Health | summer 2014

T R AV E L H E A L T H PG. 8

d o n' t b r i n g b a c k a ny u nwa n t e d s o u v e n i r s

A N N U A L R E P O RT P G . 28

f o r t h e s o u t hw e s t u t a h public health department

M U R K Y S TAT I S T I C S discerning truth in to d ay ' s h e a l t h m e d i a

P G . 16

HEALTH SOUTHWEST UTAH PUBLIC HEALTH FOUNDATION S P R I N G / S U M M E R 2 0 14

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 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 Health Iron Co. Liaison Injury Prevention Safety Resources Physical Activity & Nutrition Resources Resources to Quit Tobacco Tobacco Compliance Checks Tobacco Education(retailers) Tobacco-Free Housing Data

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

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

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

COMMUNICABLE DISEASES Disease Surveillance & Control Epidemiology 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 C h ri s Wh i t e Je f f Shumway Todd S t i rl i n g

LETTER FROM THE HEALTH OFFICER I'm pleased to introduce this publication to the residents of the five counties served by the Southwest Utah Public Health Department (SWUPHD). The Southwest Utah Public Health Magazine, now simply titled "Health", is part of our ongoing effort to get health-promoting information into the hands of community members.

It has been said that the difference between a third world country and a first world country is public health. Those of us involved in that endeavor realize that the better we do our job, the less you'll probably hear about it.

Insuring the safety of air, water, and food through prevention and surveillance efforts is a behind-the-scenes business until a disease outbreak or emergency brings us to the forefront of response efforts.

In this issue you'll find important information on healthy lifestyles, disease prevention, emergency preparedness, and water safety, along with the SWUPHD 2013 annual report.

We're also addressing the challenge of sorting through the endless health-related information available through modern media in order to help you make the best health decisions for you and your family. We can do our best to present meaningful, evidence-based knowledge, 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

BUILDING STRONG HEALTH O N E R O C K AT A T I M E .

PREVENT

(VERB) KEEP SOMETHING FROM HAPPENING OR ARISING

PROMOTE (VERB) FURTHER THE PROGRESS OF; SUPPORT OR ACTIVELY ENCOURAGE

PROTECT (VERB) KEEP SAFE FROM HARM OR INJURY

PROMOTE NUTRITION

12 EXERCISE YOUR PORTION SIZE

Tips and tricks to make the My Plate plan work for you

by Sara Fausett

PREVENT 6

MEASLES

FOOD SAFETY

14 HANDLE WITH CARE

New rules for food service workers

by Robert Beers

DISCERNING TRUTH

MEASLES IN UTAH

Will this contagious disease make a comeback?

by Lisa Starr RN

RED DIRT INFECTION

7 THE “MYSTERIOUS FUNGUS”

Stirring up Valley Fever in Washington County

by Lisa Starr RN

IMMUNIZE

8 A WORLD WITHIN A WORLD

Sometimes a trip to a third world country can show you what we take for granted

by Gloria Shakespeare

WAT E R C H E C K U P

16 TRUTH, LIES, & STATISTICS

"There are lies, there are bigger lies, and then there are statistics"

by Dr. David Blodgett

ACTIVE YOUTH

18 GET UNPLUGGED THIS SUMMER

Coming Memorial Day 2014: 101 fun activities to lure Iron County kids away from their electronics

by Cambree Applegate

WALKING

20 TAKE A WALK

It's the easiest, cheapest way to lose weight and increase physical and mental health

by Kaysha Price

10 EPIC SEPTIC

What you've always wanted to know, but were afraid to ask about septic tanks

by Shallen Sterner

PROTECT N E W WAT E R L A B

23 WHAT'S IN THE WATER

Local pool operators now have a more convenient way to test pools and spas for harmful bacteria

by Robert Beers

EARTHQUAKE 22

Facts and figures for Beaver, Garfield, Iron, Kane, and Washington Counties, get prepared

ANNUAL REPORT 28

The Southwest Utah Public Health Department reports for 2013

QUESTIONS OR COMMENTS?

email dheaton@swuhealth.org or call (435) 986-2594

swuhealth.org

BUCKLE UP

24 ZERO FATALITIES

What are the five deadly driving behaviors?

by Cambree Applegate

EMERGENCY PREPAREDNESS

26 THE BUDDY SYSTEM

Home-bound and vulnerable people can weather a disaster by following a few simple steps

by Ashley Chamberlain

@SWUpublichealth

M E AS L E S I N U TA H Lisa Starr

Lisa Starr, RN Communicable Disease Surveillance Nurse for the Southwest Utah Public Health Department.

Measles is one of the most contagious diseases in the world,

claiming the lives of over 120,000 people every year. It remains one of the leading causes of death among children internationally. Thanks to successful vaccination programs, however, measles is much less common in the U.S. than it used to be, decreasing by more than 99% since the measles vaccine was first licensed in 1963. Prior to that, Utah saw annual cases numbering in the thousands.

the second outbreak.” (Utah Bureau of Epidemiology Annual Report, 2011) Measles is a virus spread by respiratory droplets through coughing and sneezing or direct contact with nasal or throat secretions. The symptoms of measles usually appear 8 to 12 days after exposure.

The first symptoms are called the “prodrome”, which lasts two to four days and includes a fever greater than 100 degrees, malaise, cough, runny nose, and conjunctivitis. Usually around day four, a rash consisting of discolored splotches which are flat and raised begins on the face then spreads to the body and extremities. Bluish-white spots on the inside of the mouth may also be observed, appearing a day or two before or after the rash. A person with measles is contagious three tomost fiveacquire days before rash starts and no symptoms, life-longthe immunity usually stays infectious for four days after the rash starts.

{

The Southwest Utah Public Health Department last saw measles in 1996, when 110 cases were reported in the five county area. Soon afterwards, the Centers for Disease Control (CDC) recommended that a second dose of MMR (measles, mumps & rubella) vaccine Areas where Coccidioides immitis be added to children’s immunization schedules and no local cases is found in North America have been detected since. However, when children are left unvaccinated, the door is opened for the return of this disease. This of Complications from may include ear infection, pneumomild measles to moderate complications happened in 2011, when northern Utah experienced itsdeveloped first case nia, seizures (jerking and staring), brain damage and death. Meaof measles in six years: cocci sles is the leading vaccine-preventable killer of children. Death fatal without proper treatment cases “In April 2011, the first case of measles since 2005 was identified occurs in one of every 1,000 reported cases in the United States. in Utah. By the end of July, a total of 13 confirmed cases had Children less than 12 months of age who are too young to receive lung disease & significant complications been identified. A family with unvaccinated children traveled to the vaccine are the most vulnerable to this disease, which is why Poland where measles was known to be circulating. Upon returnit’s so important for everyone around them to be immunized. Peodevelop a chronic illness ing to Utah, the children, one of whom was infectious, returned to ple born in or after 1957 who lack proper documentation of measchool. Consequently, several other students were infected. Seven sles immunity and people who have not been vaccinated are also cases in Salt Lake County were identified as confirmed measles at risk of getting measles. cases, three of whom were members of the family that traveled to People exposed to measles should check their immunization rePoland. A second wave of measles occurred in Cache County sevcord to make sure they were vaccinated. Otherwise, they should eral weeks later. There has been no evidence to link these two outconsult their physician or local health department to see if they breaks; however, it is presumed that there were cases not reported need a protective vaccination. Most importantly, measles can be that would have linked the two outbreaks. In Cache County, the kept out of our community by ensuring that children are vaccinatfirst case of measles was in an unvaccinated child who spread the ed at the right ages. disease to other family members. Six cases were reported during

60% 30% 12-17% 5-10% 1-5%

symptoms

6

{

begin 8-12 days after exposure

H E A L T H | S U M M E R 2 014

prodrome

coughing fever >100º runny nose conjunctivitis

{

2-4 days after prodrome begins

rash

}

begins on face before spreading to body

looks like

{

discolored splotches, flat and raised

PREVENT

THE "MYSTERIOUS FUNGUS" Lisa Starr

Areas where Coccidioides immitis is found in North America

{

60% 30% 12-17% 5-10% 1-5%

of developed cocci cases

Recently I read a newspaper article with the words “mysterious

fungus” in the title and it really caught my attention. As a nurse tasked with tracking disease, I admit I was excited to learn about this new fungus that was spreading throughout the American Southwest.

