Lung Cancer Awareness Month: Resources, Practices, and Policies for LHDs

lamar-hasbrouck-headshot-2015By LaMar Hasbrouck, MD, MPH, Executive Director, NACCHO

November is Lung Cancer Awareness Month, a time for local health departments (LHDs) to reflect on the burden of lung cancer in their communities, raise awareness about screening and prevention, and commit to efforts that prevent this deadly disease.

According to the American Lung Association, lung cancer is the leading type of cancer death among both men and women. It causes more deaths than colorectal, breast, and prostate cancers combined. This year alone, the American Cancer Society estimates that nearly 160,000 Americans will die from lung cancer.

Lung cancer also disproportionately affects minorities. The American Lung Association estimates that the age-adjusted lung cancer incidence rate among black men is 32% higher than for white men, even though their overall exposure to cigarette smoke, the primary risk factor for lung cancer, is lower.

Smoking is the number one risk factor for developing lung cancer. Smoking contributes to 80 to 90% of lung cancer deaths in women and men, respectively, according to the American Lung Association. Men who smoke are 23 times more likely to develop lung cancer; women are 13 times more likely, compared to people who never smoked.

NACCHO is dedicated to helping LHDs mitigate the devastating impact of lung cancer in their communities through effective resources, evidence-based practices, and sound policies that promote health and well-being.

Comprehensive Cancer Control
Comprehensive Cancer Control (CCC) consists of collaborative strategies to leverage community resources for cancer prevention, early detection, and treatment. Common CCC strategies focus on reducing cancer risk, promoting healthy lifestyles, ensuring access to screenings/diagnostic technologies, improving the quality of treatment, and expanding support services to enhance survivorship.

NACCHO’s CCC toolkit contains resources, tools, and tips that cancer prevention practitioners can use to promote effective CCC strategies. The toolkit supplements NACCHO’s Cancer Control Action Guide, based on a 2011–2012 assessment of cancer control in LHDs. The guide helps LHDs build and sustain local coalitions through seven different frames: capacity, stakeholder engagement, leadership, strategic planning, cross-coalition collaboration, visibility, and data and measurement.

Tobacco Control
NACCHO offers a variety of tobacco control programs and resources. The Chronic Disease Prevention Toolkit contains tobacco control tools on preemption, cessation, regulation, and funding. NACCHO’s board of directors has passed several policy statements that can help LHDs advocate for tobacco policies that support the health of their communities.

NACCHO has also developed positions on emerging tobacco products such as e-cigarettes and hookah, which are creating regulation challenges at the local, state, and national levels. NACCHO’s position statements encourage regulating e-cigarettes to the extent that the law allows for tobacco products.

LHDs in Action
According to NACCHO’s 2013 National Profile of Local Health Departments, 68% of LHDs provide population-based primary prevention services related to tobacco control.

The Kanawha-Charleston (WV) Health Department and the Kanawha Coalition for Community Health Improvement developed the Clean Living Environment in Appalachian Neighborhoods (CLEAN) initiative to lessen the mobility and mortality due to secondhand smoke, for which the health department won a NACCHO Model Practice Award in 2013.

In 2008, the health department instituted a comprehensive clean indoor air regulation. Many residents and business owners were opposed to the expansion of the clean indoor air regulation to bars and gaming establishments. To raise awareness of the importance of the regulation and gain public support, Kanawha-Charleston Health Department used the CLEAN initiative to develop a social marketing campaign highlighting the positive effects of the regulation. The campaign’s upbeat and positive message promoted the health benefits of avoiding secondhand smoke and encouraged the public’s continued patronage and support of smoke-free businesses.

In 2011, Ingham County (MI) Health Department won a NACCHO Model Practice Award for the program Building Effective Tobacco Treatment Services for Pregnant and Parenting Women. The program provided home-based smoking cessation education and support to pregnant and parenting women who smoke. The program delivered services using a relationship-based model of care and targeted low-income pregnant and parenting women who smoked and received services at the health department. The practice was strategically integrated into existing home-visiting services to ensure its sustainability. In just a few years, the program served more than 200 women.

NACCHO Resources
NACCHO has developed a variety of resources to help LHDs develop and implement programs to address the root causes of lung cancer in their communities.

NACCHO’s Local Comprehensive Cancer Control Website

Action Guide for Building Local Comprehensive Cancer Control Coalitions: Lessons Learned from Local Health Departments

Overview of Comprehensive Tobacco Control Strategies for Local Health Departments (issue brief)

Tobacco Policy Statements

Tobacco Webpage

Using the Roots of Health Inequity: An Interview with Public Health Nurse Jennifer Weitzel

Jennifer Weitzel, MS, RN

Jennifer Weitzel, MS, RN

By Tiffany J. Huang, MPH, Program Analyst, Assessment and Planning

NACCHO’s Roots of Health Inequity Web-based course offers a learning opportunity for public health practitioners, partners, and students to explore health inequities. How can local health departments use the course? We interviewed Jennifer Weitzel, MS, RN, a public health nurse at Public Health Madison & Dane County in Wisconsin, to hear about her health department’s experience.

