Health | Fall 2014

SOUTHWEST UTAH PUBLIC HEALTH FOUNDATION

F A L L

E-CIGARETTES

PG. 24

The story behind this controversial device

WALKING THROUH TIME

PG. 20

How walking inspired great minds from history

2 0 14

FAMILY DINNER

PG. 19

Interview with The Food Nanny

SOUTHWEST UTAH PUBLIC HEALTH 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 Family Planning Health Screenings 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 Chronic Disease Management/Education 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/Sampling 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 Self-Reported Illness Website STD/HIV Investigation & Counseling Tuberculosis Program

P UBLISH E R

MAN AGI N G EDI TOR

DESIGNER

F O U N D AT IO N B OA R D

Jeff Shumw ay

D a vi d Heaton

K i nda l E r i c k s on

David B l odg e t t , M D C h ri s Wh i t e Je f f Shumway Todd S t i rl i n g

Jeff, David, Chris, Dr. Blodgett, Todd, & Kindal

I'm pleased to introduce the eighth issue of Health to the residents of the five counties

served by the Southwest Utah Public Health Department (SWUPHD). Those of us involved in public health realize that the better we do our job, the less you'll probably hear about it.

Insuring the safety of air, water, and food, along with the prevention of contagious or chronic diseases, is often a behind-the-scenes business.

This publication is part of our ongoing effort to get health-promoting information into the hands of our community members, to assist you in making the best health decisions for you and your family. We can do our best to present meaningful, evidence-based information, but it's up to you to take action. It's our goal to help you do that.

Sincerely,

David W. Blodgett, MD, MPH SWUPHD Health Officer & Director The entire contents of this publication are CopyrightŠ2014 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 advertizements, claims, and or representations made in this publication.

THIS MAGAZINE IS A PUBLICATION OF THE

FOLLOW US NOW ON INSTAGRAM @SWUHEALTH @SWUpublichealth

4

H E A L T H | F A L L 2 014

AIR QUALITY

6 BLUE SKIES

How clean is our southern Utah air?

by Robert Beers

NUTRITION

16 GOING GREEN WITH SMOOTHIES

Haven't tried a "green drink"? You're missing out

by Sara Fausett, RD, CD

U P DAT E

7 WATER LAB SUCCESS Keeping your public pools safe

by Robert Beers

H A N TAV I R U S

8 KILLER MICE

The story behind this rare but deadly virus

by Lisa Starr, RN

MALARIA

10 THE FIGHT AGAINST MALARIA The history of a worldwide disease

by Lori McGuire, RN

U S P S TA S K F O R C E

12 CHECK YOUR SOURCES

The search for trustworthy health information

by David Blodgett, MD, MPH

QUIZ

15 FLU 101

Everything you need to know about seasonal flu

VAPING

24 CLEARING THE SMOKE

The rise and regulation of e-cigarettes

by David Heaton

TEXTING AND DRIVING

F A M I LY M E A L T I M E

18 FOOD FOR THOUGHT

When families sit down and eat together, everyone benefits

by Shalyce Oman

THE FOOD NANNY

19 FAMILY DINNER IS BACK

Improve your family's nutrition and relationship

EXERCISE

20 WALKING THROUGH THE AGES

The healthy walking habits of historical figures

by David Heaton

26 FIVE SECONDS

A call to action - put the phone away

by Kaysha Price

PREPARE

28 WHEN THE HOSPITAL IS FULL Community Information and Support Centers

by Paulette Valentine

INFOGRAPHIC

30 BACK TO SCHOOL VACCINATIONS

Are your kids caught up on their shots?

by Kindal Erickson

FILM REVIEW

22 WEIGHT OF THE NATION "To win, we have to lose"

by Cambree Applegate

QUESTIONS OR COMMENTS? Email dheaton@swuhealth.org

CHOLESTEROL

23 UNDERSTANDING THE NUMBERS Interpreting cholesterol screenings

by Todd Stirling, PA-C

ALSO @SWUHEALTH

ON THE COVER WALKING THROUGH THE AGES: Special thanks to the Utah Shakespeare Festival for helping us costume Jane Austen, Thomas Jefferson, and Ludwig van Beethoven story on page 20

SWUHEALTH.ORG

5

BLUE SKIES

AIR QUALITY IN SOUTHERN UTAH Robert Beers SWUPHD Environmental Health Division Director

People enjoy Southern Utah for many reasons, but the clean

air and environment are often mentioned by tourists and residents alike. Most areas in our region enjoy over 300 days of sunshine each year. Public opinion polls indicate that people throughout the state and nation are concerned about the quality of the air we breathe and the steps being taken to improve air quality.

monitor for the end of 2014. This equipment is used to monitor fugitive dust in various areas of St. George.

Poor air quality can have a negative effect on people and the environment. Obviously, people with asthma or other medical concerns are more susceptible to air pollution. Individuals who experience breathing problems should remain indoors our region when poor air affects the area.

Most areas in 300 days of each year.

The Southern Utah Air Quality enjoy over Task Force was formed in 1996 sunshine at the request of St. George City Mayor Daniel McArthur. The initial goal was to address fugitive dust concerns, meaning dust blown in from outside the area. The Task Force has also begun to address additional air quality concerns. Representatives from public health, government, industry, transportation, business, economic development organizations, and citizens throughout Washington County have been involved with the Air Quality Task Force since its creation.

The Task Force holds an annual Air Quality Summit to educate community leaders and the public about current issues and efforts affecting the area. The 5th Annual Air Quality Summit is tentatively planned for February 2015.

The creation of the Task Force led to a partnership between the Southwest Utah Public Health Department and St. George City to operate air quality monitoring equipment borrowed from Summit County during the summer months from 2008 to 2011. St. George City purchased its own monitoring equipment in 2012. St. George plans to purchase a second air

6

H E A L T H | F A L L 2 014

Fortunately, air quality in southern Utah is generally very good and is much better than the nearest metropolitan areas. Local air quality can be affected by weather patterns, climate, industrial activities, automobiles, high winds, construction or excavation work, forest or brush fires, and agricultural burning.

Poor air quality in Southern Utah is almost always a direct result of regional fires, high wind events, or unusual weather patterns.

Southern Utah does not often fall outside air pollution standards set by the Environmental Protection Agency. Occasional inversions are generally short-lived due to the mild climate.

For this reason, southern Utah is not required to enforce “No Burn Days� or other restrictions that are broadcast by news media along the Wasatch Front.

The Utah Department of Environmental Quality has the responsibility to regulate state and federal air quality laws and regulations throughout Utah. Visit airquality.utah.gov for additional information.

PREVENT

UPDATE:

WATER LAB SUCCESS The last issue of Health Magazine announced the opening

of a new water lab in St. George (What's in the Water?, Summer 2014). The Southwest Utah Public Health Department (SWUPHD) created the lab to help operators of drinking water systems and swimming pools improve water quality and prevent the spread of water-borne disease.

The lab began receiving and analyzing water samples in October 2013. The response has been impressive. The Lab performed 36 bacteria tests in April, 392 in May, and 445 tests in June. About 550 tests are expected for the month of July 2014.

More importantly, swimming pool compliance with bacteria testing requirements has seen a remarkable improvement.

Health department staff report that bacteria testing compliance for local public pools has increased from approximately 25% to more than 90% in just over three months. Please call first for sample collection procedures and additional information.

