Category Archives: community health

NACCHO Book Club: Dreamland—The True Tale of America’s Opioid Epidemic

By Emily Yox, MPH, Global Health Program Analyst, NACCHO

Each month, NACCHO will bring you a new public health book, read and reviewed by NACCHO staff. We hope to provide a well-rounded reading list that you will find enjoyable as well as informative.

Our first recommendation, Dreamland: The True Tale of America’s Opioid Epidemic, by Sam Quinones, was published in 2015 and received many accolades for the way in which the author intertwines the multiple narratives that fit into the U.S. opioid overdose epidemic. He tells stories of epidemiologists, big pharma, entrepreneurial drug dealers, and people in recovery to showcase the different perspectives of the addiction crisis in the United States. It is clear that the book was painstakingly researched but is very well written and hard to put down. Continue reading

From the Field: Strategies to Increase Hepatitis C Screening and Linkage to Care through SSPs

By Nicole Miller, MSN, RN; Lela Riherd, BSN, RN, CIC; Zac Doobovsky, BSN, RN, CIC; and Harp Cheema, BSN, RN, Whatcom County Health Department (WA)

This post originally ran in NACCHO’s Healthy People, Healthy Places Blog.

The Centers for Disease Control and Prevention (CDC) estimates nearly 2.4 million Americans are living with the hepatitis C virus (HCV), with transmission via injection drug use being the most common mode of HCV acquisition. In Washington State, there has been a 126% increase in newly acquired HCV infections between 2013 and 2017 that is linked to the opioid crisis. In 2018, Whatcom County had approximately 13 acute HCV cases and 306 chronic HCV cases, an increase from 4 acute and 241 chronic in 2017. On July 26, 2019, in response to these increasing numbers, Washington Governor Jay Inslee launched the Hep C Free Washington Plan to Eliminate Hepatitis C in Washington State by 2030, expanding upon a 2018 proclamation calling for a coordinated strategy between state and local public health agencies, tribal governments, and other partners to eliminate hepatitis C.

Expanding prevention and screening services and increasing access to treatment are critical to Washington’s efforts to eliminate hepatitis C, yet many barriers exist for people who inject drugs (PWID) when trying to access care and needed services. Opioid misuse is a complex issue that requires a multifaceted, collaborative approach across disciplines and agencies. The Whatcom County Health Department (WCHD) is working to expand its Syringe Services Program (SSP) and Adult Health Clinic services to address the hepatitis C challenges. By expanding our services, we hope to provide our clients with the resources they need to make informed decisions regarding their health and to encourage testing and treatment for people who are living with hepatitis C.

Syringe Services Program

SSPs are shown to be safe, effective, and play an important role in reducing the transmission of viral hepatitis and other infections. The WCHD SSP is a community-based prevention program that can provide a range of services, including access to clean syringes, safe disposal of syringes, testing for infectious diseases, and linkage to treatment services. Hepatitis A and B vaccines are also available.

The WCHD started its SSP to combat the disease transmission of HCV, HIV, and other infectious diseases among PWID. The number of participants served has increased fourfold since 2009, from 219 unique participants to 881 in 2018.

Participants in our SSP reported stigma as the most common reason for avoiding medical care. We work towards a no-judgment approach to help build a trusting relationship with our clients, which is crucial in the participant’s road to change and healthy outcomes.

The increasing number of unique participants has forced our SSP to change what we ask our clients, how we test, when we test, clinic flow, and how we provide follow up services and referrals. We made changes to our dialogue with clients to facilitate a more engaging conversation and achieve a positive rapport. Our clinic flow is set up to create a safe comfortable space that allows for point of care testing in all of our exchange rooms. Clients often reported time restrictions as a barrier to testing and this change has helped us to provide testing and results in a more timely manner to meet client needs.

A standing order was approved to draw confirmatory HCV RNA testing for any of our clients that are reactive for the point of care HCV antibody test or who have received a reactive test with us in the past with no additional follow up or linkage to care. By providing confirmatory testing we can help clients document chronic HCV and initiate treatment sooner. Clients are more likely to be compliant with care if services can be provided in one centralized location.

