Avoiding extremes

by David Blodgett, MD, MPH RX SAFETY

10 PRESCRIPTION PARADOX

When the cure becomes a curse

by Kye Nordfelt

PR OT EC T

SUN SAFETY

16 ON THE BRIGHT SIDE Advice from Sid the Seagull

by Louise Saw

INFOGRAPHIC

18 HERE COMES THE SUN Sun 101

by Kindal Ridd

PR O M OT E

IMPAIRED DRIVING

24 UNNACCEPTABLE A tragic story

by Kaysha Price

NUTRITION

26 FOOD FOR THOUGHT Changing routines for better health

by Clint Albrecht, RD

SUMMER

F O R YO U R I N F O R M AT I O N

Avoiding natures hazards

by David Heaton

2 CALENDAR

EMERGENCY

28 ANNUAL REPORT

20 OUTDOOR SURVIVAL

ACTION

Upcoming events and new services NUMBERS

IMMUNIZE

12 MEASLES

Vaccines and parental concerns

by Tara Haelle

Our mission is to PROTECT the community's health through the PROMOTION of wellness and the PREVENTION of disease.

QUESTIONS OR COMMENTS? Email dheaton@swuhealth.org

FOLLOW @SWUHEALTH

22 PREPAREDNESS & PREGNANCY

Preparedness 101 for pregnant women, a refresher for the rest of us

by Paulette Valentine

SWUPHD 2014 in review H E A LT H D E P T .

28 PROGRAMS

SWUPHD services and locations

L ET T ER FRO M THE HEA LTH O FFI CER Welcome to the 10th issue of HEALTH, a magazine that has been distributed throughout southwest Utah since 2011. The mission of the Southwest Utah Public Health Department (SWUPHD) and the Foundation that produces this publication, is to protect the community’s health through the promotion of wellness and the prevention of disease. We do that not only through the programs and services we offer, but by providing reliable information that can empower you to make informed decisions regarding your health and safety.

Our hope is that something you discover in this magazine will inspire you to make a positive change, even a small one, that will improve your health in some way; whether it be through preparedness, prevention, nutrition, or increased physical activity. We’re committed to spreading health-promoting information by delivering it to your door or getting it into your hands...it’s up to you to implement it in your own life, and then into your family and community.

Sincerely,

F O U N D AT ION B OA RD Dav id B l odg e t t , MD Chr is W hit e Jeff S h u mw ay To d d S t i r lin g

PU B L IS HE R David W. Blodgett, MD, MPH SWUPHD Health Officer & Director

The entire contents of this publication are Copyright ©2015 HEALTH (the magazine of the Southwest Utah Public Health Foundation) with all rights reserved and shall not be reproduced or transmitted in any manner, either in whole or in part, without prior written permission of the publisher. Health magazine hereby disclaims all liability and is not responsible for any damage suffered as the result of claims or representations made in this publication.

Printed by Hudson Printing Company / Salt Lake City, Utah / hudsonprinting.com

Jeff S h u mw ay

M A N AGI NG ED ITOR Dav id He at o n

DESIGNER K in d al Rid d

INFLUENZA PANDEMIC

DAVID BLODGETT, MD, MPH SWUPHD Director and Health Officer

HEALTH DEPARTMENTS ESTABLISHED IN 40 STATES

FRONTIERS PAST AND PRESENT

FIRST CONTINUOUS MUNICIPAL CHLORINATION OF WATER IN UNITED STATES

LAST HUMAN-TO-HUMAN TRANSMISSION OF PLAGUE

FIRST USE OF PENICILLIN

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IN PUBLIC HEALTH T

he library at the Johns Hopkins Medical School features an imposing picture of the four founding physicians of the school’s teaching hospital. Known to many as “The Four Horsemen,” much of what they did in their careers continues to impact all of us today. One of them, pathologist William Welch, was concerned that the only requirement he faced when entering medical school at Columbia University was that he be able to read and write. The task these four set for themselves was to rewrite what it meant to practice medicine. In addition to substantially increasing the rigor of medical studies, they also set in place many of the facets of medicine that we recognize today.

Those were exciting times. In 1889, when Johns Hopkins Hospital was established (named after the entrepreneur who left his fortune for it’s creation), the germ theory of

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SALK POLIO VACCINE INTRODUCED PASSAGE OF VACCINATION ASSISTANCE ACT

1900

1920

1940

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CRUDE DEATH RATE FOR INFECTIOUS DISEASES -UNITED STATES 1900-1996 (PER 100,000 POPULATION PER YEAR)

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1980

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PREVENT disease was still fairly new. A recent invention called the microscope had only just begun to help the scientific world understand which pathogens were responsible for certain diseases and how they functioned. Public health departments had barely come into existence. The sanitary revolution was starting to curb the most burdensome of infectious diseases by eliminating some human disease vectors through the development of sewers and indoor plumbing. The 1890’s saw the first large-scale efforts to install citywide plumbing.

Later, as the sanitary movement continued; pasteurized milk, safer foods, purer drinking water, and the enforcement of safety standards for homes and work sites changed life as we know it.

William Welch founded the first school of public health at Hopkins in 1916. The science of prevention had come into its own as mortality rates began to fall rapidly. Shortly thereafter, the great influenza pandemic of 1918 spurred further efforts to find ways to prevent diseases that had claimed so

many lives. Public health interventions had a remarkable impact in the United States throughout the 20th century.

Life expectancy grew by an unprecedented average of 0.3 years annually - the equivalent of three additional years of life for every decade. Most prominently, the rate of deaths from infectious diseases plummeted, falling from 800 deaths per 100,000 people to less than 40. In 1900 the leading causes of death were pneumonia, tuberculosis, diarrhea, enteritis, and diphtheria. Heart disease and cancer accounted for only 11.7% of all deaths. Today, 54.7% of all deaths are attributable to heart disease and cancer, while 3.7% are caused by communicable diseases (including pneumonia and influenza). The discovery of antibiotics, starting with penicillin, and the addition of immunizations brought additional decreases in disease-related deaths, particularly in the very young.

With advancements in technology and improvements in public health practices, many of the diseases that terrorized

mankind throughout history are now largely conquered.

However, a new threat has appeared on the horizon. In addition to the 54.7% of current deaths resulting from heart disease and cancer, other ailments such as emphysema, stroke, liver and kidney disease have brought the percentage of annual deaths related to chronic disease to 70%. These diseases also account for 70% of annual medical costs and loss of quality of life. The challenges associated with these health trends have become the new frontier for public health.

The diseases of today are largely related to things we do to ourselves. Many of them can be prevented or at least lessened largely by the way we live our lives. There are four things (see page 8) that would make a significant difference in preventing the illnesses that are now killing most Americans. Those who are now in the habit of doing these things are well on their way to investing in a longer, healthier life.

For those who have room for improvement, a new lease on life awaits. However, there is

The Four Doctors by John Singer Sargent, Oil on Canvas, 1907, Courtesy of The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

only so much a doctor, family member, or anyone involved in promoting wellness can do to make an impact on someone else. The real power for change lies in personal responsibility for individual health.

It would be interesting to hear what William Welch would have to say about the state of wellness and healthcare in America today. When he was practicing, the average life expectancy was 50 years, now it is 78. Most of those additional years can be attributed to interventions that came about through public health.

Although we have made great progress over the past century, it seems there is much that still needs to be done, especially in the area of chronic disease prevention. As jazz musician Eubie Blake said before his death at age 96, “If I'd known I was going to live this long, I would have taken better care of myself.”

Over the next several issues of HEALTH magazine, Dr. Blodgett will be focusing on the specifics of chronic diseases, including their impact and prevention.

SWUHEALTH.ORG

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DAVID BLODGETT, MD, MPH SWUPHD Director and Health Officer HD

DIRECTOR AND HEALTH OFFICER

THE CASE FOR MODERATION

I

s it possible to take the “good health” message too far? In an age of extremes, it becomes easy to believe that everyone should be on the far end of the spectrum in order to be healthy. If you believe the hype - that if you don’t run marathons, eat only purified organic wheat grass, wear a personal respirator, eat about 3% of your food as fat, have 5% body fat, and take a variety of specialized supplements - then

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you are on the threshold of disaster and certain death.