SWUPHD Water Lab Information: St. George Office: Mondays through Thursdays from 8:00 a.m. to 4:00 p.m. (#435-986-2580)

SWUHEALTH.ORG

7

KILLER MICE

HANTAVIRUS IN SOUTHWEST UTAH Lisa Starr, RN Communicable Disease Surveillance Nurse for the SWUPHD

Hantavirus was first recognized in the

U.S. in 1993 and, as of 2012, a total of 616 human infections in 34 states have been reported nationally. About 75% of all cases were contracted in rural areas and 36% resulted in fatalities. Utah has reported 26 cases since 1993, including two in Iron County and one in Kane County.

are usually admitted to a hospital intensive care unit (ICU) where they can be supported with fluid and electrolyte balance, blood pressure control and ventilation. The mortality rate can be as high as 50%.

Although cases of hantavirus are relatively rare in our area, the serious risk to health when infections do occur is sobering enough to consider good prevention practices. To control rodent

er) inside and out with cement, lath or wire screening, or other patching materials.

•Elevate hay, woodpiles, and garbage cans to eliminate possible nesting sites.

•Use traps or an EPA-approved rodenticide with bait, then properly dispose of rodents. Live trapping of rodents is not recommended.

Hantavirus can infect anyone, regardless of age, gender, or race. Humans usually get infected by in•Don’t leave pet food out haling dust that contains overnight. Clean up To control rodent infestation, the motto to dried rodent urine or feces food preparation areas. remember is “seal up, trap up, clean up!” contaminated with the virus. Infection can also ocPeople involved in cleancur if contaminated mateing rodent-contaminated rial enters an open cut; or areas should keep the infestation, the motto to remember is directly into the mouth, nose or eyes. following recommendations in mind: “seal up, trap up, clean up!”

So far there has been no evidence of person-to-person transmission. There •Work in well-ventilated areas. Gloves, •Clear brush, grass, and garbage from are four species of mice that can carry dust/mist masks, long-sleeved clotharound building foundations to elimhantavirus. Only one, the deer mouse, ing, and protective eyewear may help inate a source of nesting materials. is found in southwest Utah. prevent exposure.

•Keep tight-fitting lids on all garbage •Clean droppings using a wet method, Symptoms include fever, cough, muscle cans. rather than a dry method such as aches and gastrointestinal upset within sweeping or vacuuming. Spray disin•Use metal flashing around the base of one to five weeks of exposure. Hantafectant (such as diluted bleach) on wooden, earthen, or adobe dwellings virus Pulmonary Syndrome can progdroppings prior to cleaning, then use to provide a barrier against rodents. ress rapidly to severe respiratory failure a wet mop or paper towels moistened and shock. There is no medication to •Seal all entry holes (¼ inches or wid with disinfectant to clean up. treat this virus, so critically ill victims

8

H E A L T H | F A L L 2 014

PREVENT HANTAVIRUS PULMONARY SYNDROME (HPS) CASES, 1993-2013

SWUHEALTH.ORG

9

THE FIGHT AGAINST MALARIA THE DEADLY MOSQUITO

What is the deadliest animal known

ease. Malaria was a common cause of death in those days. A U.S. Census Bureau from 1850 states that 45.7 out of every 1000 deaths were caused by malaria. Over 10,000 Union Army troops succumbed to the illness during the Civil War. Even at the beginning of the 20th century, malaria continued to sicken and kill. Up to 80% of the When Europeans first arrived in the workers building the Panama Canal New World at the end of the 15th cenwould fall ill from malaria at any given tury, they brought malaria with them. time. Soldiers during both World Wars Malaria followed the spread of Europewere stricken by the disease as well. ans through Central and South AmerThe U.S. Army would spearhead the Malaria has been known development of chloroto humans for millenquine, one of the first synAccording to UNICEF, about 1 million nia. Chinese medical thetic anti-malarial drugs people die annually from Malaria. literature from 2700 during World War ll. AnB.C. mentions malarother anti-malarial drug, ia, as do 4000 year old Egyptian texts. ica and then into the south of what is mefloquine, was developed during the The Greeks wrote about it in 500 B.C. now the United States. By the early Vietnam War. and it plagued much of the Old World.

19th century, malaria was occurring The Roman Empire managed to keep throughout the U.S. and in parts of In the late 19th century, with malarthe disease under control by draining Canada. Every state except what would ia ravaging the Indian subcontinent, marshes and developing the land. In eventually become Alaska had the disa British surgeon living in Bangalore, to man? In terms of sheer number of deaths caused, it would be the mosquito. It is one genus of mosquito in particular– the Anopheles mosquito – that carries the malaria parasite. According to UNICEF (United Nations Children’s Fund), about one million people die annually from malaria. The World Health Organization (WHO) reports that about half of these fatalities occur in children five years and younger who live in Africa.

Chinese medical literature 2700 B.C.

10

H E A L T H | F A L L 2 014

fact, the word malaria comes from the term mal’ aria meaning “bad air” – the bad air emanating from the swamps, which was thought to be the cause of the disease. It would be over 14 centuries after the fall of the Roman Empire before mosquitoes would be implicated in malaria transmission.

Lori McGuire, RN Nurse at the SWUPHD Kanab office

15th centery explorers to New World

Greek writings 500 B.C.

American Civil War

PREVENT Sir Ronald Ross, became interested in the disease. Scientists had recently discovered the existence of the malaria parasite Plasmodium, and Ross was intrigued by the hypothesis that mosquitoes spread the parasite. He spent the next four years proving this hypothesis by dissecting mosquitoes. With the knowledge of this discovery he traveled the world to develop malaria control measures, including a trip to Panama in 1904.

Mosquito abatement strategies were crucial. A pivotal event occurred in 1939 when Swiss chemist Paul Muller developed DDT. This insecticide, originally developed to kill a beetle that was destroying potato crops across Europe and America, was found to be effective against many pests that caused human misery and death, including fleas carrying typhus and the Anopheles mosquito. By 1951, thanks in no small part to the use of DDT, malaria had been eradicated from the U.S.

With the scientific unIf you have plans to travel overseas, conderstanding of malaria Today, malaria continues transmission and knowlto ebb and flow across sult your local health department to find edge of the Plasmodium the world. Of the 430 out if your destination has any risk for life-cycle, malaria eradAnopheles species, about malaria exposure. ication efforts began in 35 are capable of spreadearnest. The effectiveing malaria and they are ness of quinine as a treatment had been known for centuries. found on every continent except Antarctica. North America In the early 1600s, Spanish missionaries in Peru learned of remains malaria-free as do Europe and Australia. Malarthe cinchona tree. Indigenous tribes were using the bark of ia mortality in the Middle East and Southern Asia has dethis tree to effectively treat fevers. Europeans exported this creased since the beginning of the 20th century, but the risk tree for cultivation and research and, in the early 19th centuremains throughout those areas. The WHO estimates that ry, quinine was isolated and extracted from the tree bark. It there were 207 million cases of malaria in 2012 and Africa was proven to be successful in the treatment and prevention continues to be the hot bed of the disease, accounting for 85% of malaria. Most of the anti-malarial medications used today of all cases and 90% of all deaths. are based on quinine.

If you have plans to travel overseas, consult your local health In addition to pharmaceutical prevention and treatment, othdepartment (see page 2) to find out if your destination has er control measures were sought. The Communicable Disease any risk for malaria exposure. If so, there are prevention tips Center, later called the Centers for Disease Control (CDC), and medications available to help make your trip a safe one. was established in 1946 with the goal of combating malaria.

