Health | Fall 2022

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Letter from the Health Officer hank you for reading our latest issue T of HEALTH Magazine. We value this opportunity to offer a little insight into

the many developments and opportunities that the field of public health has to offer. Most of the time these efforts are behind the scenes; public health is most effective when bad things don’t happen. Prior to the COVID-19 pandemic, most people didn’t really know much about what a health department’s role in the community was. Now, most have become aware that we are charged with monitoring and trying to prevent the spread of infectious diseases like COVID-19, but there are so many other aspects of life that good health practices can impact.


We know that the right information can make a big difference, especially if it comes at a time when you’re ready to make a change. We don’t accept advertising in our publication, enabling us to avoid any conflicts of interest in what we are able to present. We want to be free to give you the best insights and practices you can use in your life to live longer and better.

The thread of good health weaves itself into everything we do.

As you’ll see, the design of this issue of HEALTH seeks to illustrate that the thread of good health weaves itself into everything we do. You can be confident in using us as a resource in your journey to the best health possible. Sincerely,

David W. Blodgett, MD, MPH Southwest Utah Public Health Department (SWUPHD) Director & Health Officer


IN THIS ISSUE Public health includes a wide variety of information and ideas; from community efforts to individual decisions and responsibility; from proven practices to exploring new possibilities. This issue includes articles that are drawn together with common themes of moderation, simplicity, and better health that is within everyone’s reach.

“Wellness is a connection of paths: knowledge and action.” – Joshua Holtz



12. THE GREAT OUTDOORS By David Heaton


16. COMMUNITY HEALTH By Jeff Smith & Alison Argyle




24. SCREEN TIME By Jean M. Twenge



SWUPHD LOCATIONS (Southwest Utah Public Health Department)


75 W 1175 N Beaver, Utah 84713 435-438-2482


601 E Center Panguitch, Utah 84759 435-676-8800



David W. Blodgett MD, MPH



David Heaton

260 E DL Sargent DR. Cedar City, Utah 84721 435-586-2437


445 North Main Kanab, Utah 84741 435-644-2537


620 S 400 E St. George, Utah 84770 435-673-3528


Kindal Ridd

QUESTIONS OR COMMENTS INFO@SWUHEALTH.ORG The entire contents of this publication are Copyright ©2022 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 /




n our annual report this year, we highlight the leading causes of death in our area (see page 30). COVID-19 has dominated our attention for the last three cold and flu seasons. We will continue to hear about COVID-19 as additional variants make headlines. Additionally, like the flu (influenza), COVID-19 will continue to present a threat to those that are at high risk for a severe infection. However, there are now reliable medications, effective vaccines, and many of us have immunity from infection. The recommendations for avoiding and minimizing the effects of COVID-19, like influenza, will not change. It is wonderful to have so many tools for those at highest risk.

mind ourselves of the principles that contribute to good health, that even proved to be important factors of how severe COVID-19 cases were. Heart disease and cancer have been the leading causes of death historically, and continued to be so throughout the pandemic. Even though we have some of the lowest rates of death from both causes of death in the state, it highlights areas where we can focus our attention in the quest to help lead the healthiest life possible.

death have decreased over the past thirty years, but the rates of decline have flattened out, with heart disease decreasing enough to allow cancer death rates to catch up with heart disease.

Unfortunately, this good news doesn’t reflect fewer people being diagnosed with - and living with - heart disease and cancer, but shows that better treatments are keeping people alive longer with those diseases. In fact, if you look at the indicators that reduce chances of chronic disease, they are headed in the wrong diHeart disease has always been the rection. I’d like to remind you of number one cause of death, usu- the four factors that would reduce ally by a wide margin. This last chronic disease by 60 percent: year, however, cancer has caught up with heart disease. Statistical- FACTOR #1: CIGARETTE ly, there really isn’t a difference However, COVID-19 has not between the two causes of death SMOKING STATUS been the leading cause of death in in our area. It is a success story Our area has very low rates of our area. I think it is helpful to re- of sorts; rates of both causes of smoking, at 7.6% for adults.


Even better, only 2.6% of our high-school aged teens use tobacco. Unfortunately, 25% of high school students report experimenting with e-cigarettes, while 8% report using e-cigarettes on a regular basis. We have much lower rates of cigarette smoking than the national average, which contributes to the overall good health status of Utahns when compared with the rest of the country.


Our district also does very well in this category, with 69% of those questioned reporting that they met the standard. This is significantly higher than the Utah state average of 55% and the US average of 50%. Additionally, high school students reported the second highest rates of exercise in the state. The benefits of exercise are well established and far reaching in improving overall health and well-being. If exercise is part of your daily routine, I salute you! If it isn’t, adding it - even in small amounts - will be something you won’t regret.

FACTOR #3: FRUIT AND VEGETABLE CONSUMPTION The standard calls for 4.5 servings (1 cup-sized) of fruits and vegetables per day. Our area meets this requirement at about the same rate as the rest of the state and nation, which isn’t good, at 12%. When you probe a little deeper and find out how many of us eat even two servings a day, only about 33% make the mark. Unfortunately, low rates of consumption of fruits and vegeta-

bles contributes to the fourth fac- on the vital role of getting enough tor, which is obesity rates. sleep in the near future.


Moderation continues to be the best policy for good health, as it is for most things in life. I was intrigued to hear that a new term has been coined; “orthorexia”, which is an obsession with eating healthy. It turns out you can do too much of a good thing. I think it is easy to think that we need to go above and beyond common sense guidelines for wellness, but the evidence shows that small, simple changes yield the largest benefits, while going to extremes can be counterproductive. The most benefit is realized during the first 30 minutes of exercise; the return on investment after that decreases, with extreme amounts of exercise actually causing damage rather than improving health.

HEALTH Magazine has featured several articles in the past few years about how chronic sleep deprivation contributes to a wide range of negative health conditions. Our young people seem to be taking on the bad habits of their parents by not getting enough sleep, which can begin to negate the benefits of the first four factors of healthy living. You’ll be hearing more from us

As a community, we put in a tremendous effort to respond to COVID-19. Never before has such a large-scale response been attempted, with so many resources devoted to one health issue. As we consider what our priorities should be as we look to the future, perhaps re-focusing even a portion of that effort towards improving these simple lifestyle habits would do wonders for the long-term health prospects of humanity.