My intrigue turned to disappointment as soon as I realized they were talking about Coccidioides immitis, a fungus that, at least in our region, has been here a long time. This native mold lives 4-12 begin 8-12 coughing inches below the surface the disdaysof the soil and has been causing fever >100º prodrome after runny Coccidioinose ease coccidioidomycosis, or “Valley Fever”, for years. exposure conjunctivitis des thrives in climates with mild winters and hot summers, which means Washington County gets a few cases of Valley Fever every month.

symptoms

{

Once it’s airborne, Coccidioides can be inhaled into the lungs, where it becomes a yeast. People can become infected with Valley Fever when they inhale as few as ten spores. The incubation period is typically 1-4 weeks. The good news is that 60% of cases have no symptoms and most of these people acquire life-long immunity.

30% of cases involve mild to moderate complications. 5-10% of

mild to moderate complications fatal without proper treatment lung disease & significant complications develop a chronic illness

cases result in significant complications such as lung disease and 1-5% will develop chronic illness. Up to 17% of cases can be fatal without proper treatment.

People with weakened immune systems are the hardest hit by this fungus. We worry about retirees moving to endemic areas because they may have never before been exposed to this fungus and their immune system function decreases with age. Others who may be severely affected include:

{

Coccidioides has two stages in its life cycle. It normally stays nice and cozy as a mold below the surface until we start digging, farming, doing construction work or driving ATVs. Severe storms, winds and earthquakes can also stir it up. Environmental conditions have been known to blow spores hundreds of miles out of their original endemic (native) areas to cause infections.

no symptoms, most acquire life-long immunity

}

begins 2-4 days on face after» Transplant patients before prodrome spreading » Cancer patients begins to body

rash

looks like

{

discolored splotches, flat and raised

» Pregnant women (especially in the third trimester) » AIDS patients » Patients on immune-suppressing drugs

Symptoms of Valley Fever are influenza-like; often starting with malaise, fever, chills and cough one to four weeks after exposure.

Valley fever is diagnosed through cultures and blood tests. Treatment usually involves antifungal medication to minimize infections and complications. Occasionally, surgical removal of abscesses is necessary.

To reduce our risk in areas where Coccidioides calls home, we should avoid inhaling dust and decrease the amount of dust in the environment by watering down construction sites and avoiding breaking the earth’s crust unnecessarily. Hopefully this information has shed some light on this “mysterious fungus”, which is, as it turns out, as old as dirt.

SWUHEALTH.ORG

7

A WORLD WITHIN A WORLD Gloria Shakespeare

AFTER VISITING A THIRD WORLD COUNTRY, YOU REALIZE HOW WELL WE LIVE AND HOW GRATEFUL YOU ARE FOR WHAT WE HAVE. ONE OF THOSE BENEFITS IS HAVING A GOOD PUBLIC HEALTH SYSTEM.

I

ndia was never a place I saw myself going. Nothing could have prepared me for it. Traffic in Delhi is an experience all of its own—a tangle of crowded streets full of beeping cars, tuk-tuks (small three-wheeled taxies), camel carts, bicycles, pedestrians, scooters, small trucks and buses. There is no enforcement when it comes to the direction anyone travels, and since cows are considered holy in India, they are part of the mix and go where they please - and yet, everyone moving through this driving chaos seems so patient with others on the roadway. Car horns are like a signaling

8

H E A L T H | S U M M E R 2 014

device (like Morse code) and not a sign of frustration.

Sanitation and cleanliness of the streets is not monitored, at least as far as I could perceive. Public restrooms are not readily available, so the locals go where they can and the sides of the streets are no exception. Garbage cans are also uncommon, leading people to dispose of their litter wherever convenient. In short, you’ve got to watch your step.

After visiting a third world country, you realize how well

PREVENT we live and how grateful you are for what we have. One of those benefits is having a good public health system.

A travel consultation, offered locally by the Southwest Utah Public Health Department, is an absolute necessity when preparing for a trip outside of the United States and requires a visit four to six weeks prior to your departure. Although every destination is different, the threat of disease is not. After arriving at the health department and filling out the required forms, you will sit down with a qualified health professional who will evaluate your personal health history and educate you on the following: » Latest health information » Needed immuniza- tions, medicines or prescriptions » Country-specific travel tips and advice

quito bites. I was glad I had the added protection of the medication on board!

I had also purchased an insect spray for clothes and bedding from the health department. After using it successfully on our beds we offered it to a woman in our travel group who was being eaten alive by bugs at night. She sprayed it on her bed and it put an end to her misery.

ONE OF THE MOST IMPORTANT FACTORS IN ENJOYING YOUR TRIP IS TAKING THE RIGHT PRECAUTIONS TO STAY HEALTHY AND WORRY-FREE.

Getting properly immunized or medicated for your trip can prevent illnesses you may possibly come in contact with while traveling. I was given malaria medication since that is one of the diseases prevalent in parts of India. Although I also had plenty of mosquito repellent on hand (since malaria comes from a mosquito), I still missed an area of my foot on one occasion, which consequently became covered with mos-

The health department nurse advised me to call my personal doctor and get his recommendation on a certain medication I needed to take. I was impressed when the nurse called me a week later to follow up and make sure I had seen my doctor and had all the medications I needed for a safe trip.

In this age of global travel when more of us have the opportunity to experience other people’s countries and cultures, the wise traveler will also realize that along with experiencing the sights and sounds of other lands, they are also being exposed to foreign viruses and bacteria which have been, for the most part, eliminated in the United States. One of the most important factors in enjoying your trip is taking the right precautions to stay healthy and worry-free.

Travel Clinics are available at SWUPHD offices in St. George, Cedar City, and Kanab. See page 2 for addresses and contact information.

Gloria Shakespeare Former St. George City Councilwoman.

She and her husband, Tom, are currently serving a mission for the Church of Jesus Christ of Latter-Day Saints in Kenya. (photos on right: Gloria’s trip to India)

SWUHEALTH.ORG

9

Shallen Sterner Environmental Health Scientist for the Southwest Utah Public Health Department

EPIC SEPTIC Shallen Sterner

Septic systems are commonly used in rural

areas where property owners cannot access sewage treatment plants. These on-site systems safely treat and dispose of wastewater produced in private homes, churches, schools, and small commercial operations.

This wastewater may contain disease-causing germs and pollutants that must be treated to protect human health and the environment.

Wastewater is transported from a building through sewer pipes to the septic tank.

When the wastewater enters the tank the solids settle to the bottom. This is referred to as sludge. The grease, fats, and lighter-than-water waste that floats to the top of the septic tank is called scum. Natural decomposition

10

H E A L T H | S U M M E R 2 014

PREVENT of waste products and bacteria occur in the septic tank while this separation takes place. The liquid portion of the wastewater, called effluent, then moves to the absorption field outside the tank.

companies will safely remove and dispose of the material removed from the septic tank.

3. AFTER CLEANING a septic tank, the tank’s interi-

or surfaces and pipes should be inspected for leaks or The absorption field provides additional treatment to the cracks using a strong light. Broken baffles and crushed, wastewater as it spreads small amounts of effluent over broken, or plugged distribution pipes should be replaced a large area of soil. Most absorption fields have severimmediately. al trenches filled with layers of washed gravel or stone 4. A WRITTEN RECORD should be kept for all cleaning placed around perforated distribution and maintenance to the septic tank and pipes. This is where the essential part absorption system. This should be kept of treatment takes place. Most harmful IMPROPER by the owner of the system and can be bacteria and chemicals are removed in WASTEWATER used to help guide future maintenance. this gravel before the water can enter SYSTEM OPERATION the soil and eventually the water table.