A 19th century image of Jack Frost as a Union General during the American Civil War with a caption reading, "Our faithful old Ally of the North, GENERAL JACK FROST, shall come and clear away the Malaria"

Now Phase of countries with Malaria Prevention Elimination Control Pre-elimination

SWUHEALTH.ORG

11

CHECK YOUR SOURCES U.S. PREVENTIVE SERVICES TASK FORCE

David Blodgett, MD, MPH Director and Health Officer for the SWUPHD

It

is bewildering to consider the onslaught of information that we are exposed to in today’s world. As more is understood about any given topic, it becomes even clearer that there is much that we do not know. It’s also exciting to live in a time when vast amounts of information are available and readily accessible to almost anyone. The internet in particular has opened these doors so that all may learn the secrets of the ages.

However, not all sources of information are equal. The modern day miracle of the internet has a downside. With very little investment in experience, education, forethought or finances, anyone can represent themselves as an expert on any issue. What people used to say about the news is now said about the internet; the joke now goes, “I found it online, so it must be true!” Even people who seem to have legitimate credentials, such as celebrity doctors, are often maintaining large financial operations and can be influenced by paid advertisers and product endorsements.

We can be easily manipulated by emotion and criticism, therefore a wellbased online article may not be able to compete with the frequently anonymous tirades that follow it. A study published in the Journal of Computer-Mediated Communication (February 2013) found that inflammatory statements made in online comment sections can influence readers on the topic more than the article itself!

12

H E A L T H | F A L L 2 014

The difficulty of navigating the inforcause their charge is to examine and inmation superhighway is compoundterpret all of the scientific data instead ed by the complexity of some issues. of advancing an agenda. Often their The media tends to explain issues in recommendations are controversial beone-liners and sound-bites and we tend cause they are made outside of the poto welcome oversimplified explanations. litical and social environment.

This is the path to misunderstanding, division, inconsistency, and often downright bad How to be a healthy skeptic information. Nowhere is this more apparent than Ask yourself these basic questions when evaluating inin politics, but a close sec- formation you find online or anywhere else, especially ond would have to be the when it affects your health: medical world.

• Does the claim fall in line with what you know about the world and common sense?

You don’t have to look far to see examples of this every day: coconut oil is bad for you/coconut oil is healthy. Whole wheat is nutritious/whole wheat is poison. Do statins (medications for high cholesterol) help or hinder? “Use this one weird trick to (insert whatever health problem is being exploited)”.

• Is the claim advocating an extreme regimen, be havior, or quantity of something? “Moderation in all things” is more than a nice phrase, and “more is better” has its limits.

• Is this an effort to sell you something or does someone’s livelihood benefit from the decision you make about the claim? Look for indications of a “paid advertisement”.

Who can you trust?

• Is the source a lone expert? In general, sources that are supported by recognizable groups of author ities in an area of expertise are more reliable than a single individual. This guideline is not foolproof, but larger professional organizations often have a process in place that helps weed out bad information.

There are several organizations that have been set up to specifically avoid the effects of politics and money on medical and public health decision making.

These groups become the most credible simply be-

• Are there any underlying agendas? Sources that do not have a financial or political stake in the issue are more credible. The role of governmental organizations (such as the Centers for Disease Control & Prevention or your local health department) should be to put science ahead of politics, so that the public benefits from accurate, unbiased information.

PREVENT Among the best of these organizations is the United States Preventive Services Task Force (USPSTF). Here’s a description from their website: “Created in 1984, the U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

Task Force members come from the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics and gynecology, and nursing. Their recommendations are based on a rigorous review of existing peer-reviewed evidence and are intended to help primary care clinicians and patients decide together whether a preventive service is right for a patient's needs.”

The USPSTF caused some controversy when it found that the best use of mammograms are for women ages 50-74, and every two years. The American Cancer society had recommended mammograms every year after age 40.

Here are some recommended tests from the task force: •Colonoscopies for everyone ages 50-75: A •Screening for gestational diabetes in pregnant women after second trimester: B •Blood pressure screening for all adults: A Conveniently, the USPSTF has also released an app for Android and iPhone called ePSS that will display all of the recommended screenings for you, based on your age and risk factors. The app will also leave out screenings that have been shown to be unnecessary or potentially harmful, based on the data you enter. The USPSTF serves as a trusted resource that does all the heavy lifting to provide reliable information on which to base your health decisions.

The USPSTF serves as a watchdog over health practices and helps protect against harm that may arise from over-testing and over-promising. Their recommendations can be found online at www.uspreventiveservicestaskforce.org. Here you will find evidence-based evaluations of many popular preventive screenings, gathered from thorough investigations and reviews of medical literature. The USPSTF makes recommendations on the following basis: Grades A and B: Recommended for everyone Grade C: Recommended only for selected individuals Grade D: Not recommended Grade I: Insufficient evidence to recommend either way These recommendations are supported by extensive research and documentation of the process the task force used to arrive at their conclusion.

Some of the recommendations of the task force may surprise you. For example, screening for prostate cancer using a prostate specific antigen (PSA) test received a D grade: not recommended. For years, men have been screened regularly using the PSA test. However, the task force found that studies on the benefits from prostate screening could not find any benefits as far as men saved from dying of prostate cancer. In fact, several harmful effects of PSA testing were found. Out of every 1,000 men screened, 30 to 40 will develop erectile dysfunction or urinary incontinence due to treatment. Two men will experience a serious cardiovascular event due to treatment, and one man will develop a serious blood clot.

One in 3,000 men screened will die due to complications from surgical treatment.

Other preventive tests that don’t make the cut: •Screening for carotid artery stenosis (CAS) does more harm than good: D •Ovarian cancer screening for most women: D •Testicular cancer screening: D SWUHEALTH.ORG

13

FLU 101

FLU SEASON ARRIVES THIS FALL. BE READY! Protect yourself, your family, and friends against the upcoming flu season. Visit the nearest Flu Shoot-Out and get vaccinated!

BEAVER

Wednesday, Sept. 17, 2014 EMS Shed 11am-3:30pm: Drive-thru or Walk-in

CEDAR CITY

Saturday, Sept. 20, 2014 Health Fair - Valley View Med. Center 9am-1pm: Walk-in (all ages)

ST. GEORGE

Wednesday, Sept. 24, 2014 Red Cliffs Mall parking lot & food court 8am-2pm: Drive-thru (ages 18+) 1pm-7pm: Walk-in (all ages)

KANAB

Saturday, Oct. 11, 2014 Health Fair at High School 9am-1pm: Walk-in (all ages), Flu Vaccine FREE to all Kane County residents!

PANQUITCH

Thursday, Oct. 16, 2014 Fire Station 11am-3pm, Drive-thru or Walk-in

Flu shots $18 (nasal spray vaccine $25), cash, check or credit card; or FREE with proof of the following insurances: Altius, CHIP, DMBA, Medicaid, Medicare(depending on HMO plan), PEHP, SelectHealth, Tall Tree, or United Healthcare •wear a short sleeved shirt • Visit www.swuhealth for updates and consent forms (print, fill out, and bring with you to save time!)

14

H E A L T H | F A L L 2 014

PREVENT HOW MUCH DO YOU KNOW ABOUT THE FLU? Test your knowledge with these questions (answers below): 1. Influenza (or flu) is a: A) Bacteria B) Virus C) Parasite 2. The 2009 flu pandemic involved which flu strain? A) H5N1 B) H7N9 C)H1N1 3. T or F? Nausea, vomiting, and diarrhea are primary symptoms of the flu 4. T or F? Flu is spread through the air 5. The flu can be prevented by: A) Hand washing B) Vaccination C) Healthy lifestyle D) All of these 6. On average, how many estimated flu deaths occur in the U.S. each year?