Obesity, defined as a BMI (body mass index) over 30, has been increasing rapidly. Being overweight, defined as a BMI over 27, has been increasing even more rapidly. While our area’s rates of obesity at 26% are lower than the rest of the State at 30%, it is still an alarming statistic. Obesity contributes to diabetes, a rapidly increasing risk to health and well-being, heart disease, cancer, and many other chronic conditions. Roughly 2/3 of all of us are overweight or obese. Abundance has made it more difficult to maintain this standard. In high school-aged youth, rates of obesity are also increasing, with about 10% considered obese. Given the likelihood that few of us are doing all four of the factors So, what percentage of us are outlined above (plus getting adeable to report meeting all of the quate sleep), imagine the dramatfour factors? About 10%. The ic improvements we would see in reward for doing all of the four the health of the community, defactors is a reduction in the risk creased health care utilization, and of chronic disease by 60%. individual quality of life if we each made it a priority to add the missing factors until we were living all BONUS FACTOR #5: of them most of the time. ADEQUATE SLEEP


The State of Utah recommends that residents use the CDC’s online County Tracker tool to check the level of COVID-19 activity in your area, which is based on cases and hospital usage. Just visit and enter your location to see if your county is at low, medium, or high. There are recommended actions for each level. Utah, including our 5-county district, currently has no COVID-19 mandates in effect. Visit for local updates on vaccinations and other pandemic information. LOW



• Stay up to date with COVID-19 vaccines • Get tested if you have symptoms

• If you are at high risk for severe illness, talk to your healthcare provider about whether you need to wear a mask and take other precautions • Stay up to date with COVID-19 vaccines • Get tested if you have symptoms

• Wear a mask indoors in public • Stay up to date with COVID-19 vaccines • Get tested if you have symptoms • Additional precautions maybe needed for people at high risk for severe illness

Find more information - Access services - Stay current on local public health events and alerts - Read past issues of HEALTH Magazine @swuhealth


Flu season is approaching! Protect yourself against influenza by getting your shot at our annual Flu Shootout. The Southwest Utah Public Health Department will be holding a drive-thru or walk-in Shootout in your county, beginning in September. These clinics provide a convenient and low cost (or no cost with many insurances) way to get a flu shot, and help us practice our emergency response plans. We were able to put those into action at our large-scale vaccination clinics in 2021 during the COVID-19 pandemic and the 2009 H1N1 flu pandemic. Remember to wear a short-sleeve shirt, bring your insurance card, and fill out the consent form (found at and bring it with you to save time.




FREE for all Kane County residents

Saturday, September 24 Cedar City Hospital (1303 N. Main) 9am-noon | Walk-in Tuesday, September 27 Red Cliffs Mall (1770 Red Cliffs Drive) 8am-noon | Drive-thru 2pm-5pm | Walk-in


Monday, October 3 Zion Clinic (120 Lion Blvd) 9am-noon | Drive-thru/Walk-in


Friday, October 7 Kanab Fire Station (601 S 100 E) 1pm-5pm | Drive-thru/Walk-in


Wednesday, October 12 EMS Building (1100 N. Main) 12pm-4pm | Drive-thru/Walk-in


Thursday, October 20 Fire Station (40 N. 100 E.) 1pm-4pm | Drive-thru/Walk-in

Wednesday, October 5 Ruby’s Inn (70 W. 100 N.) 1pm-4pm | Drive-thru/Walk-in

$25 a shot ($65 for High-Dose) or NO CHARGE with proof of the following insurances: Utah Medicaid or CHIP, Medicare, Aetna, Cigna, DMBA, Educators Mutual (EMI), Healthy Premier, Motiv Health, PEHP, Select Health, Tall Tree, United Health




ou visit your doctor for an annual physical exam, give a few vials of blood and wait for the results. You then have a follow-up appointment or maybe a call or message through an app to get notified of your results. Whichever option reflects your experience, hearing that your blood sugar is within the “prediabetic range” would likely catch you off-guard. You might immediately recall a loved one, friend, or coworker who has diabetes and their daily challenges and limitations that come with this life-altering chronic disease. What would this mean for you? At this point you have two choices. You could resign yourself to the belief that there's nothing you can do but wait it out until you develop full type 2 diabetes. Or, you can empower yourself to ask questions and do the re-

search to discover that prediabetes is reversible. You see, the best healthcare plan is about you taking personal responsibility instead of being passive or relying on someone or something else to fix you. If a chronic disease like diabetes can be prevented, postponed, and even reversed during the prediabetes stage if lifestyle changes are made, who wouldn't at least try?


You are considered prediabetic when your blood sugar is elevated but not high enough for a diagnosis of type 2 diabetes. Type 2 diabetes is a chronic disease that occurs when the body’s ability to regulate sugar (glucose) malfunctions, resulting in too much sugar in the bloodstream. If diet and exercise aren't enough to manage diabetic symptoms, medication or


insulin therapy may be required. Diabetes is among the top ten causes of death for Southwest Utah residents. Unlike type 2 diabetes, prediabetes has no symptoms. The most common way to find out if you are prediabetic is with an A1C test. This test is extremely accurate as it is able to measure what your blood glucose level has been over the past three months as a percentage: BELOW 5.7% = NORMAL 5.7% - 6.4% = PREDIABETES 6.5 & UP = TYPE 2 DIABETES

People who are prediabetic have a 50% chance of developing type 2 diabetes within 5 to10 years. As the saying goes, “an ounce of prevention is worth a pound of cure”. A1C tests are typically part of your annual blood work and

most insurances cover the cost without your deductible having to be met because they know it’s much cheaper to prevent diabetes than treat it.