The problem with the “extreme is best” approach to health is that it only works for very few people. Worse, the implication that you must be in that category to be healthy is just plain wrong, and often dangerous.

Extreme trends that win mainstream acceptance are nothing new.

Heroin, cocaine, and arsenic, for example, have all

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been considered cure-alls in popular culture. Mercury ingestion for a wide variety of ailments persisted for centuries. Bloodletting, lobotomies, and even urine-drinking have all had their turn, and some have adherents to this day. In the 1920s and 30s, dehydrated tape worm eggs were all the rage. Advertised under the heading “Eat! Eat! Eat! & Always Stay Thin,” it was a fad diet that worked to an extent,

but, as you might imagine, the cure was much worse than the problem. Diet fads have always been fodder for scams and uncertain science; the epidemic of methamphetamines for weight loss by women in the 1950s and 60s being a striking example.

The adage of "moderation in all things" remains a time-proven key to lasting success in any health regimen.

PREVENT I want to make the case for cluding a reduction in heart exercise (like a fast walk) for by a substantial benefit that good health through moder- disease and type II diabetes, 30 minutes, five days a week. continues until you reach an ate changes to your lifestyle. improved bone health and in- That means that of the 168 hour of exercise a day. But the National and local health data creased life expectancy. It has hours in any given week, you return for effort is much less paints a portrait of American also been shown to help pre- should be moving for 2 ½ of after an hour. Some studies health behaviors that are, un- vent and fight cancer, preserve them. That's only about 1.5% even suggest that the damage fortunately, quite unhealthy. vision and memory, and even of our time, but the health done after an hour may begin Aside from the “vegan or die” improve sleep. By increasing benefits are incredible; in- to outweigh the benefits of mantra of a small minority, we fruit and vegetable consump- cluding the reduction of heart continued exercise, depending know that only about 22% of tion, you also displace fats disease, diabetes, weight gain, on the activity. Again, moderosteoporosis, ation comes to the rescue. us eat four to five one-cup serv- from your diet, and it is much Alzheimer’s, ings of fruits and Smoking remains vegetables a day. the single largest Far from the fullcontributor to pretime gym-dwellers, mature deaths in only about 20% of our society. If you us exercise three or smoke, it is time to more days a week. quit, and we have Unlike the “only resources to help organic food will go (see page 3). If you into this body” purdon’t smoke, please ists, we know that don’t start.

We 20% of Americans know that 70% of still smoke. And smokers have tried lastly, instead of the to quit smoking, and “quest for size zero” that the rest will image of popular try to quit at some culture, around point. In this case, 60% of residents in moderation requires southwest Utah are us to state that there overweight or obese is no good reason to (having a body smoke. mass index [BMI] of over 25). PutThe ideal lifestyle ting it another way, we are advocating what percentage of for is a non-smokus are practicing CAPTION READS: all four of these Side effects may include: healthy weight loss & maintenance; decreased risk of heart disease, ing, moderately-excategories by eating diabetes, & cancer; improved mood, better sleep, and longer life. May cause even greater benefits ercising one with four or more fruits when combined with healthy eating. Works best when taken most days of the week in the form a few more vegeand vegetables dai- of exercise for at least 30 minutes at a time. Also works well when taken with family, friends, tables in the daiAdopting ly, exercising at pets, and fresh air. Consult your physician if you haven’t tried Getting Off The Couch for quite ly diet. such a lifestyle will least three times a a while. reduce your chance week, not smoking, of premature death and maintaining a healthy weight? The answer is easier to maintain a steady arthritis, back pain, cancer, by 70%. It will also help you a dismal 6%. Chances are you weight.

The good news is and other ailments. Some of feel healthier and happier are in the 94% rather than the that even a small increase in the benefits you're likely to throughout your lifespan.

6%. I believe that buying into the amount of fruits and veg- notice with exercise include: the notion that you have to be etables you consume has ben- reversing the effects of stress, For those of you who run ten superhuman to be healthy is efits. Going from zero to one improvement in mood, im- marathons a year or only eat harmful. The simple truth is fruit or vegetable a day (a real proved learning ability, and special imported watercress that very basic changes in your improvement for some people) increased self esteem and body from Fiji, I salute your dedihealth-related habits can make starts the process. Notice I did image. There are few areas of cation. For the rest of us, the a significant difference. not say "become a vegetarian health that are not improved moderation message is more to be healthy". The moderate with exercise . Interestingly, realistic and much easier to Take fruits and vegetables, for approach is key for the vast the exercise benefit curve ris- live with. Starting to act on es sharply to that half hour-a- the basics of good health toinstance. The current recom- majority of us. day mark, increases at a slower day will bring dramatic longmendation is that you incorporate five (one cup) servings Exercise has equally dramatic rate until you hit an hour and term rewards in the future. In of fruits and vegetables into health implications. The cur- then drops off. So, the first health, as well as in the other your daily diet. The benefits rent recommendation for exer- 30 minutes give the greatest aspects of life, moderation truof such a diet are many, in- cise is to engage in moderate bang for the buck, followed ly is the best policy.

SWUHEALTH.ORG

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KYE NORDFELT SWUPHD Health Promotion, Division Director

PRESCRIPTION

PARADOX

WHEN THE CURE BECOMES A CURSE Take your unused medications to any of the following drop-box locations, no questions asked!

WASHINGTON St. George City Police Department 265 N. 200 E. St. George Dixie State University Police 300 S. 800 E. St. George Washington City Police Department 95 N. Main Street, Washington Washington County Sheriff’s Office 750 S. 5300 W. Hurricane Hurricane City Police Department 90 S. 700 W. Hurricane

IRON Cedar City Police Department 10 N. Main Street, Cedar

GARFIELD Garfield County Sheriff’s Department 375 N. 700 W. Panguitch

KANE Southwest Utah Public Health Department 445 N. Main, Kanab

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T

he phone rang, jolting Jo Ann and Terry Petrie awake - the clock said 5:48 am. The voice on the other line informed them that their 27-year-old son had died during the night from a heroin overdose. As you can imagine, these parents were devastated.

Jordan Petrie’s path to addiction began years before that horrific night. Jordan was raised in a home with five siblings and led by parents devoted to their faith.

He was a star athlete, excelling in multiple sports, including football. As a teenager, Jordan suffered a number of sports injuries and was prescribed pain pills on multiple occasions.

After high school, Jordan ran track for a university, and experienced additional injuries that finally ended his athletic career.

With each injury came more pain

PREVENT pills, and he slipped into an addiction that began to rule his life.

When he could no longer get prescriptions from his medical provider, Jordan resorted (as people struggling with addiction often will) to buying pills illegally, on the street. Since this method is very expensive, he eventually switched to a cheaper alternative . . . heroin.

Jordan made multiple attempts to stop using and was clean for nine months until the night of the overdose from a relapse. This is a tragic story that happens too often. If even the best of parents, like the Petries, can experience this kind of heartbreak, what can be done?

Here are a few suggestions that can reduce the likelihood of your child abusing prescription drugs. If a prescription pain reliever is required, first explore all non-opiate options with your doctor. Parents should securely store the pills and distribute them one at a time. Always keep prescription drugs locked up when not using and immediately dispose of any leftover pain pills before they can become a temptation to anyone. Most people who abuse prescription medications get them from friends or relatives. Regularly talk to your kids about the dangers of drugs and addiction.

PILL DISPOSAL OPTIONS •Check with your pharmacy to see if they have a take-back program.

•Permanent pill drop boxes: located in police departments in St. George, Washington City, Hurricane, Cedar City, Panguitch, and at the Health Department in Kanab (see facing page for addresses).

•Prescription drug take back events: April 25th, 10 am to 2 pm, in the St. George Smith’s parking lot. A semi-annual event sponsored by the Washington County Prevention Coalition, free to the public.

•Home disposal: mix the pills in a ziplock with undesirable material (old food, dirt, etc.) and place in the garbage. Most medications should not be flushed.