A) 3,000 B) 23,000 C) 32,000 7. T or F? Flu vaccines have a lot of side effects

2. H1N1 (also called swine flu) was a new strain that most humans had no immunity from, so it caused the first flu pandemic since 1968. Since it is still circulating, protection against H1N1 will be included in this year's flu vaccine. H5N1 (avian or bird flu) has a 60% fatality rate and has been tracked in the eastern hemisphere since 1997. Fortunately it has not mutated enough to easily transmit person-to-person.

3. False. "Stomach flu" is not actually the flu, it's gastroenteritis, which can have numerous causes, from norovirus and salmonella to giardia and chemical toxins. Influenza can cause gastrointestinal illness on occasion, but the flu is known for high fever, body aches, fatigue, coughing and sore throat. Flu victims are often bedridden from several days to two weeks. If you have flu-like symptoms, stay home and cough into your sleeve to avoid infecting others. Most people recover at home with rest, fluids, and pain relievers. You should get medical help if you experience breathing problems, altered consciousness, or have a medical condition that worsens with illness.

4. False. The flu is not known to be airborne. You catch the flu when the virus enters your eyes, nose or mouth. This can happen when you're in range of someone coughing or sneezing (3-6 feet) or, more likely, when you touch an infected surface and then touch your face. Respirator masks only offer protection if you're providing patient care up close.

5. All of these practices will help protect you from the flu. Get vaccinated, wash your hands frequently with soap and warm water (hand sanitizer works but is second best), and make sure you're keeping a healthy immune system by managing stress and getting plenty of sleep, nutrition, and exercise.

6. On average, an estimated 32,000 Americans have died from the flu annually since 2000. Flu and pneumonia rank as the ninth most common cause of death in the U.S. Over 90% of flu deaths occur in people over age 65.

7. False. Most people have no side effects from flu shots, which can include irritation and swelling at the injection site or mild flu-like symptoms as the body builds an immune response. Serious side effects are very rare (about one in one million doses).

Flu Virus 1. Influenza is a respiratory virus, so antibiotics are useless against it (unless you get a secondary infection, like bacterial pneumonia). The flu virus mutates often, which is why you need a new flu shot every year. The annual flu vaccine contains three to four flu strains anticipated to be the most active in the upcoming flu season.

Did You Know?

•Flu season starts in late fall and peaks in February in south west Utah.

•Flu shots are recommended for everyone over six months of age.

•Flu vaccine usually becomes available as early as September at pharmacies, clinics, and local health departments.

•The Southwest Utah Public Health Department holds a "Flu Shoot-Out" in each county, providing a fast, convenient way to get immunized while participating in their annual mass-vaccination exercise. See the previous page for more in formation.

SWUHEALTH.ORG

15

GOING GREEN WITH SMOOTHIES

Sara Fausett RD, CD Clinical and outpatient dietitian for Intermountain Healthcare at Valley View Medical Center

A green, nutrition-filled glass seems like an easy way to start

eating healthier, less processed foods. The fruits and vegetables can make a guiltless glass, as long as added ingredients don’t end up creating a glorified dessert.

FRESH IS BEST: Although green smoothies are a great way to increase fruits and vegetables in our diets, whole and fresh is best. In a study by Rolls and Flood-Obbagy in 2009, participants who ate a whole apple as a first course consumed 15% less calories throughout their meal compared to those who had applesauce, who ate 6% less calories throughout their meal. People who drank juice, with or without fiber, did not lower their calorie intake at all.

A pureed glass of fruits and vegetables is very appealing because it is convenient. However, juices and blended produce make smoothies less filling because they have been converted into miniscule particles that are easier and faster to digest. A blended fruit and vegetable smoothie may leave you hungry faster than if you were to eat its components whole. The major reason why whole produce is best is that the fiber and complex carbohydrates are still completely intact. Consider it “Choice A”. As a superb Choice B, green smoothies can become part of

16

H E A L T H | F A L L 2 014

a healthy diet because they can replace less nutritious choices like flavored coffee and soda. In general, increasing any form of fruits and vegetables in the diet provides great health benefits. Green smoothies can be used as an easy way to make a snack or replace an entire meal, depending on the ingredients.

WHAT’S IN YOUR CUP? Your smoothie is only as healthy as your ingredients. The first step is vegetables. Look for spinach, celery, kale, beet greens, etc. Don’t skimp on this step. Next, add some color with fruits like berries, pineapple, plums, or apricots. Try adding healthy fats like avocados, nut butters, or seeds to make it richer. Finally, put some protein in your glass to keep you feeling full longer. Some great options include Greek style yogurt, protein powders from pea, whey or hemp, and seeds such as chia, pumpkin, or flax. Ingredients in green smoothies do not always have to be the same. Combinations and amounts may change depending on whether it is a snack or a full meal replacement. Many make the mistake of not making their smoothie filling enough and then get too hungry before their next meal.

Two cups of spinach or kale, two tablespoons of chia seeds or avocado, one small apple, half a cup of berries, almond milk, and a half cup of Greek style yogurt can provide all the necessary nutrients needed to comprise a meal - a fat, a carbohydrate, and a protein. As a snack, one cup of almond milk, one banana, one and a half cups of spinach, and one scoop of protein powder would suffice.

PROMOTE HOW COULD YOU GO WRONG? Many think they can never go wrong with a green smoothie because the ingredients are so healthy. That is only partially true. Beware of a few common beginners’ mistakes: 1. Health is not built in a day. Green smoothies can be considered a liquid version of a salad. However, shoving a pineapple, watermelon, apple, pear, avocado, a bunch of celery, a package of spinach, and an entire container of Greek yogurt in a blender may be excessive. They may be healthy calories, but too many for an individual portion.

2. Build it right. If you are making a smoothie to replace a meal, be sure it has a similar amount of calories you would normally eat in a meal. Remember, every meal needs a fat, a carbohydrate, and a protein. The smoothie should hold you over for at least three hours until a small snack can be eaten. If not, reconsider your ingredients or the timing of when you eat it.

3. Watch your sugars to maximize your efforts. If you want to stay full between meals try not to use juice in your smoothie. Juices are generally stripped of the majority of pulp and fiber, so they will not keep you feeling full compared to whole produce. They also contain a large amount of sugar which can negatively impact those watching their blood sugars. Whole fruits will take longer to digest than juice due to fiber content, so use these along with a good amount of vegetables. Remember, whole and fresh is best.

4. For some, eating fruits and vegetables can get complicated if there are medical issues. For instance, many fresh produce items found in smoothies contain oxalates which can increase the risk for kidney stones for those with previous kidney dysfunction or a family history of kidney stones.

Be aware of your individual health limitations and choose foods accordingly.

With the wonderful variety of produce available during the summer season, it’s time to give the green smoothie a try.

Refreshing, filling, and healthy, it’s a great way to boost the amount of fruits and vegetables in your diet.

Beginner's Luck

-green smoothy recipe

The Beginner’s Luck Green Smoothie is a great starter smoothie for beginners. It’s full of iron, potassium and vitamins and is sweetened with tropical fruits.

