Housing as a Platform for Health and Equity

Recently in the American Journal of Public Health, Diana Hernández PhD, and Carolyn B. Swope MPH, assess the current state of research on housing and health disparities, and share recommendations for achieving opportunities for health equity centered on a comprehensive framing of housing.

The links between housing and health are now known to be strong and multifaceted and to generally span across 4 key pillars: stability, affordability, quality and safety, and neighborhood opportunity. Housing disparities in the United States are tenaciously patterned along axes of social inequality and contribute to the burden related to persistently adverse health outcomes in affected groups. Appreciating the multidimensional relationship between housing and health is critical in moving the housing and health agenda forward to inspire greater equity.

Despite the vastness of existing research, we must contextualize the housing and health disparities nexus in a broader web of interrelated variables emerging from the same roots of structural inequalities.

Source: Am J Public Health. Diana Hernández PhD, and Carolyn B. Swope MPH. Published online ahead of print August 15, 2019: e1–e4. doi:10.2105/AJPH.2019.305210

A Framework for Increasing Equity Impact in Obesity Prevention

One of the most pressing unmet challenges for preventing and controlling epidemic obesity is ensuring that socially disadvantaged populations benefit from relevant public health interventions. Obesity levels are disproportionately high in ethnic minority, low-income, and other socially marginalized US population groups. Current policy, systems, and environmental change interventions target obesity promoting aspects of physical, economic, social, and information environments but do not necessarily account for inequities in environmental contexts and, therefore, may perpetuate disparities.

In THIS ARTICLE recently published in the American Journal of Public Health, Shiriki K. Kumanyika, PhD, MPHI, proposes a framework to guide practitioners and researchers in public health and other fields that contribute to obesity prevention in identifying ways to give greater priority to equity issues when undertaking policy, systems, and environmental change strategies. The core argument is that these approaches to improving options for healthy eating and physical activity should be linked to strategies that account for or directly address social determinants of health. Kumanyika provides research and practice examples of its use in the US context. The approach may also apply to other health problems and in countries where similar inequities are observed.

Source: Am J Public Health. Shiriki K. Kumanyika. Published online ahead of print August 15, 2019: e1–e8. doi:10. 2105/AJPH.2019.305221

Local Health Departments on the Front Lines of the Opioid Epidemic

According to the National Association of County and City Health Officials, local health departments play a critical role in responding to opioid misuse and overdose within their own communities and are well suited to serve as conveners or supporters of coalitions and partnerships.

According to the Centers for Disease Control and Prevention’s 2018 report, Morbidity and Mortality Weekly Report, 47,600 Americans died because of opioid-related overdoses in 2017—far outpacing the mortalities associated with car crashes in 2017 and those of the peak years of the AIDS epidemic. While success has been made in recent years to curb the severity of the epidemic, these recent numbers are a stark reminder of the continued suffering of individuals, families, and communities across the country.

On the “front line” of the epidemic, LHDs are well suited to serve as conveners or supporters of coalitions and partnerships. This is critical, given that collaboration at the local level is essential to address the multifaceted nature of the opioid epidemic. The coordination of federal, state, and local partners, along with the engagement of community agencies and organizations, is imperative in implementing strategies to prevent and respond to opioid misuse and overdose.

Activities located within a local health department are beneficial because opioid use looks different across jurisdictions. To support individuals living with Opiod Use Disorder (OUD), local health departments can help their communities build out treatment options, including medication-assisted treatment, and can improve community linkages to care for OUD treatment, as well as for other physical and mental health services related to opioid use. They are also well-suited to support active drug use communities and to develop and enhance support systems for individuals engaging in treatment.

The opioid epidemic skyrocketed to public consciousness on the back of the immense suffering addiction has inflicted on American communities. There will always be another crisis, and the lessons learned from a variety of domestic drug use epidemics tell us that when we fail to prepare, we fail far too many. Instead of reactionary responses to each new public health emergency, local health departments have a unique opportunity to harness the national conversation around opioids to push for structural improvements in our official response to drug use of all kinds.