According to the Utah Department of Health, about one-third of us are prediabetic but nearly 90% of those don’t know it! Anyone could become prediabetic, but there are factors that increase your risk, such as age, gender, genetics, family history, having had gestational diabetes, and various lifestyle practices. Some of these are out of your control, of course, but what actually makes the biggest difference are lifestyle practices, which are in your hands to change. Here’s some examples:


Tobacco use increases your risk for chronic diseases, including diabetes. If you would like help quitting visit


150 minutes of physical activity weekly is the recommendation. Doing simple things like gardening, housework, taking a walk, playing with children, and going on a bike ride all count as activity. Let's be honest, you are most likely doing some of these activities anyway. 15 minutes here and there throughout the day can add up surprisingly fast. Don’t get overwhelmed; start slow and easy until you reach your goal. Just get moving!


The foods and beverages you consume have a big impact on your health. Increasing your vegetable intake and reducing sugar-sweetened beverages and sodium is a great place to start. You can still enjoy your food; moderation is really the key here. Visit for simple healthy tips.


It's important to maintain a weight appropriate for your height, which can be generally measured by BMI (body mass index). Losing just 5% of your body weight can significantly decrease your risk of prediabetes.Visit for more information.

WHAT CAN YOU DO RIGHT NOW? Remember, you can reverse prediabetes and prevent getting type 2 diabetes with simple improvements to your lifestyle. First, you need to know if you have prediabetes: 1. Take this one minute prediabetes risk test by scanning this QR code or visiting diabetes 2. Make an appointment with your healthcare provider to get an A1C test and know your numbers (the health department also offers them for a small fee, visit 3. If you can confirm that you have prediabetes, get more information and support by joining a lifestyle change program. Here’s some starting points: • • •




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 of trails, and vast expanses of public land to explore. Along with nature’s beauty 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: SUN - Sunny days in the outdoors means risk of sunburn. You can also get exposure from sunlight reflected off sand, slickrock, water, and snow. Wear a brimmed hat, sunglasses, and sunscreen (at least 15 SPF). WILDLIFE - Enjoy wildlife at a distance. Animals that appear sick or easily approached should be avoided to reduce risk of exposure to diseases like plague (prairie dogs & squirrels), rabies (bats & foxes), and tularemia (rabbits). Human cases of these are rare, as are encoun-

ters or attacks from predators like bears, mountain lions, or rattlesnakes. Study up on the wildlife in your area. INSECTS - Besides the nuisance of pain and itching, biting insects can also carry diseases like West Nile virus (mosquitoes) and Rocky Mountain spotted fever (ticks), as well as tularemia (deer flies, & ticks). Wear 30% DEET repellent and protective clothing. LIGHTNING - Lightning is Utah’s second most fatal natural hazard, following avalanches, causing 67 deaths and 161 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


FLASH FLOODS - In spite of its desert environments, one of Southwest Utah’s most common natural hazards is flooding, especially during summer monsoon season (mid-July to mid-August). 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

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). It causes small, itchy red bumps that last up to a week, but is otherwise harmless. Reduce risk by toweling off or showerHEAT - Heat is the number one weather-related killer in ing immediately after leaving the water. the U.S., resulting in approximately 400 deaths per year. HIKING TIPS: To prevent heat stroke/exhaustion: • Virtually anyone can hike. Just make adjustments for • Limit or avoid strenuous outdoor activities in the age, ability, health conditions, and experience. Start heat of the day, especially if you’re elderly or unaccuswith short, easy hikes and work your way up. tomed to the climate • Research your route and get tips from others who • Wear lightweight clothing & hat have done it. Bring a map if possible. Look for and follow trail markers. Use a smartphone outdoor nav• Stay hydrated with plenty of water igation app. • Take frequent rests, under shade if possible • Check weather conditions. Wear clothing appropriHeat exhaustion can result from prolonged exate for the season but be prepared for unexpected posure to heat and dehydration. Symptoms include weather. Reconsider your plans if storms, flooding, heavy sweating, pale/cool/moist skin, weak/fast pulse, or extreme temperatures are in the forecast. muscle cramps, feeling tired/weak, dizziness/fainting, • Don’t travel alone and let others know where you’re headache, and nausea/vomiting. Treat with cool nongoing. Allow for plenty of leeway when estimating alcoholic beverages, cool shower/ bath, and air-conwhen you’ll finish or return. ditioning. Seek medical help if symptoms last over an • Bring adequate food and water. Stay hydrated. Purify/ hour or history of heart problems. filter water from lakes, streams, or springs. Heat stroke occurs when the body is no longer able • Be considerate of other hikers when passing. Don’t to sweat & cool down and can be a serious medical kick or throw rocks when there are trails below you. emergency. Symptoms include very high body temCarry out all your trash, and go a step further by pickperature (103°+), red/hot/dry skin, rapid/strong pulse, ing up trash left behind by less thoughtful hikers. throbbing headache, dizziness, nausea, confusion, and • Educate yourself on what to do if you get lost or inunconsciousness. Get immediate medical assistance jured in the outdoors. while cooling the victim using any methods available until temperature drops to 101-102°. Do not give flu- • Make an emergency first aid/survival kit appropriate ids to drink. for the season and location. WATER HAZARDS - Run out of water? Use a water fil- The benefits of enjoying the outdoors for physical and ter or boiling if you drink from streams or other outdoor mental health far outweigh the probability of any of water sources. Water contaminated by animal feces may these hazards happening to you, and a little knowledge expose you to giardia, the most commonly encountered and preparation can reduce those risks even further as intestinal parasite in the U.S. you enjoy what nature has to offer.


In 2020, Utah joined the now 19 states that have passed bills making daylight saving time permanent. None of them have actually done it, however, waiting instead on neighboring states to jump on the bandwagon or for federal action. This past March, the US Senate did just that by passing a unanimous bipartisan bill to keep daylight saving time forever. Still, the House of Representatives and the President need to sign off, and there’s not a rush, partly because of the potential health risks that need to be considered. Would going back to permanent standard time be a better choice?



pringing forward doesn’t just make for a sleepy Anita Shelgikar, M.D., MHPE, co-authored a recent Monday morning; it also affects your health position statement from the American Academy of and your safety. Sleep Medicine calling for an end to Daylight Saving Time. That’s why experts are calling for an end to the backand-forth that confuses our bodies twice per year Shelgikar, an associate professor of neurology who and instead establish permanent Standard Time. sees patients at Michigan Medicine’s Sleep DisorPROMOTE | SUMMER 2022

ders Centers, explains why she thinks the clocks With permanent Daylight Saving Time, on the othshould stop switching and stay at permanent Stan- er hand, the clock would be shifted an hour forward dard Time. even in the winter, which would mean more time in the dark in the mornings. That’s at odds with our WHY IS SPRINGING FORWARD BAD FOR intrinsic circadian rhythm.