Give this smoothie a try - you'll be pleasantly surprised! serves 2

Ingredients 2 2 1 1 2

cups spinach, fresh cups cold water cup pineapple cup mango frozen bananas (peeled)

Instructions Blend spinach and water until smooth.

Next, add the remaining fruits and blend again.

For more recipes, visit simplegreensmoothies.com, where you can sign up for their free 30-Day green smoothie challenge!

SWUHEALTH.ORG

17

FOOD FOR THOUGHT BENEFITS OF FAMILY MEALTIME

Shalyce Oman Health Educator for the SWUPHD

The Mendenhall family of Cedar City, Utah

Many families are busier today than ever before, and sharing

a meal together often has to compete with long commutes, late work hours, soccer practice, homework and other activities.

But when families sit down and eat together, parents and their children benefit in several ways.

Research also shows that frequent family dinners (five or more per week) are associated with lower rates of smoking, drinking, and illegal drug use in pre-teens and teenagers when compared to families that eat together two times per week or less. Teens who have fewer than three family meals per week are 3.5 times more likely to have abused prescription drugs, 3 times more likely to have used marijuana, 2.5 times more likely to have smoked cigarettes, and 1.5 times more likely to have tried alcohol.

Research suggests that children who participate in family mealtime are 24% more likely to eat healthier foods and 12% less likely to be overweight. The average restaurant meal has up to 60% more calories than a homeWhen families sit down The advantages of eating together as a made meal. Meals prepared and eaten at home are usually more nutritious and and eat together, parents family are obvious, but managing a comhealthy. They contain more fruits, vegand their children benefit plicated schedule can be a challenge for etables, and dairy products along with many families. If five times a week seems in several ways. additional nutrients such as fiber, calciunattainable, start with once a week and um, and vitamins. Home cooked meals work up to at least three. When children are less likely to be fried or highly salted, and soda and other are involved in sports or programs during mealtimes, plan to sweetened beverages have a lower rate of consumption at the eat dinner when most of the family can be there. A family dinner table. Eating a home cooked meal is not only more meal doesn’t need to be gourmet or served in five courses; keep nutritious, it also saves money. Meals purchased away from it simple. the home cost many times more than meals prepared in the Many American families are starved for time spent together. kitchen.

Mealtime may be the only opportunity to put away media deChildren perform better in school when they eat more meals vices and reconnect with each other. This gives parents a perwith their families. Teenagers who have family mealtime at fect chance to talk with their children and stay more in tune to least four times per week have a higher grade point average what’s going on in their lives. than their peers eating together two times per week or less.

18

H E A L T H | F A L L 2 014

PROMOTE FAMILY DINNER IS BACK Liz Edmunds is the author of "The Food Nanny Rescues Dinner" and "The Food Nanny Rescues Dinner Again!" The Food Nanny airs Wednesdays on BYUtv. to set a regular dinner hour," says Liz. "Hopefully between 5:00 and 7:30 p.m.

The days of having a big noon meal together are long gone and breakfast is too rushed. A regular dinner time provides stability. It's something to look forward to after a long day at school or work, where family members are in a safe place with people who love them. They get to talk about the day and values are taught.

It's therapy."

What about conflicting activities? "Don't punish the whole family because a couple of members aren't there," Liz advises.

"Set the dinner hour and stick with it.

That consistency will result in kids not filling up on junk when they get home because they're looking forward to a home-cooked meal. Set aside a plate for those who come in later and enjoy some interaction with them as well, while they're eating."

Liz

Edmunds, better known as "The Food Nanny" from the BYUtv reality show of the same name, is passionate about encouraging families to sit down and enjoy dinner together on a regular basis. She knows what she's doing, having raised seven children in a busy household, often at inconvenient distances from supermarkets.

"You often hear about the American family falling apart," Liz says. "The most powerful and natural time in the whole day to gather the family together is at dinner time, and nobody is doing dinner anymore. All kinds of activities are being scheduled through dinnertime. People are eating in their cars on the go and not taking the time to sit down to eat a nutritious meal every night and taking the opportunity to talk face to face with their loved ones. The communication and relationship is even more important than the nutrition."

So, if a family wants to get back on track, where do they start? "Every family needs

Now comes the hardest part: trying to figure out what to eat every night. The solution? Liz recommends a method she has used for over 25 years. "Seven years into my marriage I created a meal plan to make it easy to put dinner on the table on an ongoing basis. It's called Theme Night. Monday is for comfort food, Tuesday is Italian night; fish, meatless, or breakfast on Wednesday, Thursday is Mexican night, Friday is pizza, Saturday is grilling, and Sunday is tradition night.�

"I realized later that my family was getting a great variety of food because I had at least eight recipes to choose from under each theme," Liz says. "I also made sure to offer two to three vegetables with each meal; a combination of fresh, frozen, or canned , along with fruit." Liz's meal plan takes about ten minutes to update. "I do it every two weeks. One week is too short, and a month is too long.

Include your family in what meals they want or are craving. Then create your shopping list and go to the store. You'll

start to find you need fewer ingredients when you cook on a consistent basis because you'll have a lot on hand. You can make smaller trips in between for fresh produce. Most everything else you can refrigerate or freeze."

Liz asserts that families who stick to a simple plan and make regular mealtime a part of their schedule will enjoy a greater quality of life. "If you eat dinner as a family at least three nights a week, you're going to stick together. Get up to five nights if you can. When your family is bonding over good food, life is good!"

Other words of wisdom from The Food Nanny: Dessert: "Kids who don't get the chance to eat sweets in moderation often binge on it when they leave home. Prepare dessert once a week in small portions. I also make cookies or brownies in between."

Meat: "I believe it's important to include it in our diet but we could all use less, especially red meat. That's why I have a meatless night and many of my other recipes are meatless as well."

Bread: "I cut out bread three times a day.

Choose one meal to eat your bread, maybe two on occasion. Try whole grains."

Fruits and Veggies: "Most people don't get enough. Serve two to three veggies every meal. Try new ones often and eventually your family will end up liking them.

Try fruit for desserts."

Fast Food: "It has it's time and place, just don't eat out all the time. When you go to a restaurant, share your meal or bring home half to eat the next day."

Dieting: "Don't eliminate any foods. Most diets don't work long term. What do you love and crave? Make it healthy and practice portion control. Eat a large variety of foods along with plenty of vegetables and fruits. Eat until you're satisfied, not full, then push your plate away. Then you can enjoy a little treat. Soon you won't crave sweets as much."

If the notion of cooking at home with your family most nights seems daunting, take courage from Liz: "When you make your kitchen the heart of your home, you create an experience where you know what's going into your meals. You're chopping, handling, smelling the food. There's a connection between body and soul. It's the true life! Your family will be healthier, both physically and emotionally."

SWUHEALTH.ORG

19

WALKING

THROUGH THE AGES David Heaton Managing Editor Public Inofrmation Officer for the SWUPHD

Babies get lots of attention when they take their first steps,

which are celebrated with applause, cheers, and Facebook posts. The skill of walking is an important one and humans have employed it out of instinct and necessity throughout history to get from one point to another, whether it's across the room or across a continent. We walk around without a second thought, it's automatic. But when is the last time you walked "on purpose"?

having subdued the horse to the uses of man. But I doubt whether we have not lost more than we have gained by the use of this animal (replace 'horse' with 'motor vehicle' for our day)." Jefferson also wrote, "I repeat my advice to take a great deal of exercise, and on foot. Health is the first requisite after morality."