5. ADDITIONAL DISINFECTANTS, AND MAINTENANCE The local health department has the yeasts, or other chemicals do not need CAN CAUSE A responsibility to make sure that propto be added to any septic system. Studerty owners follow regulations for sepies show that products that claim to help SEPTIC SYSTEM tic system installation, operation, and septic systems are ineffective. Typical TO FAIL AND RELEASE maintenance. Septic system plans must household cleaning chemicals should be reviewed and approved by the health HARMFUL WASTEWATER not have adverse effects on a septic sysdepartment before installation, then the INTO THE ENVIRONMENT. tem if used according to the instructions newly-installed systems get a final apfound on the products’ labels. Hazardproval before they can be operated. ous materials, medications, prescription drugs, and other harmful substances It is essential that each septic system follows good mainthat could adversely affect a system should not be distenance and wastewater disposal practices. Improper charged into a septic system. operation can cause a septic system to fail and release harmful wastewater into the environment. To maintain 6. FINALLY, BE CAREFUL to avoid overloading your a septic system properly, an owner should follow these septic system and minimize your use of water. Wash recommendations: laundry throughout the week rather than on only one day, for example. It is also important that owners do not 1. TANKS SHOULD BE EMPTIED REGULARLY. How dispose of paper towels, facial tissue, newspaper, wrapoften a tank is emptied is determined from informaping paper, disposable diapers, sanitary napkins or other tion logged during annual inspections. Tanks should be feminine hygiene products, coffee grounds, and similar pumped when the inspection reveals a tank with excess items into their septic systems. sludge or scum. A typical tank that is adequately sized should be pumped out about every five years.

A septic tank can be a valuable and effective wastewater treatment system, especially if the proper regulatory 2. A PROFESSIONAL septic tank pumping service with requirements are met and the system is used and maina valid permit must be used for pumping tanks. These tained properly.

Brandon Fisher and Rick Adams instal a septic system at Rick's new Cedar City home.

SWUHEALTH.ORG

11

EXERCISE YOUR PORTION SIZE Sara Fausett

12

H E A L T H | S U M M E R 2 014

D ieting, food, nutrition, and everything in between becomes a blur as popular “nutrition” products, menus, and programs ap-

pear and disappear. Most of us know what foods we should be eating - a few more fruits, vegetables, and whole grains and a little less fast food and sweets. It seems like there is a predicament between humans and food. We want good-tasting, healthy food for our bodies but we still want the foods we know we shouldn’t eat for flavor and comfort. With all the information regarding protein, fat, and carbohydrates, how will we ever nail down our nutrition?

PROMOTE body with the necessary protein it needs to keep you feeling full and satisfied.

Finally, the remaining 25% of your plate should have some starchy carbohydrates. Don’t be afraid to include some pasta, potatoes, whole grains, fruit, or beans in your meals. Give your body everything it is looking for and needs to function; if you use the healthy guidlines, you will help your body at every meal.

CREATE A HEALTHY PLATE

PORTION TO KEEP YOU ON TRACK

First, get the right foods by creating a healthy plate. Make half of your plate vegetables. Fill 50% of your plate with greens, red peppers, zucchini, mushrooms, garlic, tomatoes, or any other vegetable you prefer. Pick them based on the flavors, colors, or textures you or your family enjoy. A word of caution: be aware that your eyes will see and want bigger portions than your stomach!

Watching portion sizes will keep you on track with your nutrition goals. These portion size amounts may differ between women and men, young and old, and your activity level. Many adult women may find that they eat less or more than other members of their family. Portion sizes can be adjusted accordingly. Following the healthy plate model and exercising your portion sizes will keep you feeling good about giving your body what it needs without starving or sacrificing flavor for calories. Do not let portion distortion get in the way of your nutrition goals.

Second, fill 25% of your plate with protein. Turkey, fish, beef, chicken, nuts, tofu, or cheese are excellent options to provide your

Tip:

TRICK YOUR EYES TO FEEL FULL AND EAT LESS

One way to help exercise your portion size is to use smaller plates. The recommended plate size for a healthy plate is nine inches. However, the most common size purchased is twelve inches. Watch the size of your plates! Go a size smaller and fill it up with your healthy portions to max out your plate space and feel full!

GET YOUR PORTIONS RIGHT Sometimes a healthy plate can still be a problem if the amount of food is excessive.

This continual “portion distortion” taints our view of how much food we think we need. You may have the healthiest diet in the world, but if your portions are too big you will be frustrated by discomfort and weight gain.

To understand how to build a healthy plate without getting too many calories, we recommend four easy steps:

1. VEGETABLES Remember, 50% should

be vegetables - and no, potatoes do not count in this category. Vegetables are considered complex carbohydrates- low in calories and fat and high in the vitamins and minerals that your body needs to function properly. They are also a great source of fiber. Add vegetables whenever you can to

make your plate healthier! The portion rules change for protein, starchy carbohydrates, and healthy fats; one to two servings is recommended per meal.

-

Protein should be 25% of your plate. That should look like a chicken breast about the size of a deck of cards. If you are really hungry, increase the size of your protein to the size of your check book.

Anywhere from three to six ounces (deck of cards to checkbook size) of protein is appropriate for a meal without botching your nutritional goals.

2. PROTEIN

- The case for carbohydrates is similar to protein. One or two servings (25% of your plate) are appropriate for a meal. A single carbohydrate serving is a half a cup or about the size of a woman’s fist. A double portion of carbs is one cup or about the size of a baseball. You may double the serving size for a bigger meal to provide enough calories to feel top notch or to feed those in your family who may eat more calories than 3. CARBS

you do. Keep portion size images in mind as you build or order your healthy plate.

4. HEALTHY FATS - Healthy fats are nec-

essary to a healthy plate. We use healthy fats frequently as cooking oils or sprays, oil dips, marinades for meats, or as a topping for salads. Good fat is good for you. Be careful because too much fat, regardless of whether it is healthy or not, is not good for you. It becomes portion distortion. Aim for 1-2 Tablespoons per meal. Measure it out as you cook and prepare foods, or trace the oil across your pan in the shape of your thumb. The image of your thumb is about 1 Tablespoon of healthy fat.

Sara Fausett MS, RD, CD Registered Dietician for The Biggest Loser Resort at Fitness Ridge in Ivins, Utah

SWUHEALTH.ORG

13

HANDLE WITH CARE

Robert Beers

T

he Utah state legislature recently changed the way local health departments issue food handler permits (sometimes called food handler cards). The objective of these rule changes is to provide better food handler training, allow easier access to training, increase conformity and collaboration among various health jurisdictions statewide, and eliminate availability of fraudulent food handler training and permits.

following an 8 hour, in-depth training about proper personal hygiene, prevention of food-borne disease, safe food storage methods, adequate cooking, proper food preparation techniques, and general sanitation. The purpose of this requirement is to ensure that food managers have the knowledge and capability to train food workers who are hired in their facilities. Each food service establishment in Utah is required to have a Certified Food Safety Manager on staff.

In Utah, all food service workers are required to obtain food handler permits with the exception of those who pass a Certified Food Safety Manager course. Food safety manager certification requires completion of a rigorous exam

Personal hygiene has always been one of the most important issues regarding food safety. The Centers for Disease Control (CDC) estimates that over 50% of food-borne illness could be prevented by proper hand washing alone. Health depart-

For food workers, the biggest difference IN UTAH, ALL in the new rules is the availability of onFood workers receive training in the same line food handler training. Both online subjects as food safety managers although FOOD SERVICE and in-person training providers must sucnot to the same degree. Food workers receive WORKERS cessfully complete the Utah Food Handler more generalized information with the unARE REQUIRED Training Provider application process before derstanding that food safety managers will offering food safety training. Many food provide specific training where the workTO OBTAIN workers are excited about the new online ers are employed. This makes sense when FOOD HANDLER considering that some food operations are training option because they can complete the required training and examination from PERMITS,WHICH simple (smoothie bars or ice cream stands) home or anywhere with internet access. In while others can be extremely complex (banARE VALID southwest Utah, this saves many people quet and catering operations or full-service THROUGHOUT the inconvenience of driving long distances restaurants). to take a food handler class in a crowded THE STATE. Food safety training focuses on the main classroom setting. Online training providfood-borne disease risk factors described by ers submit food handler data to the health the Food & Drug Administration (FDA) indepartment which records the data for tracking purposes cluding personal hygiene, adequate cooking, proper holdbefore mailing permits to trainees who pass the exam. Per- ing temperatures, and sanitary equipment. Failure to control mits are now printed on sturdy plastic cards, issued with these risk factors can lead to food-borne illness and disease the trainee’s name and a unique ID number. They are valid outbreaks. Paying attention to these items is important for throughout the state. meals prepared at home as well as in restaurants.