Shelgikar: There are a multitude of potential nega- WHAT WILL IT TAKE TO END DAYLIGHT tive consequences from the shift to Daylight Saving SAVING TIME IN THE UNITED STATES? Time. Shelgikar: Eliminating Daylight Saving Time nationwide would require an act of Congress; howevEven one hour of a time shift can make it harder to er, state-level legislation is possible (you may have wake up and fall asleep on a set schedule. Immedi- seen that Arizona opts out, for example.) ately following the “spring ahead” time shift, people can find it difficult to fall asleep at night and wake Changing to permanent Standard Time will take up in the morning. This can lead to less hours of some advocacy. We have to think about what indussleep overall, and that sleep deprivation can pose tries might be affected and what other policy changsafety risks, including a higher likelihood of motor es might be needed. It’s a great opportunity for sleep vehicle accidents on days following the time shift. specialists and sleep and circadian researchers to collaborate with policy makers to advocate for betThere are individual health concerns, too: switching ter sleep and better health. to Daylight Saving Time is associated with cardiovascular morbidity, a higher risk of a heart attack or Other countries are taking on Daylight Saving Time, stroke, and an increase in hospital admissions for too. The European parliament voted to end mandairregular heartbeats, for example. tory Daylight Saving Time, so now it’s our turn! Light is the most powerful regulator of our internal clock, also known as our circadian rhythm, and some people may not even adjust to the time change after several months. When the clocks on the wall shift forward our exposure to morning sunlight in the morning is reduced, which makes it harder to wake up, and our exposure to evening light increases, which makes it harder to fall asleep. Chronic misalignment between the internal clock and occupational, family and social activities can be very disruptive.


UNTIL POLICY CHANGES HAPPEN, HOW SHOULD WE DEAL WITH SPRINGING FORWARD? Shelgikar: If you’re able to make small, incremental changes in your sleep and wake times for a few days leading up to the start of Daylight Saving Time, rather than making an abrupt change of a full hour, it can ease that transition. And everyone should try to stick with the recommended behaviors that we know facilitate a healthy sleep-wake schedule. That includes things like dimming lights and avoiding electronics, or at least using a blue light filter, a couple of hours before bedtime; sticking to consistent sleep and wake times seven days a week; limiting caffeine in the afternoon and evening; and getting some exercise earlier in the day so you’re ready to wind down by bedtime.

Shelgikar: There is growing support for the idea that we should not be switching clocks twice per year. There are proponents for establishment of either permanent Standard Time or permanent Day- This article was originally published online under the light Savings Time. title “Why We Should Abolish Daylight Saving Time” on The sleep medicine societies I’m part of are advocating for permanent Standard Time. That’s because it’s more aligned with our circadian rhythm, which needs light and dark cues from the sun.

March 20, 2021 for the University of Michigan (https:// Original article published under a Creative Commons Attribution 3.0 license.




desperately needed and also helped the Utah Food Bank hand out boxes to others in the community who were struggling like Sara.

Upon learning of her circumstances, the CHW called a nearby Utah Food Bank and learned that a mobile food pantry was coming to Sara’s city in just two days. That was great news! The CHW was able to get Sara the food she

Community Health Workers are a new addition to the health department. They are members of the community who are hired to help provide basic resources and support to people in need. They are able to provide direction and follow up to help people reach their goals. Often, those who can benefit from CHW involvement are unaware of local assistance programs or resources and have been negatively impacted by the gaps in health disparities.

ara, a woman in her 20s, received a phone call from a community health worker (CHW) employed at the Southwest Utah Public Health Department after testing positive for COVID-19. She was unemployed, living with friends, and running out of food fast. It was around the holidays on a Friday afternoon so all the resources in her city were unavailable or closed.


Services that CHWs connect people Margaret find some free and fun things to do that were close by. Just to include: having someone to talk to, in addition •Aging health concerns to being connected to critical services, gave her the encouragement to contin•Child support/protection ue on her journey to find a new home •Clothing needs and begin a new life. •Disability services David, who lives in a rural county, •Domestic violence resources needed dental treatment desperate•Education ly. He had not been to the dentist in •Housing over 30 years. He did not have insurance and could not afford dental care. •Utilities Then he found out about a free dental •Employment clinic coming to his town, provided by •Food assistance the University of Utah in partnership •Medical/dental care with local health department CHWs, and he made an appointment. When •Mental health he arrived at the clinic he learned he •Utilities would need quite a lot of dental work •Veterans services. done and was understandably scared. The team did their best to help him feel Sometimes people who are struggling comfortable and took care of his needs. just need to be pointed in the right di- In the end, he was very happy with the rection and provided with tools to get results. back on their feet. Their situation may be short-term or long-term until they This is an example of how CHWs work can recover from their setback. Marga- on a larger scale with other organizaret, in her 70s, found herself homeless tions to collaborate on projects and and living in her car. She had motiva- events. The recent free dental clinics tion but needed the resources and the held in Beaver and Kane counties were coordinated by CHWs, who provided time to put things into motion. outreach and made appointments for She called a CHW and explained that over 150 eligible residents. They were she was looking for help obtaining also onsite the day of the dental clinpermanent housing. She was already ics to check people in for treatments in touch with a local organization that ranging from basic examinations and was in the process of helping, so the x-rays to more extensive work like fillCHW pointed her in the direction of ings. some additional organizations that could help her find affordable housing CHWs continually update and add to their knowledge base of community and other needs. resources and referral sources to direct Margaret continued to talk with the people to the right place, helping indiCHW about her current struggles as viduals and families meet their basic the discussion turned to her desire to needs and giving hope for a brighter relax and unwind. The worker helped future. To connect with a Community Health Worker in your area, visit: SWUHEALTH.ORG/COMMUNITY or call: WASHINGTON COUNTY: 435-218-8911 IRON & BEAVER COUNTY: 435-218-9059 KANE & GARFIELD COUNTY: 435-676-8800