Article by Evans, Higgins, and Stanford. Adapted from Journal of Public Health Management & Practice.

For Sibling Battles, Be a Sportscaster, Not a Referee

Narrate what’s happening. Repeat back what your kids say to you. Try to be neutral.

For the most part, sibling conflict is normal and to be expected: Home is a safe testing ground for social dynamics. Siblings often want to play together, but it takes skill and patience when they’re different ages.

It’s our job to let kids know we see and hear them, but we’re not necessarily going to solve siblings’ conflicts for them (or else they never get the practice). When squabbles start, imagine you’re a sportscaster and describe what you see in front of you, without judgment and without taking sides. This simple practice lets your kids know you acknowledge and respect their struggles, but you’re not immediately jumping in with a solution.

Example: You hear shouting and walk in to find your kids looking upset with each other.

Instead of: Hey settle down in here! Jack, what did you do this time?

Say: I’m hearing really loud voices in here. Alex, you’re looking mad with your hands on your hips. Jack, you’re laughing. There’s a pack of Pokémon cards on the floor.

Narrate what’s happening. Repeat back what your kids say to you. Try to be neutral.

Ah, got it. You’re telling me he always takes the best cards. You feel like he’s the boss all the time. I see. Jack, you wanted to play the game you usually play and Alex wanted to change it up. Alex, you got frustrated and threw the cards. Am I missing anything?

When you repeat back their grievances, it helps kids start to hear each other and work on their own solutions.

It’s a knee-jerk reaction for many parents to insist siblings be nice to each other, and try to smooth over tricky or unpleasant feelings. But siblings can feel love, anger, frustration and connection to each other all within the same day. If they get the message that we accept only their sunny feelings, they will either put more oomph into the darker ones so we hear them, or repress and hide them from us. Neither of these is a good outcome. Accept the negative feelings without judgment. The warm, loving ones will naturally resurface.

Example: He always ruins everything! I hate him!

Instead of: Hey, watch it. You need to calm down and apologize to your brother.

Say: Wow, you are super angry at him. What was it that made you this mad?

Example: I don’t want this new baby. I wish she were never born.

Instead of: Oh, you don’t mean that. You’re going to love her, you’ll see.

Say: I get it. Things feel so different now. It used to be just the three of us and it seems like everything changed. I feel it too sometimes!

If you feel as if your kids’ relationship is bordering on emotional or physical abuse, it’s important to intervene quickly and be ready to separate them if necessary. But for the brothers and sisters who are merely annoyed, pause and listen. When voices start to rise and conflict is escalating, those are signs you may need to step in. Start with something like,

Do you guys need help figuring this out?

Can you give me some information about what’s happening here?

Kids are capable problem solvers, even the youngest ones. Assume they have good ideas and you’re there for support.

Kids’ words and behaviors are only the tip of the iceberg. They’re the easiest to see and the part we fixate on. Usually, there’s something more telling under the surface. One sibling pushes the other not just to be mean, but because he’s angry, he’s testing boundaries, he’s been pushed at school, he’s tired, he’s overstimulated, he’s trying to get attention. As we teach and uphold family rules, it’s also our job as parents to look deeper.

Approaching the situation with curiosity will help you get to the root of the issue, and it also brings the family closer and makes the lessons stick.

The above are a few of the tools my co-author, Julie Wright, and I teach clients to help them tune in and understand what kids are feeling. But you need more for true conflict resolution. We call this strategy the A-L-P model, for the steps of attuning, limit setting and problem solving. Attuning means you lead with understanding, limit setting states the rules and realities, and problem solving is for coming up with alternatives and solutions:

Ouch, that looked like it hurt. Let me check and make sure you’re O.K. You were really mad and you slammed the door on his arm? Tell me what was going on. O.K., got it. You were angry and you wanted space from him. (Attune to both kids).

We absolutely cannot slam doors, because it’s dangerous. Remember that’s a family rule. (Limit Set).

Let’s get your brother some ice. Pause. What could you say, in clear, strong words, when you need space? Let’s write those down, because it’s really hard to remember when you’re mad. (Problem Solve).