Learn more about prescription drug safety at: southwestprevention.com (click “Drug Disposal”) useonlyasdirected.org

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This article originally appeared on Forbes.com on February 5, 2015 under the title 'Vaccine Researcher Gregory Poland Says Measles Jab Is Amazingly Effective But Not Perfect'

TARA HAELLE, GUEST COLUMNIST Tara is a freelance science journalist specializing in health, nutrition, and parenting issues. Her work has appeared in Scientific American, The Washington Post, Politico, Slate, NOVA, and Wired.

, MEASLES VACCINE CONCERNED PARE 12

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PREVENT Parental concerns and questions regarding vaccinating children have been around for a long time. Benjamin Franklin offers this sobering advice: “In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.”

, ESENTS&

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hile public health officials have scrambled to keep up with more than 175 measles cases across 17 states this year, some vaccine researchers have been calling for a solution to this problem before it arrived. Gregory Poland, editor in chief of the scientific journal Vaccine, founded and heads the Vaccine Research Group at Mayo Clinic in Rochester, Minnesota.

A major focus of his team’s research is learning how genetics play a role in how individuals respond to vaccines and whether they experience any adverse events – and measles is among the main diseases the center studies.

two hours. With primary failure, a person’s immune system doesn’t respond to the vaccine and make the necessary antibodies. In secondary failure, the body makes the antibodies, but they fade over time.

Poland said he became seriously interested in measles and the vaccine during the 1989-91 outbreak, which killed 123 people and hospitalized thousands. But anywhere from 20 to 40 percent of the cases occurred in people who had received one or two measles vaccines, leading to the recommendation of a second dose on the childhood schedule. So Poland wrote about what seemed a counterintuitive idea: in very highly immunized populations, most measles cases were going to occur in those who were immunized – but not because the vaccine is worse than others on the CDC childhood immunization schedule. Rather, it had to do with rates of primary and secondary failure of the vaccine combined with how incredibly contagious the disease is, infecting 90 percent of susceptible individuals and remaining airborne for up to

Tell me about the measles vaccine.

In the avalanche of media coverage about the current outbreak, Poland’s comments have frequently shown up, but often out of context. So I interviewed Poland to learn what he thinks about the current measles vaccine, the ongoing outbreak, those who refuse to vaccinate and the future.

On the one hand, we have the most transmissible disease known in humans, and on the other hand we have an excellent vaccine – which is not a perfect vaccine – and we don’t induce immunity in somewhere between 2 to 5 percent of the people who receive it. When everybody is vaccinated, the only cases you’ll see are those in cases who are immunized, though you’ll see very few cases compared to a population that doesn’t have high levels of herd immunity. This is counterintuitive, and people misunderstand it. For any other disease, that’s an out-of-theballpark, grand slam vaccine, but with measles, it’s not because of the high transmissibility and the high level of herd immunity needed.

What are some of the challenges of preventing measles?

While we eradicated smallpox, measles was next on the list, and we’ve missed that deadline five times now. Can we control and eliminate measles? Sure, we have. It was eliminated in 2000 in the U.S., so the only cases that occurred were imported. But as we creep toward that goal of eradicating measles, we may need an even better vaccine than what we have. I’m not saying the vaccine isn’t any good. In fact, it’s an excellent vaccine. But in the very unique niche of such a highly transmissible disease, and having a couple percent who don’t respond, and then a growing subpopulation who cannot get the vaccine, we may need an even better one. More people survive (diseases such as cancer) now, but live on anti-rejection immunosuppressants

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the rest of their lives. That was the reason for calling for an even better measles vaccine, one that perhaps would not be a live viral vaccine, where there wouldn’t be any contraindication for the immunocompromised. We make it more immunogenic, so maybe we don’t have that 2 to 5 percent who don’t respond, and we make it cheap and easy to administer worldwide.

Is there any other vaccine as effective as the measles vaccine?

Probably the one that would most fit would be the tetanus vaccine (which prevents a bacterial infection), but in terms of a viral vaccine, maybe smallpox. Probably no other routinely used viral vaccine is as effective as the measles vaccine.

we have a small failure rate of the vaccine, and a growing subpopulation of people who won’t get the vaccine. The point in my editorial was that we might be able to solve all those problems by developing an even better vaccine. But that’s what people misunderstand. Both sides hear what they want to hear, and when I’m writing to the scientific community, I think some of the nuances could be misinterpreted by laypeople or by people with an agenda. They think, “Hey, here’s somebody who’s saying it’s not a good vaccine” because that’s what they want to hear.

Tell me your thoughts about those who choose not to get their children vaccinated.

Every time you add another sub population of people who are not protected, you grow the pool of the susceptibles, and if you have a large enough pool spread across enough areas, you can reestablish measles. If the only susceptibles were those in whom the vaccine failed, you would only have very small outbreaks of one or two or three people spread across time. The reason this is a big issue is that we do have this undercurrent of vaccine-hesitant and vaccine-refusing patients. And we do have failure.

One of the things I take as valid health criticism, as my daughter, a psychologist, has pointed out, is that we in the medical profession have not done a good job of discussing or explaining this to our patients. She developed an idea that people have different preferred cognitive styles and decision-making behaviors and that what we need to do is not stick only to the highly analytic cognitive style of a physician – all about the facts and data and numbers – but to determine the cognitive style of the patient in the front of us. Then it’s incumbent upon us to best meet the cognitive styles of the patient. I think we have erred in not doing that.

The point is, to say the obvious, that we have an excellent vaccine, but we find ourselves in a unique situation right now.

We’ve eliminated measles through indigenous transmission, but

I don’t think my patients who reject vaccines are nuts. They have come to a conclusion – I believe their conclusion is in error – but they have come to a conclusion that the vaccine is not

Is measles likely to return to the U.S. for good?

You’re right buddy, measles can be found on surfaces...

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...and it’s also airborn and one of the most contagious diseases known to mankind.

But don’t worry, there’s a vaccine that’s 97% effective!

Did you know grandma and anyone else born before 1957 are immune?

PREVENT good. I’ve yet to meet a parent who doesn’t want to do the very best for their child, including vaccines. What I try to do now is try to determine the style they use to make decisions under uncertainty, and that often means I have to establish a rapport or relationship with that patient before they will consider getting a vaccine. Or they may decide never to get it, but I often view my role as a physician as a patient advisor, and I try to give them the best information we know and have. If they make a choice that I think is adverse to that, I will let them know.

How has the measles vaccine affected cases of the disease, and the complications and deaths that can come with the disease?

The measles vaccine has dramatically decreased cases because of the lower number that occur. The risk of taking the vaccine itself would be, if it was administered properly, maybe about a one in million chance of anaphylaxis. Otherwise there really aren’t life-threatening issues or complications associated with the vaccine. On the contrary side, should you develop measles, 1 in 1,000 develop encephalitis. During the outbreak in 1989-91, 3 out of 1000 kids died. It’s not a benign disease for everybody. For many children, it will be benign, but you can’t predict that, nor can you predict who they are going to expose, who may have more serious complications.

risk of any other life-threatening illness has got to be so small, maybe one in 10 million, that we can’t detect it. Now let’s look at the measles. If we’re wise, we always choose the lower risk with the higher benefit, because that’s what a rational person would do, enhancing their benefits while minimizing their risks.

During residency, I was chosen to go in and tell a mother that her baby was dead from pertussis. Back then, the fear was about SIDS and DPT, and she had elected not to immunize her baby.

It was such a bad case that this woman’s life was tragically altered by the death of her baby daughter, and for as long as this mother lives, she regrets every day that she did not immunize her child.

People get to choose, but there are consequences to those choices. Yes, parents are allowed currently to make that choice not to vaccinate, but with a disease this transmissible, and the complications that can occur, you’re also choosing for other people because your child is going to expose somebody, perhaps before you even know your child is sick. And what’s going to happen to those people? Like any rational society, we depend on the idea that people will make good decisions and have good will. I’ve spent my career talking about this stuff, and I’ve found actually, that THE most contagious disease is fear. But to be afraid is to be ignorant in a case like this.

The way I often conclude my conversation with patients is that there are no risk-free decisions. The observed risk of autism due to MMR is zero. The risk of anaphylaxis is 1 in a million. The

So, give it a shot!

Haha, get it?... it’s a shot...

That’s not funny.

So before we enter kindergarten we’ll need to be caught up on our vaccinations.

What if I’m immuno compromised?