ny musician who plays a stringed instrument, like the violin, can tell you that the right amount of tuning in the strings will result in beautiful, rich music. If too loose, the strings will sound flat; too tight and they can break. Keeping a violin sounding good requires frequent tuning and care, just like we need to keep our levels of stress and daily performance in balance. Here’s some information on stress, it’s effects, and coping skills from the Mayo Clinic. Your body is hard-wired to react to stress in ways meant to protect you against threats from predators and other aggressors. Such threats are rare today, but that doesn't mean that life is free of stress. On the contrary, you likely face many demands each day, such as taking on a huge workload, paying the

bills and taking care of your family. Your body treats these so-called minor hassles as threats. As a result, you may feel as if you're constantly under attack. But you can fight back. You don't have to let stress control your life. When you encounter a perceived threat — such as a large dog barking at you during your morning walk — your hypothalamus, a tiny region at your brain's base, sets off an alarm system in your body. Through a combination of nerve and hormonal signals, this system prompts your adrenal glands, located atop your kidneys, to release a surge of hormones, including adrenaline and cortisol. Adrenaline increases your heart rate, elevates your blood pressure and boosts energy supplies. Cortisol, the primary stress hormone, increases sugars (glu-


cose) in the bloodstream, enhances your brain's use of glucose and increases the availability of substances that repair tissues. Cortisol also curbs functions that would be nonessential or harmful in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with the brain regions that control mood, motivation and fear.

tend to be particularly vulnerable to stress. The same is true of airplane crash survivors, military personnel, police officers and firefighters, and people who have experienced violent crime. You may have some friends who seem relaxed about almost everything and others who react strongly to the slightest stress. Most people react to life stressors somewhere between those extremes. Stressful events are facts of life. You may not be able to change your current situation, but you can take

The body's stress response system is usually self-limiting. Once a perceived threat has passed, hormone levels return to normal. As adrenaline and cortisol levels drop, your heart rate and blood pressure return to baseline levels, and other systems resume their regular activities. But when stressors are always present and you constantly feel under attack, that fight-or-flight reaction stays turned on. The long-term activation of the stress response system and the overexposure to cortisol and other stress hormones that follow can disrupt almost all your body's processes. This puts you at increased risk of many health problems, including: • Anxiety • Depression • Digestive problems • Headaches • Muscle tension and pain • Heart disease, heart attack, high blood pressure and stroke • Sleep problems • Weight gain • Memory and concentration impairment

steps to manage the impact these events have on you. You can learn to identify what causes you stress and how to take care of yourself physically and emotionally in the face of stressful situations. Stress management strategies include: • Eating a healthy diet, getting regular exercise and getting plenty of sleep • Practicing relaxation techniques such as yoga, deep breathing, massage or meditation • Keeping a journal and writing about your thoughts or what you're grateful for in your life • Taking time for hobbies, such as reading, listening to music, or watching your favorite show or movie • Fostering healthy friendships and talking with friends and family • Having a sense of humor and finding ways to include humor and laughter in your life, such as watching funny movies or looking at joke websites • Volunteering in your community • Organizing and prioritizing what you need to accomplish at home and work and removing tasks that aren't necessary • Seeking professional counseling, which can help you develop specific coping strategies to manage stress Avoid unhealthy ways of managing your stress, such as using alcohol, tobacco, drugs or excess food. If you're concerned that your use of these products has increased or changed due to stress, talk to your doctor. The rewards for learning to manage stress can include peace of mind, less stress and anxiety, a better quality of life, improvement in conditions such as high blood pressure, better self-control and focus, and better relationships. It might even lead to a longer, healthier life.

That's why it's so important to learn healthy ways to cope with your life stressors. Your reaction to a potentially stressful event is different from anyone else's. How you react to your life stressors is affected by such factors as: GENETICS. The genes that control the stress response keep most people on a fairly steady emotional level, only occasionally priming the body for fight or flight. Overactive or underactive stress responses may stem from slight differences in these genes. LIFE EXPERIENCES. Strong stress reactions sometimes can be traced to traumatic events. People who were neglected or abused as children Source: SWUHEALTH.ORG | PAGE 19

By Shana Chavez SWUPHD

Requirements and Utah Laws


o you have a child entering kindergarten or 7th grade? Did you recently move to Utah and have school-age kids? Make sure your family is ready for the school year. While most parents know their kids need vaccines to attend school, some may not realize that school immunization rules can vary from state to state. For instance, schools in all 50 states require DTaP vaccine while only 17 states require Hepatitis A vaccine. School immunization requirements can also differ by grade level. Vaccines that are required for early childhood

programs are different from those required for kindergarten. There are also additional vaccines required for 7th grade entry that are not required in elementary school. If you have children who will be entering a Utah school or early childhood program or if you have a student advancing from one school to another, say elementary to middle school, you’ll want to know what immunizations are required for them to begin their next school year.


Below is a summary of Utah immunization requirements for the 2022-2023 school-year, listed by grade entry level. All of the immunizations listed are part of the Centers for Disease Control and Prevention’s routine vaccination schedule.


Children enrolled in a licensed day care center, nursery or preschool, child care facility, family home care, or Head Start Program must be immunized appropriately for their age with the following vaccines: • DTaP, Polio, Hepatitis A, Hepatitis B, MMR, Varicella (chickenpox), Hib, and Pneumococcal


Students enrolling in kindergarten through 6th grade should have received the following doses: • 5 DTaP • 4 Polio • 2 Measles, Mumps, Rubella (MMR) • 3 Hepatitis B • 2 Hepatitis A • 2 Varicella (chickenpox)


Students enrolling in 7th grade through 12th grade should have received all vaccines on the kindergarten list, plus the following which are routinely administered at age 11-12 years: • 1 Tdap • 1 Meningococcal

The information provided here is a general reference. Due to the complexity of immunization rules and each child’s unique vaccination history, your student’s record will need to be individually assessed to determine if they are adequately immunized for their age and grade level. A good opportunity to make sure your child is up-to-date on immunizations is by scheduling the recommended annual check-up with your child’s primary care physician. Vaccination appointments may also be scheduled at any of our Southwest Utah Public Health Department offices (location and contact information can be found on page 5). We accept several private insurances and also participate in the Vaccines for Children program which provides low or no cost administration of vaccines to children without insurance or those currently enrolled in a Utah Medicaid or CHIP program. Start the school year off smoothly and avoid last minute surprises and frustration by scheduling vaccination appointments early.