CHANDLER (ST. GEORGE) AND ROBERT (RIGHT, CEDAR CITY) AT WORK IN LOCAL RESTAURANTS

14

H E A L T H | S U M M E R 2 014

PROMOTE ment inspectors work with food safety managers to emphasize the importance OF workers staying home when ill. Doing so prevents diseases from spreading to coworkers and customers.

Adequate cooking can also eliminate many foodborne illnesses. Most people are aware that proper cooking kills germs that cause disease. Checking the internal temperature of a food with an accurate thermometer is the only sure way to check if that food is cooked thoroughly. Studies have shown that other ways to estimate temperature, such as the color of meat or its juices, are a poor indication of the food’s actual temperature.

Once cooked or refrigerated, keeping the food either hot or cold is vital to keeping it safe. Hot foods must be kept above 140°F while cold foods must be stored below 40°F. Allowing foods to remain in the “danger zone” (temperatures between 40°F and 140°F) allows bacteria naturally present in the food to multiply and make people sick. This is essential in restaurants where large quantities of food are prepared. Food workers are also taught the importance of heating and cooling foods to safe temperatures quickly.

Finally, A dirty kitchen can lead to cross-contamination, a situation where safe food is contaminated by bacteria from people with dirty hands or aprons, equipment, work surfaces (like cutting boards or countertops), or even other foods. Keeping the kitchen and all cooking equipment clean is key, whether in a commercial or home kitchen.

People interested in taking a food handler course can visit www.swuhealth.org for a list of approved online food handler courses or a schedule of classes held at nearby health department offices.

Robert Beers EnvironmentaL Health Scientist and Division Director for the Southwest Utah Public Health Department.

SWUHEALTH.ORG

15

T R U T H , L I E S & STAT I ST I C S

Dr. David Blodgett

David Blodgett MD, MPH Director and Health Officer for the Southwest Utah Public Health Department.

THE AMOUNT OF HEALTH INFORMATION AVAILABLE TODAY IS TRULY STAGGERING. UNDERSTANDING A FEW BASIC TERMS CAN HELP GIVE YOU A LEG UP SO THAT YOU CAN MAKE BETTER DECISIONS FOR YOUR LIFE.

The newspaper article seems quite

convincing: a scientific study has been done to show the relationship between bathing in saltwater and the likelihood of getting into college. Various statistics are cited in the article to prove the point and the article ends with a triumphant proclamation; the researchers found that their result was statistically significant! You start bathing your youngster twice daily in saltwater baths, assured that this will be their ticket to the Ivy Leagues. Two weeks later, you see an article claiming that bathing in saltwater makes you less likely to get into college. You are perplexed when you read that this finding is also statistically significant! Have you ruined your child for life with all those saltwater baths? Are statistics trustworthy?

The amount of health information available today is truly staggering.

Whether found in professional journals, popular health magazines, news media, or (for better or worse) the

16

H E A L T H | S U M M E R 2 014

internet, information can be contradictory and downright bewildering!

Understanding a few basic terms can help give you a leg up in understanding and filtering health information (and any statistical information for that matter) so that you can make better decisions for your life.

You have probably heard the phrase “there are lies, even bigger lies, and then there are statistics!” Health professionals use statistics in trying to measure and make sense of the world we live in from a scientific standpoint.

Part of the problem is that statistics borrow from mathematics the perception of precision and certainty. In reality, life is uncertain, and scientific studies involve human judgment and motivations. Unfortunately, statistics can be sensationalized to make a story more dramatic, support an agenda, or even to mislead. Hence, different sides of an issue can interpret the exact same data to suit their purposes.

Knowing just a little about statistics can help you distinguish between

their proper and improper use.

RULE # 1: “STATISTICALLY SIGNIFICANT” ISN’T A TRUMP CARD.

Just because a study is found to be “statistically significant” doesn’t mean that the premise was necessarily true, that the results are important, or that scientific debate about the topic has now ended. Statistically significant only means that the results obtained were unlikely to have happened by chance. One of the chief problems that scientists try to guard against is finding a result that was merely a random occurrence. What a statistical test does not show is what made the results non-random to begin with. The way the test was conducted, the people chosen to be studied, and many other factors can impact the result of the study other than the question being asked. There are difficult-to-follow rules for how to conduct studies that try to eliminate many of these other factors.

PROMOTE RULE #2: IF A STATISTIC IS THE ANSWER, WHAT WAS THE QUESTION?

Statistics are the product of conscious choices: what to count, how to count it, and how to express the results. We need to consider what choices were made when the study was designed.

How many people participating in a study is very important since small sample sizes are rarely representative of what happens in the larger population. How participants are chosen is also influential. It is easy to get the results you want if the study group is tailored towards those results. Understanding the assumptions and projections made by the researchers can be telling. Our saltwater test is a good example. If you found out that there were only three babies studied and that all of them were children of the researchers, you might get a little suspicious of the results. When you find that all three babies were bathing in natural mineral springs in the Tibetan mountains and are recipients of college trust funds, you might realize that this study does not apply to you or the rest of the general population. Understanding how a study is structured is critical in determining whether the test is meaningful. Every test in the scientific literature is structured to allow further scrutiny of the test and its results. Unfortunately, few studies ever receive much scrutiny.

RULE #3: UNDERSTAND THE TERMS USED TO DESCRIBE THE RESULTS.

When looking at risk, do you know the difference between an absolute change and a relative change?

Let’s go back to our saltwater example. The news report tells us that if we take saltwater baths, we are more likely to get into college. What the re-

port didn’t tell us is what our chance of getting into college was without the saltwater bath. Let’s say that a child born today has a 23% chance of getting into college, and that those that did the saltwater bath routine had a

cancer. The study reports a 20% rise in the risk of colon cancer from eating red or processed meat. This may sound alarming, but what does it mean? It depends on how large your risk of getting colon cancer is to start with.

A person has around a 5% chance of getting colon cancer during their lifetime – the absolute risk. If you eat a bacon sandwich every day, you increase your risk of getting colon cancer by 20% – the relative risk increase. So what this means is that your lifetime risk of getting colon cancer is now 6%, an increase of 1% (that is, 20% of 5% = 1%).

This kind of error is an even bigger problem for very rare events. Let’s say that a study reports that you are twice as likely to get hit by lightning if you use a smartphone That’s a 100% increase! Sounds bad, right? But before you dump the phone. Look at the absolute risk involved. If your risk of getting hit by lightning is one in a million, having a smartphone has now increased the risk to 2 in a million...still a pretty safe bet.

Knowing the absolute risk is a vital, but rarely reported factor in sensational, risk-oriented articles that seem so common in today’s media.

24% chance of getting into college.

The article can now report that you are 5% more likely to get into college if you do the baths [100%-(23/24 or about 95%)=5%]. To a certain extent, it is true; the study shows you are 5% more likely in relative terms to go to college, However, in reality, your absolute chances of getting into college really haven’t changed significantly.

Perhaps a different story will illustrate this better. Take a story about bacon sandwiches giving you colon

So, don’t be hesitant to ask questions about any study that is advocating changes in health behavior. Does the study make sense? Is it done well?

Does it apply to you? How much will it actually improve your life if you make changes based on it’s claims?

After applying some scrutiny to our bathwater example, it is likely you will find that neither study was valid and bathing in saltwater probably has nothing to do with your kids’ chances of going to college. Now, armed with a little knowledge, you’ll sleep better tonight.

SWUHEALTH.ORG

17

Elli, Ryan, Natalia, Hyrum, Alyssa play at the Cedar City Main Street Park.

GET UNPLUGGED THIS SUMMER

Cambree Applegate

Cambree Applegate Health Educator for the SWUPHD & an adjunct professor at Dixie State University. She is spearheading the Play Unplugged effort in southwest Utah.