SSPs are a tool that can help reduce transmission of viral hepatitis and other infections as well as serve as a bridge to other healthcare or treatment services. Program participants have reported that our services decrease needle reuse and sharing. This in turn helps to reduce disease transmission in our community.

Linkage to Care

Follow-up testing and linkage to care is essential for clients with a new diagnosis, but understanding the next steps for follow-up can be challenging. Our SSP program staff met with a local community health clinic about the potential to expedite referrals that screen reactive to HCV at our SSP. We worked on creating a process that ensured the appropriate testing and linkage to care happened in a timely manner. The community health clinic created a flow sheet, standing orders for HCV testing, and signed a Memorandum of Understanding (MOU) for this process. This MOU allows expedited referrals for better client outcomes.

Continue reading

CHOICES Learning Collaborative Partnership Announces New Opportunity to Develop Effective Strategies to Prevent Childhood Obesity

The CHOICES Project at the Prevention Research Center on Nutrition and Physical Activity at the Harvard T.H. Chan School of Public Health will be accepting applications beginning on August 1 for state and local health agencies to apply to participate in the CHOICES Learning Collaborative Partnership (LCP).

Over the past four years, the CHOICES team has fostered Learning Collaborative Partnerships with 15 state and local health agencies throughout the United States, with Philadelphia, Denver, San Antonio, Salt Lake County, Allegheny County, Detroit, and Houston taking part. The CHOICES LCP presents an opportunity for health agencies representing populations of 500,000 or more to receive funding, training, technical assistance, and locally tailored data to help decision-makers understand and use data on health and cost impact to identify best value for money strategies to prevent childhood obesity. Continue reading

Homelessness Among Individuals with Disabilities: Influential Factors and Scalable Solutions

By Erin Vinoski Thomas, MPH, CHES, Health and Disability Fellow, NACCHO; and Chloe Vercruysse, MBA

This post originally ran in NACCHO Essential Elements blog.

People experiencing homelessness lack sustainable access to housing and instead turn to emergency shelters, transitional housing, or places not meant for overnight residence. In the Unites States on a single night in January 2018, 552,830 people experienced homelessness; between 2.5 and 3.5 million people experience homelessness over the course of any given year. Housing is an important determinant of health, and those who experience homelessness are at greater risk for health challenges. Continue reading

Big Data Offers Big Insights into Links Between Environment, Heart Health

By Dr. Cavin Ward-Caviness, Principal Investigator (Computational Biologist), U.S. Environmental Protection Agency, ORD, NHEERL, EPHD, CRB

This post originally appeared on the EPA blog.

Air Quality Awareness Week, April 29–May 3, is a perfect time to think about how far we have come in understanding how air pollution affects the cardiovascular system. As a U.S. Environmental Protection Agency (EPA) scientist studying heart disease, I am very excited about current and future research in this area. Though the burden of heart disease on our society remains high (see the American Heart Association 2018 Statistics on Heart Disease and Stroke), we have only to look at the promising lines of current, cutting-edge research to find reasons to be optimistic about the progress we are making in our understanding and treatment of heart disease. Continue reading

NACCHO CEO Releases Statement on Ongoing Measles Outbreaks

By Lori Tremmel Freeman, NACCHO CEO

“Yesterday, the Centers for Disease Control and Prevention confirmed there have been 626 individual cases of measles diagnosed across 22 states in the United States since the first of this year. We are on track to have the highest number of measles cases in the United States in 25 years, and for man this disease of the past is becoming a threat of the present.

“626 cases are far too many. These cases are not just numbers—they represent sick children, missed days of work, and an incredible financial strain on our tax dollars that must be pulled away from other public health priorities. Continue reading

NACCHO Highlights Need for Greater Support for Local Health Departments to Combat Rise in STDs

STD Awareness Month is an opportunity to raise awareness about Sexually Transmitted Diseases (STDs), also referred to as Sexually Transmitted Infections (STIs), with local health departments and with local and national policymakers, stakeholders, and the public. The National Association of County and City Health Officials (NACCHO), the voice of the nation’s nearly 3,000 local health departments is working diligently to support their members’ work to address rising STD rates across the country and to implement innovative projects, such as its Express STI Visits Initiative, to provide new ways to link individuals to testing and treatment. Continue reading