Don’t worry, I’ve got you covered.

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LOUISE SAW Epidemiologist for Central & Southwest Utah Public Health Departments

ON THE

BRIGH Image published with the permission of the SunSmart Program at Cancer Council Victoria.

W

hen I tell people that I’m the epidemiologist at the health department, they sometimes ask me to check out a spot on their skin. Close, but they’re probably thinking of a dermatologist.

While epidermis refers to skin, epidemiology has more to do with epidemics. So, I may not be able to diagnose skin cancer,

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but I can speak to the prevalence of skin cancer and how to prevent it.

For years we have heard that too much sun exposure can cause skin cancer, and Utah has the highest rate of melanoma in the nation. It makes sense to get less sun exposure in order to prevent skin cancer.

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The tricky part is figuring out how to protect yourself from harm while still enjoying the the amazing outdoor lifestyle offered by southern Utah, with averages of up to 300 sunny days per year. As a redhead with fair skin and freckles, I know all too well the pain of sunburns. I have far exceeded the one blistering sunburn

P R OT E C T that can double the lifetime risk of developing skin cancer. In less than an hour in the sun, the damage starts. Slathering on sunscreen can be a pain, but getting a sunburn is much more painful. We humans tend to avoid pain, but knowing

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excited about using a stationary bike instead of pedaling outside. By not getting enough sunshine, I also miss out on the mood-enhancing benefits of boosted levels of serotonin that come from sun exposure through the eyes, synchronizing my circadian rhythm which regulates melatonin and sleep patterns, and the well-known benefits of vitamin D, which is primarily produced by sunlight on the skin.

the risk of getting skin cancer isn’t always enough motivation for me to turn the car around once I realize I forgot to pack the sunscreen. It also doesn’t motivate me to stop and get my hands greasy re-applying sunscreen two hours into my rock climbing adventure. Even the spray-on version is supposed to get spread by hand to ensure adequate coverage.

On the bright side, it may actually be detrimental to your health to avoid the sun.

Spending too much time indoors means more eating than I need (social eating, bored eating, TV eating). It’s hard to get

Since no sunlight is only a solution for vampires, moderation must be the key. To access sun-related health benefits, get 1520 minutes of exposure each day, preferably not when the sun is at its peak (“when your shadow is short, seek shade”). After you’ve had your quota, it’s time to follow the advice of Sid the Seagull, spokesbird for one of Australia’s most successful health campaigns in history: Slip, Slop, Slap, Seek, Slide - slip on a shirt, slop on some sunscreen, slap on a hat, seek shade, and slide on some sunglasses.

The admonishment to wear sunscreen is almost as common as “don’t smoke”, but do you know what type to use? Your choice may depend on your skin type and how quickly you get burned, time of day, elevation, if you’ll be swimming or sweating, and if you’re being exposed to reflective surfaces like snow or water. As far as SPF (Sun Protection Factor), choose a sunscreen with at least 15 SPF. A range of 30 to 50 will provide ample protection when used correctly, and the benefits of

anything above 50 SPF are questionable.

Regardless of what sunscreen you use, you should reapply it at least every two hours.

I’ve been asked if sunscreen actually causes cancer. This notion is an example of how easy it is to get caught in the association-equals-causation trap. Yes, skin cancer has increased since sunscreen came out, but many factors have changed since sunscreen gained popularity. Before the 1920s it wasn’t desirable to have tanned skin, the atmospheric ozone layer wasn’t as thin, clothing styles were different as far as coverage, people generally didn’t live as long, and diagnostic tools were not as advanced. Many things can play a role in developing skin cancer, but current evidence supports using caution with sun exposure specifically; so bottom line: sunscreen use has more benefits than risks.

Even though I’m now more vigilant in regards to prevention, sunburns from the past have made me more aware of skin cancer risk. Use the ABCDs to remember what to watch for with skin spots: Asymmetric spots (if you could fold it in half the sides would not match), Borders that are irregular, Color variations in the spot (not all one shade of brown), and Diameter bigger than a pencil eraser (that’s 6 millimeters for those who only type).

Have a dermatologist (not an epidemiologist*) check out these types of spots.

SLIP ON A SHIRT SLOP ON SUNSCREEN SLAP ON A HAT SEEK SHADE SLIDE ON SOME SUNGLASSES

*EPIDEMIOLOGIST: One who studies the patterns, causes, and effects of health and disease conditions in defined populations. Epidemiology is the cornerstone of public health.

SWUHEALTH.ORG

17

SUN PROTECTION FACTOR

UV=ULTRAVIOL INVISIBLE ENERGY

HERE’S HOW IT WORKS...

UV

( 10 ) x = 150 ( 15 ) x = 300 FAIR SKIN THAT BURNS IN

MIN

AGING R

MIN. OF PROTECTION

DERMIS=deeper pe

DARKER SKIN THAT BURNS IN MIN

THE MORE

E

MIN. OF PROTECTION

cem

93% UVB

BLOCKS

PROTECT SUNGLASSES PREVENT CATARACTS (IF LABELED 100% UVA & UVB PROTECTION)

( ) DARK, THICKER, TIGHTLY WOVEN CLOTHING

PROTECTS BET TER THAN

( ) LIGHTER, WET, & LOOSE CLOTHING

1/3 OF ALL SKIN CANCER OCCURS ON THE NOSE! A HAT CAN LOWER YOUR LIFETIME RISK OF SKIN CANCER BY 40%

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H E A L T H | S P R I N G / S U M M E R 2 015

BLOCKS

97% UVB

BLOCKS

98% UVB

NO SUNSCREEN PROTECTS 100% BROAD SPECTRUM PROTECTS AGAINST UVA & UVB WATER

RESISTANT WATER

PROOF

effective

40 MIN. submerged in water effective

80 MIN. submerged in water

SPF 30 or higher recommended for children under 6 years of age

cle

LET RAYS

FROM THE SUN

V

BENEFITS =

UV

HO

BURNING RAYS

RAYS

enetration

SEROTONIN

runs the body

CLOCK

the sun can reflect off...

snow

sand

REGULATES:

&

hunger cycles sleep cycles & hormone production

water

sun rays on skin creates nitric oxide, causing blood cells to widen, resulting in...

=

N H

SEROTONIN

sun rays trigger photoreceptors in the eye which send signals for the brain to start producing...

EPIDERMIS=superficial layer

INTENSE THE SUN, THE GREATER UV EXPOSURE TO YOUR BODY

ment

NH2

ELEVATES: energy alertness & mood BLOOD PRESSURE DROPS HEART RATE SLOWS

...RELAXATION

earer and thinner air at high altitudes gives UV rays stronger penetration sun rays on skin produces

SHORT SHADOW? SEEK SHADE!

10AM-4PM

VIT.

D

=

LOWER RISK OF HEART DISEASE, ALZHEIMER’S, STROKE, & DIABETES

15 MIN.

SUN EACH

DAY 15min of daily unprotected sun exposure creates more vitamin D than you can get through any food

DANGER 1BLISTERING SUNBURN

CAN DOUBLE A CHILD’S LIFETIME RISK OF DEVELOPING SKIN CANCER

UTAH HAS THE

HIGHEST

RATE OF MELANOMA

IN THE NATION!

©2015

SWUHEALTH.ORG

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DAVID HEATON Managing Editor/ SWUPHD Public Information Officer

SUMMER

OUTDOOR SURVIVAL S

outhwest Utah features an incredible diversity in landscape; including sandstone monoliths, volcanic formations, canyons, lakes, streams, and forested mountains.

Our corner of the state is home to a variety of state and national parks and monuments, hundreds of miles in trails, and vast expanses of public land to explore. Spring arrives in Utah’s Dixie before the snow has melted on the mountains

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in the region’s higher elevations, luring visitors and locals alike into the outdoors to enjoy sunny skies and warm temperatures that last into the fall. Along with nature’s charms come some potential hazards to personal health and safety.

Whether you venture out for a few hours or several days, here are some tips and reminders to help keep your outdoor adventures memorable in a good way:

P R OT E C T SUN - Sunny days in the outdoors means potential sunburn. You can also get exposure from sunlight reflected off sand, slickrock, water, and snow. See pages 1619 for in-depth information on sun safety.