IMAGINE HAVING 101 FUN ACTIVITIES THAT YOUR KIDS CAN DO THIS SUMMER, DESIGNED TO ENCOURAGE BEING ACTIVE INSTEAD OF SPENDING TOO MUCH TIME IN FRONT OF THE TELEVISION, COMPUTER OR OTHER ELECTRONIC DEVICES.

I

f you’ve heard the “I’m bored” complaint too many times from your children during summer, then help is on the way.

Imagine having 101 activities that your kids can do this summer with the possibility of winning cash or other prizes! This free program, called “Play Unplugged”, will be launched in Iron County on Memorial Day weekend (May 2014). This program is designed to encourage kids to have fun being active instead of spending too much time in front of the television, computer or other electronic devices.

Kids will be given a magazine with a list of 101 activities they can participate in, each sponsored by a local business or organization. After accomplishing an activity, they can visit the sponsor and collect a “brag badge” to add to their Play Unplugged lanyard (also provided). Kids will enjoy collecting these colorful badges, each uniquely designed to promote the activity and having various point values.

Brag badges can then be used to enter drawings for prizes throughout the summer for ages 18 and under (don’t worry, kids won’t have to give up their badges to be entered into the drawings). Don’t live in Iron County? Just plan a weekend getaway to cool off in the Cedar City area. Help your kids collect their brag badges and enjoy a vacation closer to home!

18

H E A L T H | S U M M E R 2 014

Bringing Play Unplugged to Iron County has been a cooperative effort involving the Healthy Iron County Coalition, the Iron County Tourism Bureau, the Iron County School District and the Southwest Utah Public Health Department.

“When I heard about this program I knew it was a great fit, not only for our youth, but for businesses in the community – plus it’s great for tourism,” says Bonnie Char Hallman, Public Relations Specialist for the Cedar City/Brian Head Tourism Bureau. “This program is a great way to highlight area attractions and is exactly what we need for Iron County.”

The Play Unplugged program debuted last summer in Heber City and was a huge success. According to the Heber Unplugged creators, there were a total of 6,300 participants with a total of 64,070 badges collected. One business sponsored an activity inviting kids to turn in any violent video games and 330 games were collected.

Play Unplugged is more than just getting kids away from their electronics, it’s also a fun way to help restore a sense of community that may have dwindled in towns and cities over the years.

For more information about the Play Unplugged program coming to Iron County, visit: www.cedarcityunplugged.com.

PROMOTE

b r e a t h e

e a s y

5K

family 5k and kids' fun run | r e g i s t e r a t b r e a t h e e a s y 5 k . o r g April 19, 2014 | St. George, Utah | awards and prizes c o t t o n w o o d

c o v e

p a r k

1 0 2 7

s o u t h

d i x i e

d r .

SWUHEALTH.ORG

19

Kaysha Price Health Educator for SWUPHD and Washington County Youth Coalition Advisor.

TA K E A WA L K

Kaysha Price

20

H E A L T H | S U M M E R 2 014

PROMOTE Many of us wish we were getting more exercise.

We know it’s good for us, but there are a million reasons why we don’t. According to a recent U.S. Surgeon General’s report on physical activity and health, more than half of America’s population does not participate regularly in any type of exercise. When we hear the word exercise, some of us immediately envision a gym, a fitness DVD, or an athletic event. We assume it will take time, lots of money, and will be difficult. The good news is that physical activity doesn’t need to be complicated, expensive, or overly time-consuming. A simple thirty-minute, brisk walk is not only considered exercise, but is one of the best choices for getting-and staying- fit.

» REDUCE THE RISK OF CORONARY HEART DISEASE » IMPROVE BLOOD PRESSURE AND BLOOD SUGAR LEVELS » IMPROVE BLOOD LIPID PROFILE » MAINTAIN BODY WEIGHT AND LOWER THE RISK OF OBESITY » REDUCE THE RISK OF OSTEOPOROSIS » REDUCE THE RISK OF BREAST AND COLON CANCER » REDUCE THE RISK OF NON-INSU LIN DEPENDENT (TYPE 2) DIABETES There are many health benefits to walking. The CDC also states that walking can help control weight and improve health.

Walking is one of the easiest ways to Besides increasing physical health, get the exercise you need, and almost walking also boosts mental health. A anyone can do it. Walking works for all survey by Mind, a charity in the Unitages, fitness levels, weights, and almost ed Kingdom, found that 83 percent of all health conditions. In fact the Cenpeople with mental health issues look ters for Disease Control (CDC) reports to exercise to help lift their mood.

Tina and Penelope Platt walk together on that more than 145 million adults now Jared, the Snow Canyon trail for beautiful family exercise. Getting active releases feel-good eninclude walking as part of a physically dorphins into the bloodstream, reactive lifestyle. Many doctors, exercise physiologists, ducing depression, stress and anxiety. Walking can and other experts stress that the key to reaping the also be a social activity. Joining a walking group or health and fitness benefits of physical activity is to meeting friends to walk and chat is a great way to choose a regular, moderate exercise program that banish feelings of isolation and loneliness. you enjoy and can stick with for life. While there are Now we know that walking can increase our physical countless physical activities out there, the American and mental health, but what about those of us who Heart Association states that walking has the lowest are looking to lose weight? If you’re trying to lose dropout rate of them all. weight, you need to burn more calories a day than Research has shown that the benefits of walking for you’re eating. Putting one foot in front of the other is at least 30 minutes a day can help you: one of the easiest ways to do that.

F O R E D WA R D D E N N I S ,

A 32 YEAR OLD ST. GEORGE RESIDENT, A WALK WAS ALL IT TOOK TO GET HIM MOVING TOWARDS A HEALTHIER LIFE.

«

In December, 2011 I was asked to go on a walk with a friend of mine. At that point in my life I weighed over 300 pounds and was starting to really struggle with my health. Sleepless nights, joint pain, and waves of depression were a very common thing for me then. We had planned to walk up to the water tower near the Green Valley Gap. We started going up hills and that was when I came to the realization of how bad my health had become. Not even halfway up the first hill I was winded and in pain. I pushed through the trek and had the opportunity to discuss health and nutrition as we went.

By the time I was done I knew, without a doubt, that something had to change. I sought out help and discovered that the key to weight loss was 80% nutrition, 20% exercise, and 100% mindset. So with months of personal development, forming new dietary habits, and incorporating healthy supplementation on top of going for walks and hikes I was able to lose over 110 pounds. My life is not what it was the first time I went for that walk. I am not the same overweight, scared person. And it all started with going for a walk.

» SWUHEALTH.ORG

21

the sudden release of energy stored in the rocks below the surface, radiating from a fault along which movement has just taken place.

how often do major earthquakes occur in the world?

magnitude

while here in

UTAH we

damages

8.0+ 7-7.9

total community destruction

6-6.9 5-5.9 4-4.9

badly damages average buildings with fatalities

3-3.9 2-2.9

often felt with minor damage

destroys well built structures

strong vibrations with damage to weaker structures widely felt and cracks plaster

not even felt but charted

700 QUAKES 2% ARE FELT a year but only

average

which leaves utah with a

avg. frequency per year 1 15 134 1,319 13,000 130,000 1,300,000

6+

MAGNITUDE

EARTH QUAKE

: a trembling or shaking of the ground caused by

every year...

in other words, we live in earthquake country!

“LARGE EARTHQUAKES ARE POSSIBLE ANYWHERE IN UTAH, BUT THEY ARE MOST LIKELY IN A ‘SEISMIC BELT’ ABOUT 100 MILES WIDE EXTENDING NORTH-SOUTH ALONG THE WASATCH FRONT AND THROUGH RICHFIELD TO CEDAR CITY AND ST. GEORGE.”