Many great authors, artists, musicians, and thinkers made walking part of their routines. Mason Curry, in his book DaiWalking for good health is currently highly recommended; it's ly Ritual, found many examples in his research. Beethoven low-impact, free, and beneficial for the heart, lungs, joints, and took two-hour long vigorous walks with pencil and music pamind. You're exposed to nature, fresh air, and sunshine. Deper stuffed in his pocket in case inspiration struck. Sigmund pression and anxiety are reduced, healthy weight is achieved Freud took daily one-hour walks around Vienna at "terrific and maintained, and sleep is improved. Done with family, speed". John Milton spent up to four hours a day walking up friends, and pets, walking can even strengthen relationships. and down his garden. Jane Austen took part in frequent walks Fitness guru Jack LaLanne said, "Walkwith company, a custom often portrayed ing is a big part of my life. If you walk Why not follow in the foot- in her novels. Victor Hugo chose the vigorously, it's just as good for you as steps of the great minds of beach for his daily two-hour walks. For running." Author Rebecca Solnit adds, Charles Dickens had three-hour the past and add a daily walk years, "Walking articulates both physical and walks through London or the counto your schedule? mental freedom." tryside. Darwin beat Dickens by halfan-hour in his schedule. Tchaikovsky The virtues of walking have been known since ancient times. walked for thirty minutes in the morning, then two hours Hippocrates proclaimed, "Walking is man's best medicine." later in the day. Louisa May Alcott walked with her family, Diogenes coined the Latin phrase solvitur ambulando - "it is who were ahead of their time in advocating healthy lifestyles. solved by walking". A Bulgarian proverb reads, "From walking-something, from sitting-nothing." It turns out sitting is Who knows what you will contribute to the world? Why not worse than nothing, it's actually linked to early death, espefollow in the footsteps of the great minds of the past and add cially for those with sitting jobs. a daily walk to your schedule? Thomas Jefferson encourages, "No one knows till he (or she) tries how easily the habit of Thomas Jefferson, who took daily long walks throughout his walking is acquired." How easy? Just follow the advice of this life, was concerned that "the Europeans value themselves on Chinese proverb: "One step at a time is good walking."

20

H E A L T H | F A L L 2 014

PROMOTE COAL CREEK TRAIL

By Weslie Graham, Managing Editor of Iron County Today An issue as old as time and as common as leaves on a tree, I am often juggling tasks and responsibilities until I can barely remember my own name, let alone the day of the week. When I find myself fighting a losing battle with my sanity I know it’s time to get out of the office, throw on my tennis shoes and “hit the trail.�

And my favorite place to sweat it out? The Coal Creek Trail in Cedar City.

According to www.cedarcity.org, the trail runs from Bicentennial Park, north and east past the city ball fields and Rotary Centennial Veterans Park, through East Canyon Park, and east up Cedar Canyon.

What I love about this trail is that it has something to offer everyone. The west, or park, portion of this trail is fairly level and provides a view of community sporting events that can be highly entertaining. The east, or canyon, portion is my favorite as it provides slight inclines, winds its way alongside the creek and is fairly shaded in the evening. This trail is approximately six miles round trip but can be accessed at many points.

Many community members join me in taking advantage of this trail and as I make frequent visits I have begun to make connections and friends with individuals who I enjoy recognizing around town.

Something that keeps me on my toes (literally) is the wildlife that I encounter on this trail. I have to keep an active eye out for lizards that may be sunbathing on the pavement or that run by, momentarily distracting me from a side ache that I may be working through. On this trail I encounter children on bikes, women with babies in strollers, elderly couples and athletes who appear to be training for something far beyond my level of physical comprehension. I never regret time spent outside on this trail and it always leaves me feeling refreshed and ready for a new day at the office.

ST. GEORGE TRAIL SYSTEM A unique way you can see the beauty of St. George is to travel its trail system which includes mostly paved surfaces. The City of St. George has developed approximately 25 miles of public trails and paths that traverse the city - with plans to add more in the near future.

While you avoid the traffic and stoplights on the road, you can also see and inspect the natural flora and fauna of the area. There are also many services along most of the paths including restrooms, drinking water, shelters, picnic areas, information kiosks and even access to some city parks.

Proper etiquette is greatly appreciated when using the trails. Pedestrians have the ultimate right-of-way, but they are encouraged to readily yield to cyclists and skaters. Travelers should stay to the right and pass on the left while audibly alerting others when passing. Some trails have marked path lines that facilitate the flow of traffic.

These trails offer safe ways to explore the city for pedestrians, runners, cyclists, and skaters. Motorized vehicles are not allowed. Many of the trails are paved while the rest have well groomed natural surfaces. Most are handicap accessible. (source:utahstgeorge.com) For more information on St. George's trails, visit sgcity.org and find Parks & Trails

SWUHEALTH.ORG

21

Cambree Applegate Former Health Educator for the SWUPHD. She is now the Safe Kids Utah Coordinator for the Utah Department of Health

FILM REVIEW

In 2012, HBO produced a documentary about the obesity

epidemic in the United States, titled Weight of the Nation. The film is divided into a four part series, each about an hour long. Watching Weight of the Nation is an eye opening experience that will leave you wanting to jump out of your seat and look for ways you can help yourself, your family,and your community become healthier. You will see the stories of real people who live with obesity and get a glimpse into their everyday lives.

The movie goes beyond giving information and statistics about obesity. You will connect with the people being interviewed and, as you do, the many faces of obesity become very real. The problems people face on a daily

22

H E A L T H | F A L L 2 014

basis are no longer solely consequences of choice, but the result of an environment that America must face as a national crisis.

The tagline “the weight of the nation is out of control, but we can fix that” offers hope that we can change our current behaviors into lifestyles that allow us to be healthier and happier no matter what our circumstances may be. If you enjoy moving and educational films, then take some time to watch Weight of the Nation. You won’t regret it, neither will you be left unchanged.

HBO’s Weight of the Nation is available to view free, online at: https://theweightofthenation.hbo.com/films.

PROMOTE

CHOLESTEROL

UNDERSTANDING THE NUMBERS Todd Stirling, PA-C SWUPHD Nursing Division Director

Screening

for high cholesterol levels can help you understand your risk for heart disease. Experts recommend that men ages 35 and older and women ages 45 and older get screened with a blood test called a lipid panel. It is also recommnded that people at high risk for lipid disorders begin screening at age 20. The lipid panel includes: •Total cholesterol •LDL (low-density lipoprotein cholesterol, also called "bad" cholesterol) •HDL (high-density lipoprotein cholesterol, also called "good" cholesterol) •Triglycerides (fats carried in the blood from the food we eat. Excess calories, alcohol, or sugar in the body are con verted into triglycerides and stored in fat cells throughout the body.)

Results of your blood test will come in the forms of numbers. Here is how to interpret your cholesterol numbers. The first thing you need to know is that the numbers by themselves are not enough to predict your risk of heart problems or to determine what you need to do to lower that risk. They are, instead, one part of a larger equation that includes your age, your blood pressure, your smoking status, and your use of blood pressure

medicines. Your doctor will use this information to calculate your 10-year risk for serious heart problems. Then the two of you will develop a strategy for reducing that risk.

LDL CHOLESTEROL LDL cholesterol can build up on the walls of your arteries and increase your chances of getting heart disease. That is why LDL cholesterol is referred to as "bad" cholesterol. The lower your LDL cholesterol number, the lower your risk.