WILDLIFE - Enjoy wildlife at a distance. Animals that appear sick or easily approached should be avoided to reduce risk of exposure to diseases that can infect humans (i.e. rabies, plague, etc.).

INSECTS - Besides the nuisance of pain and itching, biting insects can also carry diseases like West Nile virus (mosquitoes), tularemia (deer flies, ticks) , and Rocky Mountain spotted fever (ticks). Wear 30% DEET repellent and protective clothing.

WATER HAZARDS - Run out of water? Use a water filter or boiling if you drink from streams or other outdoor water sources. Water contaminated by animal feces may expose you to giardia, the most commonly encountered intestinal parasite in the U.S. Aquatic recreation: Wear life jackets, keep an eye on kids, don’t overestimate your swimming ability, don’t dive into spots you haven’t checked out first, and don’t use drugs or alcohol.

Swimmer’s Itch is caused by exposure to parasite larvae in warm, shallow water along shorelines (not uncommon in local reservoirs). Causes small, itchy red bumps that last up to a week, but is otherwise harmless. Prevent by toweling off or showering immediately after leaving the water.

FLASH FLOODS - Despite desert environments, one of southwest Utah’s most common natural hazards is flooding, especially during summer monsoon season. Flash floods can be especially dangerous if you find yourself in a narrow canyon or any other waterway. Caused by storm runoff (even from miles away), flash floods can appear without warning and transform a dry creek into a raging torrent within seconds. Keep safe by: •Checking the region’s weather before you enter canyons •Immediately climbing to the closest higher ground if flooding occurs •Waiting until flooding subsides before approaching lower ground. Do not attempt to cross a flooding waterway; there may be boulders, logs, and branches underneath the surface

HEAT - Heat is the number one weather-related killer in the U.S., resulting in approximately 400 deaths per year. To prevent heat stroke/exhaustion: •Limit or avoid strenuous outdoor activities in the heat of the day, especially if you’re elderly or unaccustomed to the climate •Wear lightweight clothing & hat•Stay hydrated with plenty of water•Take frequent rests, under shade if possible HEAT EXHAUSTION - Prolonged exposure to heat and dehydration •Heavy sweating •Skin pale/cool/moist •Weak, fast pulse •Muscle cramps •Tired/weak •Dizziness/fainting •Headache •Nausea/vomiting HELP: cool nonalcoholic beverages, cool shower/ bath, air-conditioning. Seek medical help if symptoms last over an hour or history of heart problems.

FOOD - Skip the foraging option (which carries it’s own risks) and bring your own food. To avoid food poisoning, keep cold foods cold (perishable foods can become unsafe after 2 hours without refrigeration, or just 1 hour in direct sun). Try these outdoor nutrition ideas: •granola •dried fruits and nuts •jerky •canned meats •dried noodles and soups •dehydrated foods •powdered drinks

HEAT STROKE - Body no longer able to sweat & cool down. Can be serious •Very high body temp (103°+) •Skin red, hot, dryt •Rapid, strong pulse •Throbbing headache •Dizziness •Nausea •Confusion •Unconsciousness HELP: Get immediate medical assistance while cooling victim using any methods available until temp drops to 101-102°. Do not give fluids to drink

LIGHTNING - is Utah’s second most fatal natural hazard, following avalanches, causing 51 deaths and 131 injuries since 1950. •Postpone outdoor adventures if thunderstorms are forecast •If you’re outside and a storm approaches, immediately seek shelter in a vehicle or sturdy building •DO NOT seek shelter under isolated trees •Get out of watercraft and stay away from water •No shelter? Seek the lowest spot away from tall objects. Select shorter trees if in a forest

OTHER TIPS - •Carry a compact survival kit containing emergency first aid, signaling, light, warmth, and other implements •Research your destination beforehand •Use the buddy system •Tell others where you are going

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PAULETTE VALENTINE SWUPHD Emergency Preparedness Divison Director

PREPAREDNESS AND

PREGNANCY EXPECTING THE BEST WHILE BEING PREPARED FOR THE UNEXPECTED

A

local mayor recently said, “We prepare now so that when something happens, it’s not so much an emergency as a reminder of what we had already planned for, just in case.”

Southern Utah is no stranger to the occasional calamity; whether it be flooding, wildfire, earthquake, winter storm, high winds, or power outage. Making plans to weather these events is a good idea for everyone, especially those who are elderly, disabled, living alone, or otherwise vulnerable.

Being pregnant would also have unique challenges in an emergency. If you’re a woman (or have one in your family) with this “condition”, take some time to cover the bases. Your pregnancy and delivery will likely be routine, but a little just-in-case preparedness could give you peace of mind and ease

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the anxiety or discomfort that may come with an unexpected disaster.

HOME ALONE

In the unlikely event that you were unable to get to a hospital for delivery due to impassable roads or bridges, damaged facilities, or simply going into labor early, do you understand the birth and delivery process? Ask your doctor or healthcare provider, “What are the most important things I should be aware of in case of an emergency?” Be sure you know how to recognize signs of fetal distress. Hospitals often offer prenatal classes that will cover all the details. The dad may be the closest person available to assume the delivery- assistant role, so make sure he is up to speed on this information! Be reassured that almost all emergency births turn out normal and without complications.

P R OT E C T A SAFE ENVIRONMENT

Make your home a safer place.

This is a good idea, regardless.

Have smoke and carbon monoxide detectors installed and check them regularly. Keep a fire extinguisher handy and know how to use it. Know where the gas shutoff valve is and how to turn it off.

Don’t turn it off unless you smell gas, or are instructed to do so by emergency personnel. Once it’s off, leave it off until you can have the gas company come and turn it back on.

COMMUNICATION

If the power goes out, an AM/FM radio with good batteries (stored separately) could be essential for getting information on emergency events. You could also use your car radio, but be careful not to run down the battery.

If your cordless phone system stops working in an outage, a simple phone set that plugs directly into the phone jack will still work, since phone lines carry their own electricity. If cell phone lines are jammed, try texting, which will sometimes get through when calls won’t. Keep your cell phone charged and important phone numbers with you at all times.

It can be hard to remember simple things like numbers under stress, especially when trying to tell someone who is dialing for you. Besides numbers for family, friends, and medical providers, include contacts outside the state.

They can sometimes be reached when local communications are down and can assist in getting help to you.

THE RIGHT STUFF

Your home/car first-aid kit might need an upgrade to include items useful in handling a delivery: •Hand-sanitizer/anti-germ lotion •Large gauze pads/sanitary napkins •Scissors •Pair of new/clean shoelaces •Cold pack •Pain-relieving medications Every family should have at least three days worth of ready-to-eat or easy-to-prepare food stored at home, along with drinking water

and emergency lighting. A portable emergency preparedness bag should be prepared in case you need to evacuate and leave home.

Here are some essentials, customized for expectant moms: •Change of clothes & underwear that fit the season •Comfortable shoes •Bottled water •Food items (granola bars, crackers, candy, other snacks, etc.)

•Flashlight/headlamp with extra batteries •Mirror and whistle for attracting attention/help •Cash in small bills (in case ATM/credit card machines aren’t working) •Copies of important papers that would help those who may be helping you: medical records, medications, blood type, insurance, physician/family/friend contact information •Personal hygiene items •New baby needs: diapers, cleaning wipes, lotions, pacifiers •Baby carrier (can be used to hold bag)

STAY HEALTHY

Sometimes overlooked in preparedness efforts is the benefit of taking care of yourself, especially if you’re pregnant. Practice good habits of eating well, getting enough sleep and rest, along with appropriate physical activity. Avoid alcohol, smoking, or any drugs that might harm you or your baby. Have regular visits with your doctor or healthcare provider to monitor the health of both of you. Keep stress low and maintain close relationships with loved ones.

There’s a good chance that you won’t have to worry about making it through a major disaster during pregnancy or experience an emergency delivery. Any worry can be reduced even further if you are prepared, which would make your life much more manageable if or when the unexpected happens.

SPEAKING OF BABIES… See page 30 for the most popular baby names in southwest Utah!