BEAVER IRON

beaver

2/7/2013

ENOCH: MAG 3.7 parowan

GARFIELD panguitch

IRON SPRINGS: MAG 3.8

8/8/2010

4/11/2012

TROPIC: MAG 4.3

cedar city

KANE WASHINGTON 9/2/1992

kanab

CEDAR CITY: MAG 4.1

4.5 -4.9

fault line age:

FREDONIA: MAG 5.6 7/1959

DROP

EARTHQUAKES DON’T INJURE OR KILL PEOPLE; BUILDINGS AND FALLING OBJECTS DO. DO NOT ATTEMPT TO USE THE STAIRS OR AN ELEVATOR OR RUN OUT OF THE BUILDING. DROP.

COVER

IF YOU ARE INDOORS WHEN YOU FEEL THE GROUND START TO SHAKE TAKE COVER IMMEDIATELY UNDER A TABLE OR STURDY PIECE OF FURNITURE, PLACING A BARRIER BETWEEN FALLING OBJECTS AND YOURSELF. COVER.

22

3.5 -3.9 4.0 -4.4

5.5 -5.9

1/4/2010

so what should I do?

HOLD

magnitude: (past 50 years)

5.0 -5.4

WASHINGTON: MAG 5.6 st. george

5 COUNTY MAP KEY

IF YOU TAKE COVER UNDER A STURDY PIECE OF FURNITURE, HOLD ON TO IT AND BE PREPARED TO MOVE WITH IT. HOLD THE POSITION UNTIL THE GROUND STOPS SHAKING.

HOLD.

< 15,000 years < 130,000 years

CRIBS SHOULD BE PLACED AWAY FROM WINDOWS AND TALL UNSECURED BOOKCASES AND SHELVES THAT COULD SLIDE OR TOPPLE- INSTAL BUMPERS OR PADS TO PROTECT FROM SHAKING.

USE STURDY TABLES TO TEACH CHILDREN TO DUCK, COVER AND HOLD. WALK THROUGH EACH ROOM OF YOUR HOME TO PRACTICE AND DRILL SAFE AREAS SUCH AS DESKS, DOORWAY AND TABLES.

PRE-ARRANGE TO HAVE A “PREPAREDNESS BUDDY” CALL YOU IMMEDIATELY AFTER AN EARTHQUAKE. KEEP A LIST OF MEDICATION AND IMPORTANT DOCTOR AND FAMILY #S VISIBLY CLOSE. PLACE SECURITY LIGHTS AND WALKING AIDS IN EVERY ROOM.

KEEP PET ID UP TO DATE. DO NOT TRY TO HOLD ONTO PET DURING SHAKING, ANIMALS INSTINCTIVELY PROTECT THEMSELVES. KEEP OUTDOOR PETS INDOORS UNTIL THE AFTERSHOCKS HAVE SUBSIDED AND PETS ARE CALM.

for more information and references

QUAKE.UTAH.EDU / EARTHQUAKES.USGS.ORG BEREADY.UTAH.GOV / SEIS.UTAH.EDU H E A L T H | S U M M E R 2 014 copyright©2014 southwest utah public health department

DO YOU WANT TO GIVE YOUR FAMILY, BUSINESS, OR SCHOOL A CHANCE TO PRACTICE WHAT TO DO IN CASE OF AN EARTHQUAKE? PARTICIPATE IN THE 3RD ANNUAL " GREAT UTAH SHAKEOUT” DRILL.

04.17.14 REGISTER NOW AT SHAKEOUT.ORG/UTAH

PROTECT

W H AT ' S I N T H E WAT E R ?

Robert Beers

Robert Beers EnvironmentaL Health Scientist and Division Director for the Southwest Utah Public Health Department.

R

ecreational swimming in southwest Utah is big business. Many visitors to this region include swimming as a big part of their vacation plans. Most hotel operators recognize that many of their guests consider the swimming pool and spa amenities a high priority when selecting accommodations. A good share of our residents, drawn to live or retire in this area because of the warmer climate, prefer apartments, condominiums, and neighborhoods where swimming pools are available. As a result, the Southwest Utah Public Health Department permits over 600 swimming pools and spas at more than 300 facilities throughout the five-county region; including Beaver, Garfield, Kane, Iron, and Washington counties.

Public swimming pools (basically any pool used by four or more families) are protected by regulations requiring pool operators to test pools and spas monthly for coliform bacteria and E. coli. In the past, the only lab that routinely accepted these samples from the public was located at Southern Utah University in Cedar City, which required many pool operators to travel long distances to deliver samples. In response, the health department decided to create its own water lab, which opened in September 2013.

THE NEW WATER LAB, HOUSED AT THE HEALTH DEPARTMENT’S ST. GEORGE OFFICE, IS CERTIFIED TO PERFORM BACTERIAL TESTING ON WATER SAMPLES AND IS AT A MORE CONVENIENT LOCATION FOR MOST OF THE DISTRICT’S POOL OPERATORS. The new water lab, housed at the health department’s St. George office, is certified to perform bacterial testing on water samples and is at a more convenient location for most of the district’s pool operators.

Operators of drinking water systems are also required by state and federal regulations to test monthly for bacteria. Contamination can occur during scheduled maintenance, if improper connections are made to the system, if water treatment measures are inadequate, or when water lines break. Routine sampling allows operators to verify that water purification and delivery methods are safe and functioning.

While operators of drinking water systems have sampled their systems for years, many swimming pool owners have not. Health department records indicate that approximately 70% of swimming pools and spas have not conducted required bacteria testing. Pool operators are now able to easily submit samples to the new health department water lab, which will also begin offering sample collection pickup services in Washington County in 2014. This service may be available in other counties at a later date. Most people understand that potentially harmful bacteria can be present in lakes, streams, and other

recreational bodies of water. They might wonder how bacteria can grow in swimming pools and spas where disinfectants, usually chlorine, are used to treat the water.

Despite treatment, 10% of the pools that have conducted regular bacteria testing find coliform bacteria in their samples. Chlorine is only one of several chemicals used to treat pools and spas and if any one of these chemical levels is too low or too high, bacteria can become a problem.

Operators need to check pH, alkalinity, hardness, and cyanuric acid levels, to name a few.

When properly balanced, these chemicals interact to prohibit bacterial growth. Testing through a water lab can alert operators when there’s a problem so they can take action to prevent the spread of water-borne disease.

Although the water lab serves public drinking water systems and swimming pools, samples from private water sources and pools can be submitted for analysis. The Southwest Utah Public Health Water Lab accepts samples Monday through Thursday from 8:00 a.m. to 3:00 p.m. This schedule may vary depending on holidays. Any questions, including those about sample collection procedures, can be answered by calling the lab at (435) 986-2580.

18 month old Jayda's first time playing at a pool. in St. George, Utah

SWUHEALTH.ORG

23

Z E R O FATA L I T I E S Cambree Applegate

photo credit @ Harrach Glass

Cambree Applegate Health Educator for the SWUPHD & an adjunct professor at Dixie State University.

THE ROAD TO ZERO FATALITIES BEGINS WITH THE RESPONSIBILITY THAT WE ALL ASSUME EVERY TIME WE GET INTO A CAR AND TURN THE KEY.

A

ccording to the Utah Department of Health, 49,256 crashes occurred on Utah roads in 2012. 33,984 people were injured in those crashes and there were 217 deaths.

"Zero Fatalities" is a united effort in Utah to save lives on our roads. In polling across the state, we find that most people do not actually think that this is an achievable goal.

If you find yourself in this group of people, try asking yourself this question: “How many fatalities are acceptable to

24

H E A L T H | S U M M E R 2 014

me among my friends and family?” When asked from that perspective, the answer is always zero. If all of us have the individual goal of having Zero Fatalities, couldn’t that easily become a statewide objective?

The road to Zero Fatalities begins with the responsibility that we all assume every time we get into a car and turn the key. We each expect other drivers to do their part to follow the laws designed to safely get us from one place

PROTECT to the next. You expect me to stay in my lane, to not text while driving, and to stop at each stop sign. I expect the same from you.

To help educate soon-to-be drivers and remind those who have been driving for awhile, Zero Fatalities has partnered with the Southwest Utah Public Health Department to offer a presentation geared towards high school drivers-ed students and their parents. This presentation emphasizes preventing

the five deadliest behaviors that take place on Utah’s roads. As we all know, it is dangerous or careless driving behavior on the roads that is killing people, not the roads themselves.