How are you using the Roots of Health Inequity course in your health department?

Our health department hosts student interns from across disciplines and levels, from bachelor’s-level nursing students to doctoral students. Our largest cohorts are usually during the summer. While they are typically recruited to work on a particular project, we also engage them in additional activities that, until recently, I facilitated. For the past two summers, we’ve used the Roots course.

Because the interns were new to the health department, we used Units 3, 4, and 5 [on Public Health History, Root Causes, and Social Justice]. The students worked through the course on their own and posted on the online discussion boards. We then met every other week for in-person discussions on the unit content. These discussions were an informal opportunity to debrief face-to-face about what they learned and how it related to what they were experiencing in the health department and in their respective fields.

We also often bring in current events that may be applicable. For instance, last summer, the New York Times published an exposé on exploitation of workers in the New York City nail salon industry. We discussed the article in terms of what they had learned in the course about the intersections between racism, sexism, and class and how they were playing out in that particular setting.

I’m a huge advocate of the course, and I also use it outside of the health department in a university course I teach on population health and health policy.

What benefits have you seen from using the course?

The feedback from students both summers was very positive. The students said that it was very informative, particularly in providing a good grounding in the underpinnings of public health practice and the historical perspective—how public health started in social justice, activism, and policy work, then shifted to an individual-level focus rooted in the biomedical paradigm, and is now coming back full circle to its social justice roots.

Our goal is to prepare a competent public health workforce moving forward. This is something we hope can plant the seed in students and open them up to what addressing root causes means. Our hope is that by introducing these concepts here and seeing it in action at a local health department, they can take that forward in whatever setting they work in.

What recommendations do you have for other health departments interested in the course?

I would encourage them not to be intimidated by the volume of information. The course is very robust and contains so many activities, discussions, and supplemental readings. Go in and use the parts applicable to you, or take it in small pieces—don’t feel like you need to move through it at any particular pace. I would also recommend having smaller groups that stay constant over time. Because the course really gets at the root causes of health inequities, which can be difficult, sensitive topics, I think you need to build that trust within a group to have meaningful conversations moving through the course. So I would recommend small cohorts that participate online but have the opportunity to meet face-to-face with a facilitator who’s well-versed in equity discussions.

To learn more about NACCHO’s Roots of Health Inequity course, visit


American Diabetes Month: The Important Role of Local Health Departments

By Dr. Swannie Jett, NACCHO President and Health Officer for the Florida Department of Health in Seminole County

Diabetes is a growing burden in the United States, affecting the health and quality of life of millions of Americans. Local health departments (LHDs) across the country work with their communities to raise awareness about diabetes and its risk factors and to develop programs and policies that support diabetes prevention and control.

November is American Diabetes Month, an important time for LHDs to highlight their role in helping their constituents prevent, screen for, and effectively manage diabetes. “Eat Well, America!” is the theme of this year’s awareness month, sponsored by the American Diabetes Association. The theme highlights the important role diet and nutrition play in preventing and managing diabetes.

The Compounding Cost of Diabetes
According to the 2014 National Diabetes Statistics Report, more than 27 million Americans had type 2 diabetes in 2012. An additional 79 million adults are at risk of developing diabetes. Diabetes was the seventh leading cause of death in the United States in 2010; it is a major risk factor in the development of heart disease, stroke, kidney failure, non-traumatic lower-limb amputations, and blindness.

The American Diabetes Association estimates that the total cost of diagnosed diabetes in 2012 was $245 billion: $176 billion in direct medical costs and $69 billion in reduced productivity. One in every 10 healthcare dollars is spent treating diabetes and its complications.

What Local Health Departments Can Do
The Community Preventive Services Task Force recommends programs that jointly promote healthy changes in diet and increased physical activity for people at increased risk of type 2 diabetes. Many LHDs, including my own, have partnered with community-based organizations to implement diabetes prevention and management programs. My health department partnered with the YMCA of Central Florida to hold community events that provided free diabetes screening, education, and information.

During Food Day Week in October 2014, my health department’s School Health program collaborated with local stakeholders to develop the Pick of the Pantry cookbook. The cookbook showcases easy, healthy recipes that can be fixed with items obtained from a food pantry or farmers market. An informational booth with food samples from the recipe book were shared throughout the entire week.

Fellow LHDs have successfully implemented the Stanford University Patient Education Research Center’s Diabetes Self-Management Program and the Centers for Disease Control and Prevention’s National Diabetes Prevention Program.