We wish all Utah students a successful, rewarding, and healthy school year!




hen disaster strikes, do you know how to get accurate and timely information that could be critical to you and your family's safety? Fortunately, every county in Southwest Utah has its own emergency alert system which can be used to quickly notify the public of potentially life-saving information. But there is a catch; YOU HAVE TO SIGN UP TO RECEIVE IT. These notifications are sent by county emergency managers or 911 dispatch centers. They include information about local emergency events and recommend actions you should take to protect yourself and your loved ones. Some examples include public safety incidents, evacuations, shelter-in-place orders, missing persons, hazardous materials incidents, wildfires, flooding, and many others. These notifications may also be used to send information about how you can help, like the alerts issued during the flooding in Enoch in summer 2021 which requested volunteers to fill and place sandbags. Unlike Amber Alerts which everyone receives automatically, county-specific emergency notification systems only work for residents who have registered online to receive them. To make this process easier, the Southwest Utah Public


Health Department (SWUPHD) has a webpage with all five county alert system sign-ups in one place. Go to swuhealth. org/emergency-preparedness and scroll down to the Emergency Alert section, then click on your county logo. You can specify how you prefer to receive alerts, including a landline, cell phone, business phone, email, text message, hearing impaired receiving devices, and more. These systems are only as good as the information you provide. If your contact information changes, you should log into your profile and update the information. It is recommended that you store the number for your county alerts as a contact so that you recognize the alert as credible when you receive one.

MORE ABOUT THE SWUPHD EMERGENCY PREPAREDNESS & RESPONSE DIVISION The mission of the Emergency Preparedness and Response Division of the Southwest Utah Public Health Department is to enhance the capability and capacity of individuals and communities; to prepare for, respond to, and recover from man-made or natural disasters that affect the health of the Southwest Utah population. We receive several annual federal grants that make it possible to run programs that address emergency preparedness for public health emergencies, healthcare system preparedness, opioid overdose prevention, and volunteer response. The health department works closely with county, city, and state emergency managers, partner agencies, and several coalitions to train for a variety of potential crises that might impact our community. During a large-scale emergency, we are able to join forces with these other organizations under an Emergency Operations Center (EOC) if requested by a city or county emergency manager. Public health emergency preparedness focuses on 15 capabilities, as defined by the Centers for Disease Control: 1. Community Preparedness 2. Community Recovery

3. Emergency Operations Coordination 4. Emergency Public Information & Warning 5. Fatality Management 6. Information Sharing 7. Mass Care 8. Medical Countermeasure Dispensing & Administration 9. Medical Materiel Management & Distribution 10. Medical Surge 11. Nonpharmaceutical Interventions 12. Public Health Laboratory Testing 13. Public Health Surveillance & Epidemiological Investigation 14. Responder Safety & Health 15. Volunteer Management An essential coalition hosted by the health department that covers several of these capabilities is the Southwest Utah Healthcare Preparedness Coalition, which meets regularly in each county. Its mission is to develop and maintain collaborative planning, communication, and sharing of resources as hospitals, healthcare organizations, and communities, and to prepare as a region to deliver effective patient care during a medical surge event. Visit to learn more. The Access and Functional Needs (AFN) Coalition has the specific mission to enhance the preparation of individuals with disabilities or access and functional needs (AFN) to survive and recover from emergencies and disasters. The AFN Coalition supports agencies, organizations, and families who have responsibilities for people with disabilities by identifying those needs and creating emergency plans that include ways to help during and following a disaster. We also want to involve individuals with disabilities in the planning process. To learn more, visit To address volunteer management, our department administers the local unit of the Medical Reserve Corps (MRC), which is a national network of more than 200,000 volunteers. MRC volunteers step up to keep their family, friends, and neighbors safe and healthy, and can be activated by our department’s Health Officer for support during a declared public health disaster. Our unit has approximately 500 volunteers from various backgrounds and levels of experience and donates thousands of hours annually. We hold monthly training and have been active throughout the COVID-19 pandemic response. If you would like to volunteer, sign up at





Finding the Middle Ground


eing a parent today comes with what seems like a never-ending challenge: Getting kids to put down their electronic devices. As I write this, our two youngest children (ages 10 and 12) are playing Minecraft on their school-issued laptops. Our oldest, who is 15, is in her room, probably on her laptop

as well. Even though none of them have their own smartphone or tablet, the draw of screens seems constant. Screen technology is everywhere. The average American child gets their own smartphone by age 10, and many get their own tablet before that. Even if you hold back from getting children their own devices, they will often be


issued one by their school, or will constantly ask to borrow yours. As a result, according to a 2019 study by Common Sense Media, kids ages eight to 12 spent more than five hours a day total with screen media, and teens 13 to 18 spent seven and a half hours.

when. Although most of these studies have looked at teens, some also inform how parents should regulate younger kids’ screen time as well.

This is not a good situation: Study after study has found that kids and teens who spend a large number of hours a day with screens suffer from negative outcomes including more depression, self-harm and obesity.


Based on the latest research, here is my best advice for parents: Surprisingly, teens who don’t watch TV at all are more likely to be unhappy than those who watch it excessively. TV watching between one and five hours a day is about the same in terms of happiness levels. As long as teens are getting their homework done, are hanging out with their friends sometimes and are getting enough exercise, TV time is not a big factor for happiness.