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This article is fourth in a series spotlighting “Zero Fatalities”, a united effort to save lives by preventing the five deadliest behaviors that occur on Utah’s roads. Not buckling up, distracted driving, and drowsy driving were covered in the last three issues of HEALTH magazine. Aggressive driving will be addressed next issue.

KAYSHA PRICE SWUPHD Health Educator

UNACCEPTABLE THE CONSEQUENCES OF IMPAIRED DRIVING

C

ollin Worland's tragic death (see facing page) was one of 10,839 deaths that occurred in the United States in 2011 as a result of impaired driving.

After hearing Collin’s story and others like it, most of us would consider driving under the influence of alcohol and drugs to be unacceptable, yet some people still make the choice to get behind the wheel under those circumstances. In Utah alone, during 2012, there were over 11,600 DUI arrests and 765 drug-impaired driver crashes, which resulted in 545 injuries and 40 deaths.

With car accidents being the number one killer of teens, one can only imagine what happens when we throw impaired driving into the mix. In 2011, 24% of young drivers ages 15-20 involved in fatal crashes were drinking. Another 24% of teens report recently riding as a passenger with a teen driver who had been drinking.

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Collin’s story reminds us that it’s not just alcohol we should be concerned about. Impaired driving can also result from the use of prescription and illegal drugs, including marijuana. All have been shown to weaken a driver’s motor skills, reaction time, judgment, concentration, and reflexes. If your prescription warnings include not operating heavy equipment, that includes driving a vehicle. Safe driving requires attention, awareness, good judgment, and coordination at all times.

While we agree that impaired driving is unacceptable, it will take specific actions to curb and eliminate this alltoo-common behavior. When Collin Worland exclaimed “Because I’m awesome!” he was speaking the truth. At the age of four, he won the title of “Southern Utah Most Talented Kid.” He shared his talents in singing and acting with oth-

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ers and continues to be greatly missed by family and friends.

In honor of Collin, and in memory of all other fatalities from impaired driving, we present the following “Because I am Awesome” guidelines. We challenge you to live by them and inspire others to do so as well, especially any young drivers in your life.

BECAUSE I'M AWESOME, I: •Support laws and penalties intended to reduce impaired driving; such as administrative license suspension, sobriety checkpoints, and alcohol interlocks (people are less likely to use substances and drive if they believe will get caught).

•Make personal efforts by designating a driver, reading my prescription medication guidelines, and being open to others about my desire for them to do the same.

•Set rules, guidelines, and role-play driving expectations with my teens at home.

I discuss the harmful effects of drugs and alcohol, and the consequences of their use.

•Am an active part of my community, and am not afraid to report an impaired driver (warning signs include: drives unreasonably fast, slow or inconsistently, weaves in or out of their lane, makes frequent lane changes, ignores traffic signs and signals, drives at night without lights, drives too close to curbs, shoulders, or the center of the lane).

To get additional information for parents of new drivers, Utah’s graduated driver licensing laws, the 5 Deadly Behaviors, and more, visit DontDriveStupid.com

P R O M OT E "BECAUSE I’M AWESOME—” Words we will never again hear our precious Collin say—now engraved upon a headstone. Before, we’d laugh at his humor and unwavering confidence; now, we cry at the truthfulness of this statement and remembrance of what was lost.

Collin truly was AWESOME. He was talented, intelligent, fun-loving, outgoing and adored by many. He was destined for greatness with limitless potential. He was anxious to grow up, to drive, get a job, serve an LDS church mission, get his own apartment and be independent.

Collin was the oldest of five children and an incredible big brother! He would carry his sister on his shoulders when she was too tired to walk, called his one-yearold twin brothers his “babies,” and was inseparable from his younger brother, his best friend.

On the morning of November 2, 2011 (only two weeks after his 13th birthday), Collin was tragically stolen from us by a 19-yearold driver high on marijuana.

The day began as any other.

Collin woke up and got himself ready for school. We lived across the street from the Jr. High, so he and his friends walked together. At 7:20 a.m., I awoke to Collin in my bedroom doorway as he said, “Bye, Mom, I’m going.” I replied, “Okay, I love you.”

About five minutes after he left, I heard a siren. My heart sank a little, but I told myself not to jump to conclusions. Upon seeing traffic backed up behind my house, I grew more concerned, and looked out a window to see an ambulance and paramedics gathered around somebody on the ground. I yelled to my hus-

band to make sure it wasn’t Collin.

Impatiently, I ran outside praying. As I approached the scene, I saw a pair of blue and black DC shoes in the road.

Collin’s shoes. My worst nightmare had come true. I ran over to my precious boy, who was unconscious and lying in a pool of blood. I couldn’t believe this was real. The officer informed us they were going to fly him to Primary Children’s. My husband and I cried and prayed harder than we ever had before.

A moment later, the officer approached us again to say they’d canceled Life Flight. Collin had gone into cardiac arrest. I ran over to the ambulance, where they were administering CPR, and yelled, “Collin, come on buddy!! You’ve gotta pull through! We need you!”

A few minutes later, the officer approached us one last time, shaking his head and saying, “I’m sorry.” I have never felt such intense, unbearable, pain, shock, disbelief and sorrow as I did in that moment. My life, as I knew it, was over.

Next came the responsibility of telling our other children that their big brother was gone. This has been incredibly hard on our family, as well as countless friends, neighbors and classmates.

Many hearts were broken that day and some, like my own, will never fully heal. Collin was an indispensable part of our lives. One of the hardest things is knowing his twin brothers will never know him.

If there is any good that can come from this, I hope it will send a message to young people about the dangers of drugs and the importance of attentive driving. There are some mistakes that can’t be undone and will forever rob us of what could have been.

-Erin Worland

MARIJUANA: THE SAFE DRUG?

● Slows reaction time, doubling risk of being in a car accident ● Can be addictive to some users ● Unpredictable drug strength ● Can worsen liver disease, diabetes, and low blood pressure ● Can cause or exacerbate depression, anxiety, suicidal thoughts, and psychosis ● Linked to schizophrenia-related brain changes SWUHEALTH.ORG

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CLINT ALBRECHT, RD SWUPHD Health Educator

FOOD FOR T

THOUGHT

he science of nutrition is a complex and often confusing topic.

In what field have we seen more deviations, conflicting literature and opposing advice from so many experts? There are thousands of diets (each of them claiming to be the best one), copious amounts of supplements and a plethora of nutrition theories. So how does someone make sense of the nutrition industry? What should we be eating? Ironically, is there an area of science that the general public knows more about? Probably not. Who doesn’t know we should eat more fruits and vegetables, whole grains, and lean protein?

Who doesn’t know that we should downsize our portions, limit simple sugar intake, and avoid trans fats? Yet, despite all of the information and knowledge available, trends in nutrition-related diseases, such as diabetes and obesity, continue to rise. So why don’t we act in accordance with what we know as it relates to nutrition and health? That’s where it can get complicated. We have physiological, social, and emotional triggers that influence our food decisions.

Food is a nourisher, nurturer, energizer, comforter, congratulator, partier, stress reliever, rewarder, and healer.

Many of us recognize that we would benefit from a lifestyle change. What does that mean ex-

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actly? Does it mean transforming from a “couch potato” to a “fitness nut”? If so, no wonder we fail. There are many things that affect our lifestyle which aren’t so easily manipulated but definitely contribute to our eating patterns; including where we work, where we live, and how many children we have. However, some change needs to occur if we are to eat healthier. It’s no different than a smoker trying to quit who must figure out a different way to cope with stress or an alcoholic who chooses to hang out with different people on a Friday night. If a lifestyle change is needed, how do we make the necessary changes within the context of who we are? Because food has become so many different things to so many people, there isn’t one simple solution to help people eat healthier.

Although we may each need to overcome our individual barriers to healthy eating, might there be one common strategy that would work universally?

The answer is yes, and it has to do with altering our daily routine.

We are creatures of habit, a tendency built inside our brains from the beginning of time as a survival mechanism. The more we can run on autopilot, the less energy we use, thus the better chance at survival. The brain is continually trying to associate and group stim-

P R O M OT E

1. WASH

2. PEEL

3. CUT

4. SOAK 5. SEASON in water for an hour to release starch, making your fries crunchier when baked. Pat dry.

with olive oil, salt and pepper, paprika, garlic salt or other seasonings.