These five behaviors are: 1.

2.

3.

4.

5.

DROWSY DRIVING DISTRACTED DRIVING AGGRESSIVE DRIVING IMPAIRED DRIVING NOT BUCKLING UP

The first four behaviors are things you should avoid doing to keep from getting in a crash in the first place. Buckling up is something you can do to decrease the chance of serious injury in case you get in an accident. Over the next five issues, Health magazine will feature stories of accidents that have occurred in our area involving each of the five deadly driving behaviors.

W E ' L L STA R T W I T H T H E I M P O R TA N C E O F B U C K L I N G U P :

MY NAME IS SHALYCE My name is Shalyce and I had never been in a car crash until a couple of months ago. I had always considered myself to be a good driver, but there is something that we often forget as good drivers; that no matter how many traffic laws and “rules of the road” we obey, there is still that uncontrollable probability of being in an crash.

I remember hearing somewhere that the majority of car crashes happen within a few miles of your home. In my case, it was less than a mile. I was the front passenger of a car that was driving west on Brigham Road in St. George, towards I-15. A semi-truck that had recently exited the freeway was making a left hand turn into a gas station. The driver of the semi had underestimated

the amount of time needed to cross over our two lanes into the gas station, causing the road to be completely blocked by his trailer.

Because of a concussion resulting from the crash, I don’t remember hitting the semi, I don’t remember having to be cut out of the car by the fire department, and I don’t remember my ride to the hospital in the ambulance.

That night I went home with stitches in my forehead and my right wrist broken. These are minor injuries in comparison to the ones I could have suffered if I hadn’t been wearing my seatbelt, something I fortunately remember to do on a regular basis!

If you are interested in getting the Parent Drivers Ed Program into your school or if you have a story to share about a car accident you or a loved one were involved in, please contact Cambree Applegate at 435-865-5151 or cjohnson@swuhealth.org.

SWUHEALTH.ORG

25

T H E B U D DY SYST E M Ashley Chamberlain

Ashley Chamberlain Former Health Educator for the SWUPHD. She is now a school counselor for Valley High in Kane County and a graduate student in psychology at Utah State University.

A C O M M U N I T Y I S J U D G E D D U R I N G A D I S AST E R BY W H AT W E D I D TO TA K E C A R E O F T H O S E W H O C A N ' T TA K E C A R E O F T H E M S E LV E S .

It is said that a society is judged by how it cares for it’s most vulnerable. Disasters have often revealed underlying weaknesses and severe shortcomings in how a country operates. Widespread media coverage throughout the aftermath of Hurricane Katrina showed America that its disaster response was sorely lacking in its capabilities to care for the young, the elderly, and the disabled. Since then, significant progress has been made, but much still remains to be done.

ability to receive and act upon critical, lifesaving information.

Recent natural disasters and tragedies are reminders that such catastrophes have the potential to devastate all of us, but they are especially serious threats to older Americans and people with disabilities.

In New Orleans, after Hurricane Katrina, people confined to wheelchairs were awaiting rescue or evacuation. Many nursing homes had inadequate evacuation plans, leaving residents to fend for themselves. News media publicized the aftermath extensively, and according to AARP, an estimated 1,330 people, many of whom were elderly, were killed as a result of Hurricane Katrina. In Louisiana, roughly 71 percent of the victims were older than age 60, and 47 percent of those were over age 75. Most of these victims died in their homes and communities, and at least 68 were found in nursing homes.

Unfortunately, vulnerable populations have traditionally been left behind in disaster preparedness and response. This group can include the very young, the elderly, immigrants, refugees, and others who may otherwise be disadvantaged physically, linguistically, socially, or economically. The elderly or people with disabilities can face challenges when it comes to physical mobility and their

“These catastrophic events have taught us that we have to pay greater attention to evacuating, identifying, and ensuring the safe return of the thousands of frail older adults living on their own or in care facilities,” says Bill Novelli, AARP Chief Executive Officer. “Much of the suffering and loss was undoubtedly preventable, and it must not be allowed to happen again.”

26

H E A L T H | S U M M E R 2 014

“Older Americans and persons with disabilities face several unique challenges in disasters,” Novelli points out. “Many have limited mobility, cope with chronic illnesses, and depend on medications for survival. Those whose homes were destroyed not only lost a place to live, but their largest retirement security as well. Others suffered tremendously because they were evacuated too late, couldn’t access needed resources, or simply slipped through the cracks.”

What impact would preparedness and warning systems have had in reducing fatalities if they addressed the specific needs of people with disabilities? If our neighbors who are considered vulnerable are not incorporated fully into our planning process, then the best evacuation scenarios will not aid them.

The Southwest Utah Public Health Department has developed a program through its Emergency Preparedness Division to address this issue. The “Preparedness Buddy” program, piloted in Kane County, has had a very successful start and is based on the belief

PROTECT that educating at-risk populations is key to their survival.

The Preparedness Buddy program is specifically developed for the elderly and vulnerable in mind. It compliments and incorporates the “Plan 9” program, which details the nine items that every household should have on hand in the event of a disaster.

The Preparedness Buddy program starts when educators visit home-bound residents and use the Plan 9 information to teach them about basic emergency preparedness, adapting the message to their individual situation. After their needs are assessed and recorded, each resident is asked to choose a Preparedness Buddy to share the information with and check on them in the event of an emergency, disaster, or public health threat.

The designated person is then notified and is provided with the pertinent information provided by the vulnerable person. Special medical equipment, life sustaining medica-

tion, and continuing needs are recorded in the plan. The final goal is that, in the event of a disaster, each home-bound resident will be checked on and accounted for and has someone to help them safely evacuate if needed.

Paulette Valentine, Director of Emergency Preparedness for the Southwest Utah Public Health Department says, "The importance of a prepared community is vital in the world today. Being a resilient community is more than just having preparedness items, though that is important, it also is knowing what to do in an emergency and acting appropriately.

It is being willing to help others, share with others and care for those around us. The value of the "Preparedness Buddy" program is individual preparedness responsibility paired with our responsibility to care for the vulnerable people in our own neighborhoods. A community is judged during a disaster not necessarily by what everyone did to respond, but what we did as a community to take care of those who can't take care of themselves.

The elderly and disabled are at the top of this list."

Craig Hansen, director of the Kane County Senior Center and Care and Share, along with the health department, facilitated the “Meals on Wheels” program to contact homebound residents and provide Preparedness Buddy education in Kanab. Plans to take the program to the outlying areas of Kane County are in the works and implementation in other counties will be underway throughout 2014.

“We remind those we visit that it is their responsibility to be prepared, not the government’s,” says Valentine. “Past natural disasters have taught us that it often takes anywhere from 72 hours to two weeks for help to come. One-on-one, in-home education is the key to the success of this program. Anyone has the capability to work toward being more prepared, even those who are in need of extra assistance.”

choose your preparedness buddy. fill out the important information below. save it. be prepared.

personal emergency plan YOU CAN DO THIS, JUST CHECK OFF THE BOXES.

Now write down any MEDICATION you need to sustain life.

Do you have someone who could check in on you if an emergency happened?

WHO IS IT?

What medical EQUIPMENT would you need in case of an emergency evacuation?

What else does your buddy need to know?

What is the PHONE NUMBER(s) of your buddy?

Thank you for being prepared!

This plan will help others (including first responders) to better assist you in the event of an emergency.

SWUHEALTH.ORG

27

A N N U A L R E P O R T 2013 The Southwest Utah Public Health Department (SWUPHD) serves the 210,000 residents of Washington, Iron, Kane, Beaver, and Garfield counties. Our mission is to protect the community's health through the promotion of wellness and the prevention of disease.