What’s a parent to do? Some experts have suggested that because technology is so pervasive, there is no point in fighting it — we should just let kids do what they want online. Another group of parents advocates for the opposite, keeping their kids off screens nearly all the time. Too often, the discussion around ALLOW TEENS TO USE SCREENS TO screens and kids is all or nothing. That’s unfortunate, because there is a third way: limited use of screens. This strategy is based on a startling fact: Some use of screens might be good for kids, even though too much use is not good. In this philosophy, screen time has its time and place. You use it for what it’s good for, and then go do something else. I have researched the links between screen time and mental health in kids and teens for the last six years, combing large surveys and small experiments for insight into how much — and what kind — of screen time is healthy for children, and how much is not. In dataset after dataset, a consistent pattern has emerged: The best-adjusted teens are not those who never used screens, but those who use screens a limited amount of time. There are also meaningful variations depending on what teens do on screens and


A teen who has no access to texting, video chat or gaming has few opportunities to communicate with their friends when they’re not face to face. This generation (whom I call iGen in my book of the same name) rarely talks on the phone. Even before the pandemic, they saw each other in person less. Many teens now spend time with each other via gaming programs, and texting and video chat also allow real-time or near-real-time communication. This type of communication is not as essential for younger children, who are more often content to play with their friends at school or only in-person. But by middle school, keeping up friendships usually means some kind of electronic communication.


That’s probably why teens who don’t game or text at all are more likely to be unhappy than those who engage in these activities a small to moderate amount. They are best in limited amounts (up to about three hours a day), because heavy users (especially heavy gamers) are more unhappy than nonusers. Heavy use crowds out time for healthy activities like sleep and exercise and might replace more beneficial social interaction like in-person socializing.

Moderation can be difficult for teens themselves to implement. The algorithms of social media sites are designed to be addictive, keeping users on the site as long as possible. Thus, it’s probably a good idea to use the parental controls available on most devices to limit the amount of time your teen spends on social media apps. You can also consider not allowing social media at all, since there are other ways teens can communicate with their friends.

This is the choice we’ve made for our 15-yearold, and an increasing number of iGeners themselves are advocating for teens postponing social media (like college student Emma Of the four activities, social media is the most Lembke, who founded a movement called strongly linked to unhappiness, especially for Log Off). girls, with nearly each hour of use marching toward more unhappiness. Heavy users are As for kids 12 or younger, it’s simple: Kids are almost twice as likely to be unhappy as light not allowed to have a social media page in users. For boys there is little link to unhappi- their own name until they turn 13. (That’s unness until three to five hours a day, while for der a children’s privacy law known as COPPA, girls the uptick in unhappiness appears after though kids routinely lie about their age and the age minimum is only unevenly enforced an hour of social media use a day. by the platforms). Teens do use social media to communicate with their friends, but most social media in- Having an age minimum makes sense, given volves communicating with a group and not both the content and the addictive nature of in real time. That gives it a performative as- social media. Even 13 is likely too young, as pect, with teens worrying about how many it comes during the fraught years of middle likes their posts will get and how many follow- school when social pressures are already running high. Lawmakers may eventually raise ers they have. the age for social media to 16 or even 18. Until Some platforms, such as Instagram, also have then, it’s up to parents to decide whether their algorithms that expose teens to questionable younger teens are ready for social media. content (such as pages encouraging unhealthy eating). In September 2021, internal compa- NO SCREENS IN THE BEDROOM ny research leaked by a whistleblower showed AFTER LIGHTS OUT that Instagram caused depression and body image issues among teen girls, causing in Although some use of screens during the day some cases a “grief spiral” of negative feelings. can be good, having electronic devices in the Instagram is, at base, a platform where teen bedroom during sleep time should be nonnegirls and young women post pictures of their gotiable for kids and teens: They have to go. bodies and ask others to comment on them — not a good situation. When phones and tablets are within reach during sleep time, sleep quality and length Thus, if you allow your teen to have social both suffer. If you want to implement just one media, it should probably be a platform like piece of advice on screens, it should be this Snapchat (where messages disappear, and one: No devices in the bedroom after lights more communication is among friends) in- out. stead of a platform like Instagram (where posts are curated, and there is more content If you want to take it a step further, eliminate from celebrities and influencers, which can screens in the hour before bedtime. Digital lead to body image issues). activities are both psychologically stimulating



(Did my crush text me back? Did anyone like my Instagram post?) and physiologically stimulating (the blue light from devices tricks our brains into thinking it’s still daytime). If you replace device time with TV time, which is not as psychologically stimulating, take steps to filter its blue light. This can be done by wearing orange safety glasses and setting the tablet screen to warmer tones (on Apple devices, it’s called Night Shift). Overall, the research on screen time and mental health is actually good news. The research doesn’t suggest kids and teens give up using devices completely — just that they use them in moderation, and cut back or eliminate certain activities more than others. Our kids can enjoy what screens have to offer, and then put them away and enjoy the real world as well. Maybe they will even go outside. Well, a mom can dream. Jean M. Twenge is a professor of psychology at San Diego State University and the author of “iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy — and Completely Unprepared for Adulthood.” This story originally appeared in the March 2022 issue of Deseret Magazine, used with permission. HOW DO I MONITOR AND PROTECT MY KIDS’ SCREEN USE?

Some devices have built-in parental controls. There are also wireless routers that govern device use and internet access. Apps like Qustodio, Norton Family, Boomerang, Circle Home Plus, and Screen Time are among the best tools for parental supervision. Many of them provide customizable time limits, site-blocking, and reporting features. Although these apps are helpful, it’s even more important to have open communication with your kids of all ages about balancing life activities, how technology and online activity can help or hurt, and what to do when (not if) they encounter questionable or shocking material.


is to plan enough activities that are in-person, outdoors, physically engaging, and interesting enough that your child’s desire for screen time becomes just one of many options of how to spend their day.



Many children don’t yet have the self-regulation to balance technology use on their own. Most phones, tablets, and game consoles have internet browsers, which easily expose kids to violence, pornography, and predator risk if left un-checked. Some families turn in their electronics at bedtime, during family time, mealtime, or “screenfree” days.

Some parents start with middle or high school, while others start in grade school with appropriate monitor apps or call/text-only phones. Devices can also be shared by siblings and checked out when needed.