This system helped a mom in our practice to feel empathy for her “problem child” — her middle son, who seemed to find every opportunity to provoke and aggravate his little sister. He was downright mean to her in a way that made the mom furious. She sometimes felt as if she didn’t like him.

We had her sketch an iceberg and fill in the possible sources of her son’s behaviors. As she did this exercise, she started to cry. She had written notes like, “Resentment toward little sister for being the baby of the family, attention from adults always on her, jealousy for her easygoing nature, overwhelmed at school, anger at recent family changes.” She worked on seeing him through this lens of curiosity and it made her less reactive and able to acknowledge his struggles.

Eventually, he started opening up and telling her more about how he was feeling. When she reminded him of family rules, rather than sending him to his room, she asked him what he could do instead of provoking his sister, and he actually started coming up with his own ideas.

As time went on, she still heard them fighting, but she also heard them working things out, chatting and laughing. The ratio of enjoyment to conflict was going up. Her empathy for her son was spreading through the family.

Article by Heather Turgeon. Adapted from The New York Times.

10 Ways to Lower the Cancer Risk of Grilling

If you plan to grill often experts suggest taking some small steps to make a big difference in lowering your exposure to compounds that are tied to cancer.

Many people would be surprised to hear that grilling carries potential cancer risks. But each year, the American Institute for Cancer Research publishes guidance for “cancer-safe grilling,” cautioning consumers to avoid two types of compounds that have been tied to cancer. These compounds, called polycyclic aromatic hydrocarbons and heterocyclic amines, get generated when food, especially meat, is cooked on a grill. They have not been proven to cause cancer in people, but lab studies have shown they alter DNA in a way that could lead to cancer.

“Polycyclic aromatic hydrocarbons are formed when any kind of organic matter,” primarily fat that drips off meat and down into the grill grates, “gets burned, because the carbon inside is being combusted in the flames, and those hydrocarbons get carried up in the smoke,” said Rashmi Sinha, senior investigator in the Division of Cancer Epidemiology and Genetics at the National Cancer Institute. The resulting smoke can envelop the meat and coat it in the potentially carcinogenic compounds.

The black char we’ve all seen on grill grates and grilled food? That’s the heterocyclic amines, or HCAs, which occur when high temperatures meet muscle meat, which includes red meat (pork, beef, lamb, goat), poultry (turkey, chicken) and fish. “Grilling — or even pan-frying — at these high temps causes amino acids found in the meat to react with another substance found in meat called creatine,” said Colleen Doyle, managing director of nutrition and physical activity at the American Cancer Society and a registered dietitian. Creatine is found only in muscle meat.

“It’s the reaction of those amino acids and the creatine that form the HCAs, which is why we don’t see HCAs formed when grilling asparagus, squash, peppers and other vegetables.”

As with most lifestyle choices related to dialing up or down one’s cancer risk, the dose makes the poison. Which means if you’re grilling once or twice a year, don’t sweat it. But if you plan to grill often — once or twice a week throughout the summer, say — experts suggest taking some small steps to make a big difference in lowering your exposure to these compounds.

Grill fish, seafood, poultry or plant-based foods rather than red meat and especially processed meats like hot dogs; the World Health Organization considers processed meats a carcinogen and red meat a probable carcinogen. While HCAs are still formed while grilling fish and seafood, Ms. Doyle pointed out that you typically don’t have to cook seafood as long as beef and chicken, which reduces the accumulation of the compounds.

Research suggests that marinating for at least 30 minutes can reduce the formation of HCAs on meat, poultry and fish. The reason for this is not entirely clear to researchers, but one possibility is a kind of shield effect. “If you put a barrier of basically sugar and oil between the meat and the heat, then that is what becomes seared instead of the meat,” said Nigel Brockton, vice president of research at the American Institute for Cancer Research. It also makes your meat more flavorful.