This year, Panhandle Public Health District in Nebraska won a NACCHO Model Practice Award for its implementation of the National Diabetes Prevention Program. The effort aimed to recruit and train individuals within partner organizations to deliver the evidence-based lifestyle change intervention; raise awareness about diabetes risk factors and the availability of the program; facilitate relationships between partner organizations delivering the program and referring clinical partners; and develop a healthcare provider protocol or algorithm to facilitate referrals into the program. The program was successful in several ways; perhaps most notably, every dollar the health district spent on the program in the startup phase and the first year resulted in $28 in benefits.

The Nassau County (NY) Department of Health also won a 2015 Model Practice Award for its efforts to promote better nutrition by developing and distributing a cookbook with healthy recipes. The cookbook contained recipes that used fresh ingredients and minimal salt, fat, and sugar. The health department also worked with a local community farmers market to promote the recipes and offer samples.

NACCHO has also developed a toolkit to help LHDs bill for and sustain diabetes self-management programs. The toolkit highlights the North Carolina Diabetes Education Recognition Program and shows how Wilkes County Health Department, one of the LHDs involved in the program, established a billing program. It also contains resources that LHDs can use to develop reimbursement models and better understand how the Affordable Care Act impacts diabetes services.

LHDs can also advocate for policies that address the root causes of diabetes. NACCHO has several relevant policy positions that LHDs can adapt on issues such as healthy community design, comprehensive obesity prevention, healthy food access, and menu labeling.

NACCHO encourages LHDs to use American Diabetes Month as an opportunity to raise awareness and continue the innovative, effective programs that are addressing the burden in their communities. Together, we can successfully reduce the incidence and impact of diabetes.

Additional Resources
NACCHO Toolkit: Billing and Reimbursement for Diabetes Self-Management: A Local Perspective

NACCHO Policy Positions

Local Health Departments’ Capacity to Prevent and Control Diabetes in Priority Populations (research brief)

NACCHO Supports Local Health Departments Funded by the CDC’s State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke Program (fact sheet)

Chronic Disease Model Practices Case Study: Jefferson County Health Department Successes in Diabetes Prevention (case study)

NACCHO Exchange: Chronic Disease (Summer 2015)

American Diabetes Association Facts

American Diabetes Association – Diabetes Fast Facts

American Diabetes Month resources

Using Triple P as a Model to Engage Communities and Prevent Child Maltreatment

By Calondra Tibbs, MPH, Senior Director, Safe and Healthy Families, NACCHO

Positive relationships between caregivers and children play an important role in the health and well-being of children throughout their lives. Establishing safe, stable, and nurturing environments and relationships and limiting exposure to adverse experiences (e.g., trauma, abuse, and neglect) can potentially reduce poor health outcomes and behaviors in a child’s adolescent and adult lives.1 The Adverse Childhood Experience (ACE) Study demonstrated that increased exposure to maltreatment can increase risk for alcoholism and alcohol abuse, illicit drug use, liver disease, smoking, unintended pregnancies, and chronic obstructive pulmonary disease.1 Continue reading

Congress Should Support Fund that Prevents Disease and Saves Lives

lamar-hasbrouck-headshot-2015The following article was originally published in The Hill. View the original article

By LaMar Hasbrouck, MD, MPH

In 1736 Benjamin Franklin said “an ounce of prevention is worth a pound of cure.” In 2010 Congress followed this wise advice and created the Prevention and Public Health Fund (PPHF), which has invested nearly $5.25 billion to prevent people from falling victim to infectious and chronic diseases that are the leading causes of disability and death in the United States.

It’s hard to imagine anyone wanting to end this valuable life-saving initiative, but that’s exactly what’s happening today. The PPHF is threatened with elimination by some in Congress who want to shut down the fund in a misguided attempt to save money. Continue reading

National Depression and Mental Health Screening Month Provides Opportunities for Local Health Departments

By Dr. Swannie Jett, NACCHO President and Health Officer for the Florida Department of Health in Seminole County

The issue of mental illness was thrust into the national spotlight on Oct. 1, when a gunman killed nine people at a community college in Oregon, drawing worldwide media attention. Far less attention is paid to the millions of people in communities across the United States who experience mental illness and never resort to violence. However, it’s important that they get public attention and the attention of local health departments as well. Continue reading

Congress to Decide Funding for Public Health Emergencies

The following article was originally published in Domestic Preparedness. View the original article here.

lamar-hasbrouck-headshot-2015By Dr. LaMar Hasbrouck, MD, MPH, Executive Director, NACCHO

Federal spending on public health emergency preparedness, response, and recovery has been falling since 2005, and Congress is now considering how much to spend in the 2016 fiscal year. The final spending figure will play a key role in determining how well the American people are protected from disease, injury, and death in times of emergency. Continue reading