425° until desired crispness 6. BAKE atis achieved (at least 20 min)

Try this easy recipe for sweet potato fries as a healthy alternative to the greasy standard.

Sweet potatoes are high in vitamin B6 and carotenoids and are a good source of vitamin C and D. They also contain iron, magnesium, and potassium, and their natural sugar releases slowly into your bloodstream for a balanced source of energy. uli together so we become more efficient.

How does this apply to nutrition behavior? Answer the following questions: What do I eat for breakfast?

Why? Do I eat while watching a movie or ball game?

Why? When I celebrate something, is food involved? What kind of food? Why? Do I go for a coffee or soda run daily?

Why? Many of the foods we eat are tied to our daily routine and its association with life events. It’s easy. It’s comfortable. It’s just what we do.

It’s our autopilot.

Instead of going out to eat for lunch everyday where it’s easy to make unhealthy choices, pack a lunch from home. In-

ples with a little caramel dip instead of a huge bowl of buttered popcorn when watching a ballgame, or chatting with an old friend by phone, text, or social media when you’re feeling lonely versus eating a bowl of ice cream.

THE FIRST STEP IS TO IDENTIFY YOUR PROBLEM BEHAVIORS AND THE ROUTINE SURROUNDING THE PROBLEM.

When we begin to change our routine, we also begin to change the unwanted behaviors associated with that routine, even if it’s subtle at first. The first step is to identify your problem behaviors and the routine surrounding the problem. Then zig instead of zag and see if that helps curb the unhealthy behavior. For instance, by taking a new route to work, you don’t stop and buy that latté or donut on your way.

stead of going for a 44-ounce soda run, bring a 12-ounce can of soda and go for a 15 minute walk with a coworker.

Substitution can also be a great tool to facilitate change. Look for ways to substitute a less healthy behavior with a healthier one that will give you close to the same effect. For instance, eating ap-

When it comes to food, we are guilty by association. When we to find ways to mix up our routine it creates opportunities to shake up and avoid unhealthy behaviors associated with that routine. Whether it is unwanted emotional eating or social eating, pick a scenario and substitute a healthier behavior instead. By doing this we start to unravel the complex association between food and mood. We become more conscious of why we are eating and can begin to focus more on listening to our body and eating because we are hungry, not because “it’s just what we do” in that circumstance.

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BOARD OF HEALTH Co m m issioner Victor Iv erson » w ash i ng ton cou nt y

Linda Rider

» w ash i ng ton

cou nt y

C o mm issioner D ale Brinkerhof f » i ro n co u n t y

Dr. Clayton Petty » i ron cou nt y

Co m m issioner Jim M atson » k ane cou nt y

Rosalind M etcalf

» k a ne

co unt y

Co mm issioner M ark Whitney » b e aver cou nt y

Kenneth Elm er

» b e aver

cou nt y

Co mm issioner D av id Tebbs » ga rf i el d co u n t y

N ick Reynolds

» g ar f i el d

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cou nt y

The Southwest Utah Public Health Department (SWUPHD) serves the 210,000 residents of Washington, Iron, Kane, Beaver, and Garfield counties. Our mission is to protect the community's health through the promotion of wellness and the prevention of disease.

SERVING OUR COMMUNIT Y NURSING SERVICES

•UNIVERSAL SERVICES: To better serve the public, nursing staff have cross-trained and combined multiple programs under one point of contact for clientele; including immunizations, international travel consultation, WIC, and vital records. All services are also now offered on a walk-in basis, with no appointment needed.

•2014 TOTALS: for all five counties: Immunizations: 17,442 (4,143 flu vaccines) International Travel Consults: 658 Vital records services: 19,706 records issued WIC: 16,000 client contacts •HEALTH SCREENINGS: The St. George, Cedar City, and Kanab offices now offer low-cost tests to monitor cholesterol, diabetes, anemia, and blood clotting, along with free blood pressure and BMI checks.

•REOPENING OF WATER CANYON SCHOOL IN HILDALE: Less than 20% of enrolled students were adequately immunized. At the request of the Washington County School District, the health department ran an immunization clinic, resulting in over 80% of the students becoming eligible to begin school on time.

•ON-SITE FLU VACCINE CLINICS: MRC volunteers joined health department staff to administer 1957 flu vaccinations at 37 on-location clinics for local businesses in throughout the district.

•KANAB SCHOOL NURSING: The health department provided school nursing services to Kane County schools, including 148 scoliosis screenings, 463 vision screenings, maturation programs, staff train ings, and immunizations.

•KANE COUNTY MOBILE PUBLIC HEALTH CLINIC: This mobile service provides services small rural locations throughout Kane County and made multiple visits to provide immunizations and health screenings in Bullfrog, Duck Creek, Alton, Big Water, and Orderville.

•MOBILE DENTAL CLINIC: This annual event held in Kanab provides low-cost dental services to uninsured residents, and is coordinated, scheduled, and promoted by the health department. The 2014 clinic provided 408 procedures to 47 clients over the course of a week.

•NURSING STUDENTS: Students from both DSC and SUU are now job shadowing at the health department each semester and assisted with our Flu “Shoot-Outs”.

•VITAL RECORDS services are now being offered in Garfield County.

EMERGENCY PREPAREDNESS •STRATEGIC NATIONAL STOCKPILE (SNS): This CDC program is designed to quickly distribute medical supplies to affected populations and is locally coordinated by the health department. A coalition of pharmacies was established to assist in this process and POD (point of distribution) partners (organizations and businesses who could deliver supplies to their staff and clientele) now number 197. 85 of these POD partners participated in a drill in July.

•PREPAREDNESS BUDDY: This program was created to assist vulnerable residents (elderly, disabled, living alone, etc.) in securing trusted friends or neighbors who would know their specific needs and be able to assist them in an emergency. The program was recently adopted by the Healthcare System Pre paredness Program of Minnesota.

•MEDICAL RESERVE CORPS: The health department administers this federal volunteer program and has now registered and trained 425 MRC members.

•COMMUNITY INFORMATION & SUPPORT CENTERS are now established in almost all local communities. CISC locations would be activated to dispense vital information and coordinate follow-up with ill individuals in a health emergency when hospitals reach capacity.

•EMERGENCY COMMUNICATIONS: Ham radio units were installed in all regional hospitals and the health department main office in St. George.

•MASS FATALITY TRAINING: Religious leaders and mental health professionals throughout the 5-county district assembled for training on how to coordinate efforts and support the public in the event of a mass fatality disaster.

HEALTH PROMOTION •NEW DIVISION DIRECTOR: The SWUPHD welcomed a new Health Promotion Division director, Kye Nordfelt, who had been working for Utah County for six years as the SMART Coalition Coordinator.

•OUTDOOR POLICY GUIDE: Created as a resource for local policymakers interested in drafting no-smoking regulations for public areas and venues.

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ANNUAL REPORT HEALTH PROMOTION CONT. •YOUTH COALITIONS: The Washington County Youth Coalition (WCYC), sponsored by the health department, doubled its membership to 46.

A similar group, the Kane Community Youth Coalition, was also created in 2014. WCYC’s coordinator, Kaysha Price (SWUPHD Health Educator), received the “Butt Kicker of the Year” award from the Utah Department of Health’s Tobacco Prevention and Control Program for her efforts.

•DRIVER’S ED PARENT NIGHTS: This one-session presentation for students and their parents addresses Utah’s graduated driver’s license laws for teens and dangerous driving behaviors. Health Promotion more than doubled these events in 2014, which educated 570 people.

•PLAY UNPLUGGED: The division took the lead in bringing Play Unplugged to Cedar City. A fun summer program designed to motivate kids to disengage from electronics and enjoy a more active lifestyle, Play Unplugged was first implemented in Heber City, Utah in 2013. Cedar City’s twin program enjoyed a successful first run in 2014 and will join Kanab and fifteen other communities in four states in 2015 as the concept becomes more popular (see page 4).

•TOBACCO-FREE HOUSING: The “Proud 2B Tobacco Free” initiative was launched, working with managers of multi-unit housing complexes to prohibit smoking on their properties in order to create healthier living conditions for local residents.