If your LDL is 190 or more, it is considered very high. Your doctor will most likely recommend a statin in addition to making healthy lifestyle choices. Statins are medicines that can help lower cholesterol levels.

You may also need to take a statin even though your LDL level is lower than 190.

After figuring your 10-year risk, your doctor will recommend a percentage by which you should try to lower your LDL level through diet, exercise, and medication if necessary.

HDL CHOLESTEROL When it comes to HDL cholesterol"good" cholesterol – a higher number

means lower risk. This is because HDL cholesterol protects against heart disease by taking the "bad" cholesterol out of your blood and keeping it from building up in your arteries. A statin can slightly increase your HDL, as can exercise.

TRIGLYCERIDES Triglycerides are the form in which most fat exists in food and the body. A high triglyceride level has been linked to higher risk of coronary artery disease.

Here's the breakdown.

TRIGLYCERIDES

TRIGLYCERIDE CATEGORY

Less than 150 150 - 199 200 - 499 500 or higher

Normal Mildly High High Very high

TOTAL CHOLESTEROL Your total blood cholesterol is a measure of LDL cholesterol, HDL cholesterol, and other lipid components. Your doctor will use your total cholesterol number when determining your risk for heart disease and how best to manage it.

Now at Southwest Utah Public Health Department, St. George and Cedar City Offices (see page 2 for locations)

LOW-COST

HEALTH SCREENINGS

LIPID PANEL: $35 (Cholesterol screening for risk factors in heart disease.

Tests LDL, HDL, triglycerides, and glucose)

A1C: $25 (Tests blood sugar for diabetes control) PT-INR $25

(Monitors effectiveness of blood-clotting medications like

Coumadin)

HEMATOCRIT $15 (Screening for anemia) FREE BLOOD PRESSURE & BMI WITH EVERY SCREENING!

Save time and money with these screenings for managing chronic disease SWUHEALTH.ORG

23

CLEARING THE SMOKE THE STORY BEHIND ELECTRONIC CIGARETTES

David Heaton Managing Editor, Public Information Officer for the SWUPHD

ORIGINS effort to impose further regulations on e-cigarettes such as age The "e-cigarette" was actually first conceived in 1963, when restrictions, ingredient disclosure, and health warning labels.

Herbert Gilbert invented a smokeless, non-tobacco cigarette.

Although Popular Mechanics magazine hailed the battery-powIn Utah, e-cigarettes fall under the same restrictions as stanered device as having great potential, the world wasn't ready. dard cigarettes in the Utah Indoor Clean Air Act, which Tobacco use had not yet been deemed unhealthy in the United means they cannot be used in any indoor location accessible States, where smoking was portrayed by the public. favorably in the media and allowed virIn Utah, e-cigarettes fall tually everywhere.

ANATOMY OF AN E-CIGARETTE

under the same restricAn e-cigarette is an electronic device Decades later, the market for an alterwhich provides inhaled doses of nicotions as standard cigarettes native to smoking became more promtine and other additives to the user. A in the Utah Indoor Clean ising. Hon Lik, a Chinese pharmacist rechargeable battery powers an atomAir Act. and smoker himself, invented a nicoizer, which in turn heats the cartridge tine inhaler device after his father died containing the "juice". This is a liquid from lung cancer. His Ruyan ("like made up of a base (propylene glycol or smoke") was marketed in China in 2004 as a cigarette replaceglycerin), flavor, nicotine, water and, frequently, many unment and cessation aid. known chemicals. The heated juice becomes an aerosol which REGULATORY QUESTIONS The electronic, or e-cigarette, reached the United States by 2009 and was immediately controversial. The FDA stopped shipments of the product, stating that e-cigarettes were a health hazard and required formal registration. Some states banned them. E-cigarette companies refuted the FDA's claims. Finally, the U.S. Court of Appeals decreed that e-cigarettes were not a drug (unless marketed as such), but could be regulated as a tobacco product by the FDA. This still leaves levels of nicotine and other chemicals in question, although there is now an

24

H E A L T H | F A L L 2 014

is inhaled into the lungs, where it becomes condensed and is absorbed into the bloodstream. It is often claimed that users only inhale and exhale water vapor, but the vapor can contain hundreds of different chemicals.

Many e-cigarettes were originally designed to look like normal cigarettes, with an LED that lights up on the end when activated. E-cigs are now marketed in many different shapes, colors, and sizes. The cartridges can be replaced or refilled with a wide variety of flavors. People smoking, or "vaping" e-cigarettes are becoming a more common sight. Small vape

PROTECT shops have opened up in many communities while big tobacco firms now have e-cigarette subsidiaries.

SAFETY AND CESSATION While e-cigarette proponents may suggest the device can help people stop smoking (cessation), there is not yet enough research to determine if this is the case. Anti-smoking advocates are concerned that the device may simply provide an additional, less-intrusive method of getting a nicotine fix (dual-use) or encourage people to get into the habit who wouldn't have been smokers otherwise. They feel the candy and fruit flavors, along with customization options, make the e-cigarette especially attractive to young people.

Nicotine is known to be a highly addictive substance which can raise blood pressure and cholesterol levels, increase insulin resistance, and be fatal in high doses (10 milligrams is lethal for children). E-cigarette juice containers are not currently required to be childproof, and curious children can be poisoned through ingestion, inhaling, or absorbing the liquid through the skin or eyes. The Utah Poison Control Center reported 15 poison calls involving e-cigarettes in 2012 and 75 calls in 2013.

Since January 2012, over 80 children under age 6 were sent to Utah hospitals after using the devices.

2nd generation cigarette, available in many shapes and sizes - made for lasting use

cartridges now available in numerous flavors

tobacco cartridge (mouthpiece)

usb charger 1st generation rechargable e-cigarette

1st generation electronic cigarette resembling a tobacco cigarette- one time use

THE FUTURE OF E-CIGARETTES While the results of misuse by children are obvious, the long-term effects of regular adult use on the heart, lungs, and cardiovascular system will remain unknown for some time. Increased regulation is likely. The value of e-cigarettes for cessation or a smoke-free alternative to tobacco cigarettes remains to be seen. Public health officials, while not endorsing e-cigarettes for those purposes, rank the device as potentially less harmful to health than cigarettes, chew, and dissolvable tobacco, but inferior to FDA-approved cessation methods such as nicotine-replacement patches and gum.

SWUHEALTH.ORG

25

FIVE SECONDS

TEXTING AND DRIVING Kaysha Price

The average text takes your eyes off the road for nearly five seconds. At highway speeds, that's enough time to travel the length of a football field.

26

H E A L T H | F A L L 2 014

Health Educator for the SWUPHD and Washington County Youth Coalition Advisor.

PROTECT Dave Henson with grandchildren

On March 4th, 2013, my parents, Dave & Leslee Henson went on a morning walk on Dixie Drive in St George, UT and were hit by a car while walking on the sidewalk. The driver at fault was texting and speeding. My dad saved my mom's life by taking the full impact and shielding her from the car. My mom survived with a broken neck, broken back, separated shoulder and several other injuries including over 5000 stitches and staples in and on her head. She is a miracle and we are so blessed that she survived the accident.

We know she is meant to be here on earth. We hope that together we can save lives by educating teens AND adults on the dangers of distracted driving, most specifically, texting and talking on cell phones while driving.

-Haley Warner

Five seconds is the average time your eyes leave the road while texting and driving. Five seconds at 55 miles per hour is enough time to cover the length of a football field. At any given moment across America, approximately 660,000 people are using cellphones while driving. How many of them are texting, distracted five seconds at a time, covering numerous football field lengths without looking?