2 0 21 A N N U A L R E P O R T B OA R D O F H E A LT H Commissioner Gil Almquist » w ash ing ton count y

Ke n n e t h Snow

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Commissioner Pa u l Cozzens » i r on cou nty

D r. C l a y t o n Pe t t y » iron count y

Commissioner Andrew Gant » kane count y

Ro s a l i n d Metcalf

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cou nty

Commissioner Wa d e Hollingshead » b e ave r count y

S c ot t Symond

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Commissioner Jerry Ta y l o r » g ar fi eld cou nty

The Southwest Utah Public Health Department (SWUPHD) serves the approximately 277,472 residents of Washington, Iron, Kane, Beaver, and Garfield counties.


Immunizations administered (non-COVID-19): 11,058 COVID-19 vaccine doses administered: 121,032 International travel immunizations: 450 TB (Tuberculosis) tests: 998 Epidemiology investigation contacts (including COVID-19): 12,337 Total deaths in 5-county district (2020): 2,325 Total births in the 5-county district (2020): 3,196 Vital Statistics certificates (includes birth & death certificates): 20,190


Certified car seat installation checks: 172 Students, parents, and administrators completing Clearing the Vapor course: 13,475 Decrease in 10th grade 30-day vape use: 19% Retailer tobacco compliance checks: 370 (84% in compliance, 84 clerks trained) Residents referred by clinicians to Quit-line to stop using tobacco: 209 Entities assisted and/or funded to expand or create active transportation (walking/biking) plans: Washington City (17.5 miles of new bike lanes), St. George (7.8 miles of new bike lanes), Enoch, Cedar City, Springdale, Utah Tech University

EMERGENCY PREPAREDNESS • MRC (Medical Reserve Corps) registered volunteers: 520 (5,734 hours volunteered) • Sponsored emergency preparedness trainings & events: 324 • Full-Scale Strategic National Stockpile / Medical Countermeasure Exercises (Flu “Shootouts”): 8 Locations (1,600 Flu Shots Administered) • COVID-19 Vaccination Clinics: 450 (including 35 mobile) • Health Care Preparedness Coalition Meetings: 15 • AFN (Access & Functional Needs) Coalition Members: 294

ENVIRONMENTAL HEALTH • Total food service inspections and consultations: 4,405 (1,409 routine, 57 follow-up, 2,939 consultations) • Food Handler Cards issued: 8,293 • Water samples analyzed (for swimming pools and drinking water facilities): 6,876 (5,473 pool, 1,403 drinking water) • Public pools & spas in district: 782 • Restaurants/food establishments in district: 1,151 • Total septic inspections and consultations: 7,176 (541 inspections, 6,635 consultations)

REVENUE Fees: 14% Other: 1% Contracts/Grants: 66%

Nick Re y n o l d s

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County Contributions: 19%

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Every year, the SWUPHD selects members of the community who have demonstrated exceptional support and service to the field of public health.


Former Southwest Utah Board of Health member

Representing Kane County, Rosalind (Roddy) Metcalf recently retired as a member of the Southwest Utah Board of Health where she had served for 8 years. Roddy has always been an advocate for the health of others, especially during her long career as a nurse. Roddy has been diligent in staying current on public health issues, actively participating in the board of health, and contributing to the health of the community at large by advocating for good health practices and demonstrating them in her personal life.


Public Relations, Intermountain Healthcare South Hospitals

Also known for her journalism and voice talent, Becki has been the driving force behind the creation and consistency of the Iron County PIO Association, enabling communications representatives from diverse organizations to train, plan, and work together for emergencies. She also facilitated the return of the SWUPHD Flu Shootout at Cedar City Hospital’s annual Fall Health Fair.


Child Nutrition Program SWUPHD health inspectors report that this school district stands out with cleanest kitchens and excellent inspection scores, all while serving several million meals every school year. Accepting the award are Sharon Stucki (Program Supervisor) and Stefenee Hymus (Program Secretary). Sharon has been at her job for almost 40 years and is proud of the fact that they’ve never had a single case of food poisoning linked to the district’s lunchrooms.


Search @swuhealth to stay caught up on everything happening at the health department and check out our newly revamped website for SO MUCH good stuff!


2 0 21 A N N U A L R E P O R T HEALTHY RESTAURANTS Healthy Habits Award recognizes restaurants in our community that offer healthy choices on their menu and maintain high standards of excellence. You can find the sticker below on the doors of these winning locations. (To apply and see if

your restaurant qualifies visit




Gaia's Garden Cafe Teriyaki Grill Twisted Noodle Cafe The Hearty Beet Viva Chicken Xetava Gardens Cafe

Chick Fil'a First Watch Main Street Cafe

Tia's Artisan Bakery Deep Creek Coffee Co. Teriyaki Madness

TOP 10 SOUTHWEST UTAH CAUSES OF DEATH 1. Cancer 2. Heart Disease 3. Alzheimer’s Disease 4. COVID-19 5. Stroke 6. Accidents 7. Chronic Lower Respiratory Diseases 8. Diabetes 9. Kidney Disease 10. Suicide Source: Most recent CDC data (2020)

BEST OF STATE 2021 HEALTH Magazine won its fifth Best of State medal in the Community Development - Publication category, awarded at the July 2021 gala.

Pictured from left to right: David Heaton (Editor/SWUPHD PIO), Jeff Shumway (Publisher/SWUPHD Business Manager), Kindal Ridd (Art & Design/SWUPHD Graphic Designer), Cameron Mitchell (SWUPHD Deputy Director) HEALTH MAGAZINE | SUMMER 2022

S O U T H W E ST U TA H P U B L I C H E A L T H D E PA R T M E N T WHAT IS THE ROLE OF THE HEALTH DEPARTMENT IN MY COMMUNITY? Our mission is to Protect the community's health through the Promotion of wellness and the Prevention of disease.

CONTACT US Call or visit your county’s office (see page 5) or visit for information on our services, programs, and COVID-19 updates. For questions or comments regarding this issue of HEALTH Magazine please email

YOUR FRIENDLY HEALTH DEPARTMENT FACES Thank you to our wonderful team for working so hard during a landmark vaccination year at the health department. Your attitude and excellence brings higher health to our southern Utah communities.



Utah Best of State 2017, 2018, 2019, 2020, 2021, 2022 @SWUhealth