•BULLFROG GREENHOUSE: Purchased by the SWUPHD and set up at the Lake Powell School in Bullfrog, Utah, where residents have limited access to fresh fruits and vegetables. Produce will be used to supplement school lunches, and any extra will be sold as a fundraiser.

ENVIRONMENTAL HEALTH •WATER LAB: The health department opened an in-house water lab, providing a convenient resource to pool and drinking water system operators.

Test results are immediately e-mailed to clientele and there is a sample pick-up service available. The lab analyzed 3,162 swimming pool, spa, and public drinking water samples during 2014.

•HEALTH INSPECTIONS: Environmental Health staff completed 2,000 inspections, including commercial kitchens (restaurants, day care kitchens, school cafeterias, and nursing home kitchens), public swimming pools & spas (municipal pools, condominiums, townhomes, apartment complexes hotels), body art facilities (tanning, permanent cosmetics, tattoo parlors, and body piercing shops), schools, and septic systems (new construction).

•FOOD SAFETY GRANT: For the third year in a row, the division was awarded a $70,000 grant to improve the food safety program, resulting in better-trained staff and increased interaction with constituents. Efforts have greatly improved safety measures at community events, temporary food vendors, and mobile food operations.

•COMMUNITY INTERACTION: Additionally, division personnel logged over 6,100 hours in plan reviews, consultations, training and presentations, and processing complaints and information requests.

•GARFIELD & KANE COUNTIES GET THEIR OWN EH SPECIALIST: Clint Albrecht was hired in September 2014 and works out of the Panguitch office, covering Garfield and Kane Counties. Clint is also a registered dietician and covers additional duties for the Health Promotion and Emergency Preparedness divisions.

SPOTLIGHTS PAULETTE GOES TO WASHINGTON Paulette Valentine, SWUPHD Division Director for Emergency Preparedness and Response, shared one of twenty testimonials featured in the Coalition for Health Funding report, “Faces of Austerity: How Budget Cuts Hurt America’s Health.” The report detailed the human impact of deep public health budget cuts along with the inability of existing funding levels to meet mounting health demands across the nation.

“The Southwest Utah Public Health Department receives little local or state support for its emergency preparedness activities,” said Paulette in her account.

"In many ways, the policymakers have become complacent about preparing for public health risks.”

In conjunction with the report’s release, Paulette was invited to join four other local public health professionals and speak before Congress on July 15, 2014 in Washington, D.C.

DRIVEN TO QUIT Always looking for new ways to promote health and prevention messages, the health department stepped outside the box in 2014 and sponsored a demolition derby team, called Driven to Quit.

“Quitting is a lot like a demolition derby,” said Jordan Mathis, SWUPHD Tobacco Treatment Specialist and Health Promotion Director. “The more support and resources a derby team or someone trying to quit has available to them, the greater the chances for success. Our sponsorship is an effort to make the public more aware of the resources available to tobacco-users who want to make a change.”

The team consisted of three cars (‘79 Ford Thunderbird, ‘64 Ford pickup, ‘64 Chrysler Newport) and two drivers (Randy Little and Paul Cox). After demolishing the competition during the Washington County Fair in August, Driven to Quit went on to compete in fairs in Utah and Iron counties. The last event of the season was scheduled in Kane County on September 6th, but no drivers were available. That’s where Jordan stepped up, took a crash course in derby driving, and donned a jumpsuit and helmet so he could drive the Thunderbird himself.

He took second place.

Jordan’s affinity for adventure continued when, later that month, he left his job at the SWUPHD to take the position of Health Officer at Tricounty Health Department, based in Vernal.

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DISEASE SURVEILLANCE

The SWUPHD is responsible for tracking and taking appropriate action on 77 “reportable” diseases, ranging from hospitalized influenza to potential bioterrorism agents. In 2014, 33 of these diseases (741 total cases) were reported to our health department. Although many of these illnesses are serious, our overall disease rates remain low when compared to the rest of the state and nation, particularly in STDs such as Chlamydia and Gonorrhea.

Diseases causing gastrointestinal symptoms usually come from food or drink, i.e. salmonella in eggs, campylobacter in raw milk, and giardia in water.

TOP REPORTED DISEASES CHLAMYDIA

436

INFLUENZA (HOSPITALIZED)

128 88

PERTUSSIS (WHOOPING COUGH)

VALLEY FEVER

40

28

SALMONELLOSIS 27

COUNTS

43

GONORRHEA 22

46

CAMPYLOBACTERIOSIS 18 GIARDIASIS

15

PNEUMOCOCCUS

13

GROUP B STREP

13

CHICKENPOX 11

57 68 85 88 100

SUICIDE INFLUENZA & PNEUMONIA DIABETES KIDNEY DISEASE ALZHEIMER'S CLRD* ACCIDENTS STROKE CANCER

328

HEART DISEASE

351

LEADING CAUSE OF DEATH *Chronic lower respiratory disease (CLRD) includes chronic obstructive pulmonary disease, asthma, bronchitis, and emphysema.

Our area’s top ten causes of death are close to those on a national level. Interestingly, a large percentage of these deaths are related to behaviors that impact our health and are preventable. Obesity (resulting from low activity and unhealthy eating) and smoking are behaviors that directly cause or contribute to almost all of the conditions on the list.

REVENUE SUMMARY GRANTS PATIENT/CLIENT REVENUE COUNTY CONTRIBUTION TENANT REVENUE 26.1%

1% 50.5%

22.4%

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TOP 5 BABY GIRL NAMES

2014 VITAL STATISTICS

OLIVIA EMMA SOPHIA EMILY LILY

BEAVER

95

72

GARFIELD

61

39

TOP 5 BABY BOY NAMES

IRON

825

279

KANE

72

82

WILLIAM JAXON ASHER EASTON LOGAN

BIRTHS DEATHS

WASHINGTON 2247

1197

TOTAL

1669

3300

S O U T H W E S T U T A H APN U BN L IU C AHLE ARLET P HO R T D E PA R T M E N T P R O G R A M S OUR MISSION IS TO: PROTECT the community’s health through the PROMOTION of wellness and the PREVENTION of disease.

BEAVER

I RON

WAS H IN GTO N

K AN E

G AR F IELD

75 West 1175 North Beaver, Ut. 84713 (435)438-2482

260 East DL Sargent Dr. Cedar City, Ut. 84721 (435)586-2437

620 South 400 East St. George, Ut. 84770 (435)673-3528

445 North Main Kanab, Ut. 84741 (435)644-2537

601 East Center Panguitch, Ut. 84759 (435)676-8800

ENVIRONMENTAL HEALTH

EMERGENCY PREPAREDNESS

NURSING SERVICES Baby Your Baby Breastfeeding Consultation Case Management Child Care Resources/Referrals Early Intervention Home Visitation Immunizations International Travel Clinic Maternal Child Health Mobile Clinic (rural counties) Pregnancy Testing Prenatal Resource Referrals Reproductive Health School Exemptions Education & Tracking School Health/Nursing WIC

HEALTH PROMOTION Bicycle Safety Car Seat Classes Certified Car Seat Inspection Points Community Training and Outreach Healthy Dixie Liaison Healthy Iron Co. Liaison Injury Prevention Safety Resources Physical Activity & Nutrition Resources Resources to Quit Tobacco Tobacco Compliance Checks Tobacco Education(retailers) Tobacco-Free Housing Data

Air & Water Quality Body Art Regulation Child Care Inspections Food Handler Permits Hotel Sanitation Inspections Pool Inspections Restaurant Inspections School Inspections Septic System Inspections Tanning Bed Sanitation Inspection/Enforcement Temporary Mass Gathering Permits Used Oil Utah Indoor Clean Air Act Inspection/Enforcement Water Lab

Bioterrorism Prep/Planning Community Training & Outreach Free Emergency Resources Hospital Surge Planning Mass Flu Vaccination Events Medical Reserve Corps Pandemic Prep/Planning Preparedness Buddy Strategic National Stockpile (SNS) Coordination

VITAL RECORDS Birth Certificates Death Certificates Disinterment Certificates Divorce Certificates Marriage Certificates

COMMUNICABLE DISEASES Disease Surveillance & Control Epidemiology Tuberculosis Program

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