Text messaging requires visual, manual, and cognitive attention from the driver. All of this attention is compromised while texting.

It’s no wonder that the number of people killed in distraction-related crashes in 2011 was over 3,300 and an estimated 421,000 people were injured. The fact is, there are simply too many crashes resulting from texting and driving. It is a habit that’s becoming deadlier than drunk driving.

To curb this deadly behavior, a new Utah law went into effect on May 13th, 2014, prohibiting the use of cellphones, laptops, tablets, or any similar device while operating a motor vehicle. If you are found entering any data onto your device while driving, including writing, reading, or sending a message, dialing a phone number, accessing the internet, or viewing a video, you are breaking the law. While there are some exceptions, including medical emergencies, the best way to avoid a penalty is to simply leave your hands and eyes off of your device while driving . The consequence ranges from a $100 fine to a Class B misdemeanor if someone is injured.

The following is a list of five tips to help you (and others) stay safe on the road:

1. Set up Family Rules.

3. Stop It.

Gather your family together and set rules that work for you. Remind each other of these rules and talk about them often. Be an example to your family by abiding by these rules. Practice with mock scenarios and encourage each other to drive phone-free. Attend a Parent Night, offered at your local high schools through Zero Fatalities and the Southwest Utah Public Health Department. Parent Nights educate new drivers and reminds their parents about deadly driving behaviors, along with helping families set guidelines.

Don’t just stop yourself from texting, stop others! If you are in the car with a driver who is texting, remind him or her of the hazards. Offer to text for them, or ask them to pull over to finish texting. Follow the advice of another local effort, the “Speak Up! Stop the Texts, Stop the Wrecks” campaign, which helps kids realize that they can speak up when they are passengers in a car with a distracted driver.

2. Stay Focused.

When you’re driving, put your focus on driving. Put away anything that may cause a distraction, especially your phone. Turn off your ringer and put your phone in your briefcase, purse, or pocket. Take advice from a local effort put together by the St. George Police Department: keep your “Heads Up and Thumbs Up”.

When you’re driving with your head up and your thumbs up on the steering wheel, then you’re staying focused and paying attention to what’s happening around you when driving.

4.Stay involved.

Support local initiatives. Sign local pledges through the campaigns mentioned above. Take a pledge at distraction.gov, a nationwide effort to stop texting and driving. Decide where you can take action and become an advocate for safe driving. Attend a Zero Fatalities Parent Night. Become informed, then do what you can to help educate those around you.

5. Start with you.

The most important tip is to start with you. Be part of the solution by personally being a safe driver. Make the commitment to drive phone-free today.

SWUHEALTH.ORG

27

WHEN THE HOSPITAL IS FULL THE ROLE OF COMMUNITY INFORMATION & SUPPORT CENTERS

It has been well-documented that hav-

Paulette Valentine SWUPHD Emergency Preparedness Division Director

cern. Since then, the world has seen ilant in surveillance efforts to detect the emergence of several new diseases and track local disease activity, we also ing a close connection to neighbors and with pandemic potential. Examples inplan for response and recovery should a the community makes a big difference clude the 2009 H1N1 flu, the MERS worst case scenario occur. Since hospifor people involved in the recovery procoronavirus from the Middle East, and tals would likely reach full capacity in cess after a disaster or emergency. With the new H7N9 flu strain currently cirthe event of a large disease outbreak, this in mind, the Southwest Utah Pubculating in China. When one of these the CISC was developed to provide lic Health Department (SWUPHD) diseases mutates enough to become essential information and limited supEmergency Preparedness and Response plies to those who might be Division has been working turned away. closely with the Southwest Healthcare facilities can be easily Utah Healthcare Preparedness overwhelmed during disasters. One There is a CISC location desigCoalition and other partners to nated in each of the 43 incordecide on steps we can take to of the many tools developed in our porated cities or towns in the ensure the best possible recovcommunities emergency plan is the five counties comprising southery if something “big” were to Community Information and Supwest Utah. They fall under the happen in our communities. port Center concept, to provide esresponsibility of the elected Since healthcare facilities can city officials. be easily overwhelmed during sential information and limited supdisasters, one of the many tools plies to those who might be turned When a hospital is getting to developed in our emergency away from hospitals. the point of “no more room”, plan is the Community Inforlocal CISCs can be activated. mation and Support Center easily contagious, the spread could be People unable to get into the hospital (CISC) concept. rapid and widespread, considering the will be directed to the CISC, where fact that we live in a global society with they will receive specific disease inforThe CISC plan began to take shape frequent international travel. Many of mation and instructions on how to care in 2006 when Mike Leavitt, Secreus travel overseas and many foreign for themselves or loved ones at home, tary of Health and Human Services tourists make southwest Utah their desalong with any available medical supat the time, started talking about the tination. A serious disease outbreak in port supplies. If ill individuals don’t importance of preparing for an influour area is not out of the question. have someone to help care for them enza pandemic. H5N1 (or “Bird Flu”) once they get home, then their reliwas becoming a leading cause for conAs the health department remains viggious organization will be contacted to

28

H E A L T H | F A L L 2 014

make sure they will be checked on and basic needs met. Local units of The Church of Jesus Christ of Latter-Day Saints have agreed to fill this need for those with no religious affiliation.

Hopefully, most of us have family, friends, or neighbors who would make sure we had food, water, and support during such an event.

It is comforting to know we live in communities where so many people are willing to help their neighbors during difficult times. We’ve seen this kind of support after natural disasters in recent years and would likely see the same spirit of volunteerism and caring during a pandemic.

Want to get more involved in local emergency preparedness?

•Sign up to be a SWUPHD volunteer at www.utahresponds.org (after registering, make sure and click on southwest Utah as your emergency responding area).

•Ask your mayor or city manager about the CISC plan and location for your town or city.

•Join a local CERT (Community Emergency Response Team).

•Assemble a home flu-preparedness kit:

plan

PROTECT

9}

Gather these nine essential items you’ll want to have on hand in case of an emergency:

1. water 2. food 3. clothes 4. medications 5. flashlight 6. can opener 7. radio

. Boxes of facial tissue (for covering sneezes & coughs, blowing nose)

8. hygiene items

. Hand Sanitizer (use in between hand washings, when leaving and entering home, sick rooms, etc.)

9. first aid

. Bottles of sports drink (to rehydrate and replenish electrolytes) . Thermometer (monitoring fever) . Over-the-counter pain relievers (for treating flu symptom . Lozenges (to treat sore throat and coughs) . Respirator masks (“N95” type, use when caring for the sick at close proximity) . Disinfectant spray or wipes (to disinfect hard surfaces in home, doorknobs, han dles, counters, etc.)

SWUHEALTH.ORG

29

OCTOBER IS AWARENESS MONTH FOR

ADULT IMMUNIZATIONS

SOME THINGS YOU OUTGROW. VACCINES AREN'T ONE OF THEM.

For many adults, vaccinations are a distant childhood memory. Did you know that about 50,000 adults die each year from vaccine-preventable diseases? Vaccines aren't just for kids. Stay current on your vaccinations and keep a personal vaccination record.

Talk to your local health department about the vaccines you need. See page 2.

SWUHEALTH.ORG

31

NON PROFIT ORG US POSTAGE PAID SALT LAKE CITY, UT 841 PERMIT # 6563

@SWUpublichealth