Many kinds of fruits and vegetables are actually protective as far as cancer risk, and they don’t form HCAs when grilled. Several experts recommend using meat as a condiment. Think of alternating cubes of chicken with peppers and onions or peaches and pineapple on a skewer, for instance. This trick, which also works when pan frying, reduces the surface area of meat exposed to the hot surface, Dr. Brockton explained, since the meat is also touching other ingredients throughout the cooking process.

According to Dr. Brockton, cooking your meat with herbs, spices, tea, chili peppers and the like — ingredients with phenolic compounds — can be a helpful approach because “it seems they quench the formation of the potentially carcinogenic compounds because of the antioxidant properties of those ingredients.”

Try to minimize how much smoke you’re breathing in, the Harvard T.H. Chan School of Public Health recommends as part of a helpful resource on healthy summer picnic practices.

The black, crispy crust that you often see on the bony edges of ribs or steak is more likely to contain a higher concentration of potentially carcinogenic compounds. Ms. Doyle also recommends cleaning the grill grates ahead of time, to remove any previously generated char.

“The longer you cook something, the longer the chemical reaction is happening, the higher the amount of HCAs are formed,” Dr. Brockton said. If you partially precook your meat, such as by baking or cooking in the microwave, the layer of HCAs that gets formed won’t be as thick. The same goes for meat cut into smaller pieces, such as with kabobs, because it cooks faster. Grilling in foil can also help protect the food from smoke and speed up the cooking time, according to the Harvard resource on healthy picnics.

“Types of wood can influence HCA formation,” Ms. Doyle said. “Hardwoods, such as hickory and maple, and charcoal all burn at lower temperatures than soft woods, such as pine. Cooking with wood that burns at a lower temperature is desirable.”

To minimize your exposure to polycyclic aromatic hydrocarbons, experts recommend selecting leaner cuts of meat or trimming any visible fat, which can lower the amount that drips down through the grates and comes back up in the smoke. To minimize dripping, Ms. Doyle suggests not piercing your meats while they’re on the grill.

According to guidance from the National Cancer Institute, fewer HCAs are formed if you turn meat over frequently while cooking it on high heat.

Article by Sophie Egan. Adapted from The New York Times.

West Nile virus detected in Canyon County mosquitoes

Because of Malheur County’s proximity to Canyon County, Idaho, we will share health advisories from neighboring areas to alert people to local concerns. Thanks to the Idaho Department of Health and Welfare for the important information.

Mosquitoes infected with West Nile virus (WNV) were detected in Canyon County on June 14, 2019, prompting public health officials to remind people to take precautions to “Fight the Bite.” The positive mosquitoes, which are the first detected in the state this year, were collected by the Canyon County Mosquito Abatement District. The positive lab results were confirmed Tuesday.

Last year, one death was reported because of WNV complications, and 11 counties across Idaho reported finding mosquito pools that tested positive for West Nile virus. Sixteen people and five horses were infected. This first detection of 2019 occurred in western Idaho, an area where positive mosquitoes have been found almost every year since West Nile virus was first detected in Idaho in 2004.

West Nile virus is contracted from the bite of an infected mosquito; it is not spread from person-to-person through casual contact. Symptoms often include fever, headache, body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash. In some cases, the virus can cause severe illness, especially in people over the age of 50, and may require hospitalization. On rare occasion, it can lead to death. 

“This is the time of year we expect West Nile virus-positive mosquitos to be found in Idaho,” says Dr. Christine Hahn, Idaho Division of Public Health Medical Director. “Avoiding mosquito bites is the best protection against infection with the virus.”

To reduce the likelihood of infection, take steps to avoid mosquitoes, particularly between dusk and dawn when they are most active. In addition, you should:

  • Cover up exposed skin when outdoors and apply DEET or other U.S. Environmental Protection Agency-approved insect repellent to exposed skin and clothing. DEET may be used on adults, children, and infants older than 2 months of age. Carefully follow instructions on the product label, especially for children. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant or breastfeeding women.
  • Insect-proof your home by repairing or replacing screens.
  • Reduce standing water on your property; check and drain toys, trays, or pots outdoors that may hold water and harbor mosquito eggs.
  • Change bird baths and static decorative ponds weekly as they may also provide a suitable mosquito habitat.