BOARD OF HEALTH Co mmis s ioner J ame s E ardley » w ashington c ount y

L in da Ride r

» w ashington

c ou nt y

Co mmis s ioner D ale Brin k e rhoff » i ron cou n ty

D r. C layton Pe tty » iron c ou nt y

Co mmis s ioner Jim Mats on » kane c ou nt y

Ros alind Metcalf

» kane

co unty

Co mmis s ioner Mark Whitn e y » b e ave r c ount y

Ke nn e th E lme r

» b e ave r

Nick Reynolds

28

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

ASHLEY STARR

Ashley Starr opened the fist Bountiful Baskets site in Southern Utah in September 2009 after hearing about the Arizona-based produce co-op. Bountiful Baskets is an all-volunteer effort which has provided fresh fruits and vegetables to thousands of local residents, often at a significant discount. As the program's popularity spread, Ashley accepted the position of Volunteer Area Coordinator and began training new site coordinators to find and open sites in their own communities. Ashley donated her time for 3 years to maintain and troubleshoot 45 Bountiful Baskets sites in 7 Utah counties, involving 270 volunteers assembling up to 2250 baskets a week.

MIKE MCGARY

Mike McGary is a well-known radio personality on KDXU (AM 890). He invites Dr. Blodgett to join his hour-long call in show, Open Mike, on the first Wednesday of every month, in which the community can ask any question related to public health. He also facilitates the weekly "Public Health Update" radio spot on Wednesday mornings. This arrangement has allowed the health department to have a more familiar and trusted voice in the public opinion arena. Mike has been a good sport by getting his flu shot on the air every fall to promote vaccination efforts.

c ount y

Co mmis s ioner L eland Pollock » garf i e ld cou n ty

» g ar f ield

FRIE NDS O F P UBLIC H E A LT H

c ou nt y

H E A L T H | S U M M E R 2 014

DAN MCARTHUR

Dan McArthur has been mayor of St. George for the past twenty years. During that time he has been an avid supporter of physical fitness with the promotion of biking and walking trails, city parks, softball complexes, the World Senior Games, the St. George Marathon, Ironman Triathlons, and “Mayor's Walk” program. He has also been actively involved in supporting local air quality, healthy lifestyles, and immunizations.

SERVING OUR COMMUNITY NURSING SERVICES •Over 891 free TDAP vaccinations were given, immunizing adults against whooping cough and in turn protecting infants in their care.

•Over 4,329 travel-related immunizations were given to people going to foreign countries for vacations, business, humanitarian, and mis sionary work.

•4,639 doses of vaccines for children were administered.

•Over 12,876 doses of adult vaccines were administered.

•770 home visits for the Baby Your Baby program were made.

•Over 17,000 service encounters for WIC (Women, Infants & Children) occurred.

ENVIRONMENTAL HEALTH •876 consultations for wastewater systems were given.

•541 Pool/spa inspections done.

•1,305 food service inspections were completed.

•151 Temporary food service permits were granted.

•4,562 food handler cards approved.

•Renewal of FDA grant to improve inspection quality and reduce food-borne illness.

•Approval and building of water lab (see page 23)

EMERGENCY PREPAREDNESS •113 Medical Reserve Corps volunteers trained, over 400 now registered.

•120 community emergency preparedness presentations, trainings, and drills held; over 4,200 participants.

•182 local partner agencies, facilities, and busi nesses have agreements in place to assist in the distribution of medication, vaccine, or supplies in the event of an emergency.

VITAL RECORDS •6,270 birth certificates issued •2,033 death certificates issued •11,437 additional copies of certificates issued

HEALTH PROMOTION •For details in this catergory, see next page (29)

HEALTH PROMOTION DIXIE STATE UNIVERSITY GOES TOBACCO FREE With a unanimous vote by the trustees, Dixie State University became the first public institution of higher education in Utah to adopt a policy making its campus tobacco free; joining thousands of other campuses nationwide to restrict tobacco use on campus. Staff from the Southwest Utah Public Health Department worked closely with the student senate, campus administration, and the trustees to support this effort.

While most tobacco users start using before they are college age, regular use and addiction typically set in during the young adult years. “It was important for us to support an effort like this,” said Jordan Mathis, Director of SWUPHD Health Promotion. “These measures have a marked impact on not only secondhand smoke exposure, but also on the perceptions of use, and actual use of tobacco itself.” In fact, a study published in the Journal of Preventive Medicine in 2011 found that students exposed to a smoke-free campus policy demonstrated significant favorable changes in smoking behavior , perceptions of peer tobacco use, and smoking norms compared to students on the control campus.

Department staff are working closely with campus staff to offer cessation services and support to tobacco users on campus who may be spurred to quit as a result of the policy. “It is important that the policy work to support these individuals, not merely isolate them.” Mathis concluded.

BUS STOP SIGNS The Washington County Youth Coalition (WCYC) worked with the City of St. George and SunTran to protect mass transit riders from the harmful effects of secondhand smoke; by posting signs at bus stops, to make riders aware of city ordinance restricting smoking at all bus tops. “Without the signs no one was really aware that there was even an ordinance in place to protect them,” said Kaysha Price, SWUPHD advisor for the coalition. In a coordinated effort with SunTran officials, the WCYC was able to hang 60 additional signs throughout St. George.

CAR SEAT EDUCATION Unintentional motor vehicle crashes are the third leading cause of injury deaths in the five counties. Children, due to their size, are often the most vulnerable to injury and death in a crash. For this reason the SWUPHD has continued to offer one of the best child passenger safety education programs in the state. This program is offered free to the public.

INDIVIDUALS EDUCATED : 211 | CAR SEATS CHECKED: 181 | CAR SEATS DISTRIBUTED: 94

SWUHEALTH.ORG

29

ANNUAL REPORT DISEASE SURVEILLANCE

PERTUSSIS UPDATE

The SWUPHD is responsible for tracking and taking appropriate action on 77 “reportable” diseases, ranging from influenza resulting in hospitalization to potential bioterrorism agents. In 2013, 32 of these diseases (1,440 total cases) were reported to our health department. Although many of these illnesses are serious, our overall disease rates remain low when compared to the rest of the state and nation.

In 2012 the United States had the worst outbreak of pertussis in more than fifty years, with over 48,000 cases reported and 20 deaths. While most states, including Utah, reported a decrease in cases into 2013, southwest Utah has seen a steady increase, tripling the number seen in 2012.

TOP REPORTED DISEASES 381

CHLAMYDIA 135

HEPATITIS C (CHRONIC)

127

PERTUSSIS (WHOOPING COUGH)

INFLUENZA (HOSPITALIZED)

97

SALMONELLOSIS 34 CAMPYLOBACTERIOSIS

Pertussis is a vaccine-preventable disease. Infants take at least 18 months to become fully immunized, which is why everyone else in the home should be vaccinated to protect them. Adolescents and adults should get one booster shot (Tdap) and expectant mothers should get a booster with each pregnancy.

PERTUSSIS RATES IN SOUTHWEST UTAH

29 22

80

16

70 U TA H

COUNTS

GONORRHEA 15 PNEUMOCOCCUS 13

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

HEART DISEASE

294

ACCIDENTS

95

STROKE

91

CLRD*

40 30 20 10

YEARS

2009

2010

2011

2012

2013

REVENUE SUMMARY GRANTS PATIENT/CLIENT REVENUE COUNTY CONTRIBUTION TENANT REVENUE

76

ALZHEIMER'S

26.1%

56

SUICIDE

49

INFLUENZA & PNEUMONIA

45 34

COUNTS

KIDNEY DISEASE** 29 *Chronic lower respiratory disease (CLRD) includes chronic obstructive pulmonary disease, asthma, bronchitis, and emphysema. ** Kidney Disease includes Nephritis, nephrotic syndrome and nephrosis.

30

50

308

CANCER

DIABETES

SW U P H D

GIARDIASIS 12

60 R AT E P E R 100, 000

VALLEY FEVER GROUP B STREP

Pertussis, also known as whooping cough, is a contagious respiratory disease caused by the bacteria Bordetella pertussis. Sometimes called “the hundred-day cough”, this contagious respiratory disease develops into uncontrolled coughing fits which can cause sleeplessness, vomiting, even fractured ribs. Complications in children include pneumonia and occasionally inflammation of the brain. In rare cases (1 out of 200), pertussis can cause death, the highest risk group being infants.

H E A L T H | S U M M E R 2 014

22.4%

1% 50.5%

NON PROFIT ORG US POSTAGE PAID HURRICANE UT 84737 PERMIT # 15

@SWUpublichealth