WNV does not usually affect domestic animals such as dogs and cats, but it can cause severe illness in horses and certain species of birds. Although there is no vaccine available for people, there are several vaccines available for horses. People are advised to have their horses vaccinated annually.

For the latest information, visit www.westnile.idaho.gov. Article adapted from the DHW blog.

Tanning industry uses promos, cheap prices to lure adolescents and young adults, study finds

Everyone knows cigarette smoking causes cancer and as a result, prices and advertising are closely regulated to discourage youth from starting. But another cancer risk, indoor tanning, which has been shown to cause melanoma, lags in regulation. Researchers at the Colorado School of Public Health have found that the tanning industry uses marketing strategies that appeal to adolescents and young adults, including unlimited tanning packages, discounts, and even offering free tanning when paired with other services like an apartment rental or gym membership.

“This study highlights the fact that a lot of businesses out there are providing this service at a low cost which removes a barrier to adolescents and young adults,” said Nancy Asdigian, lead author of the study and a Research Associate in the Department of Community and Behavioral Health at the Colorado School of Public Health. “Young people who want to tan do so when they can afford it and don’t when they can’t. The industry capitalizes on this with the strategies they use to price and promote this risk behavior.”

The study was published June 17, 2019 in the Journal of Public Health Policy.

According to the Global Burden of Disease Study, about 352,000 people worldwide were diagnosed with potentially deadly melanoma in 2015. That includes 81,000 cases in the U.S.

High profile public health and policy efforts along with state age restrictions have helped decrease the prevalence of indoor tanning among youth, but the study said levels remain ‘unacceptably high.’

Source: University of Colorado Anschutz Medical Campus. Adapted from an article in ScienceDaily.

HPV Vaccine Proving Very Successful

The HPV vaccine is available at little to no cost at the Malheur County Health Department for ages 9-26 for both males and females. Call 541-889-7279 to make an appointment to protect you and those you love and care for.

The prevalence of cancer-causing HPV strains has dropped markedly in women who have been vaccinated.

The vaccine against HPV, introduced in 2006, appears to be very successful in preventing cancer in real-world circumstances.

HPV, or human papilloma virus, is a common sexually transmitted disease, and while most cases are harmless, some types of the virus can cause genital warts and cancer.

Researchers reviewed 40 studies of HPV infection in 14 high-income countries, with data from more than 60 million people followed for up to eight years after vaccination. The study is in The Lancet.

They found that the prevalence of HPV 16 and 18, which cause most cases of cervical cancer, decreased over the period by 83 percent among girls ages 13 to 19, and by 66 percent among women 20 to 24. Infection with three other high-risk types, 31, 33 and 45, decreased 54 percent among girls 13 to 19.

The prevalence of genital warts also decreased sharply in women and, thanks to herd immunity, in unvaccinated men. Cases of precancerous cervical lesions decreased by 51 percent among girls 15 to 19, and by 31 percent among women 20 to 24.

“HPV infections, the cause of cervical cancer and precancerous lesions, are significantly declining in countries with high vaccination coverage,” said the senior author, Marc Brisson, a professor of epidemiology at Laval University in Quebec City.

Adapted from an article in The New York Times.

Ready. Set. Quit Smoking.

Curious about what happens when you contact the Quit Line?

  1. You can get help to stop smoking—free, with no judgment.
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Using proven techniques tested over 25 years, the Quit Line program has helped millions of people and it can help you, too. Get started today, and connect with 1-on-1 support to beat urges, manage withdrawal symptoms and switch up your habits so you can enjoy life tobacco-free.

Sun Safety

You can reduce your risk of skin damage and skin cancer by seeking shade under an umbrella, tree, or other shelter before you need relief from the sun.

The sun’s ultraviolet (UV) rays can damage your skin in as little as 15 minutes. Follow these recommendations to help protect yourself and your family.

Shade

You can reduce your risk of skin damage and skin cancer by seeking shade under an umbrella, tree, or other shelter before you need relief from the sun. Your best bet to protect your skin is to use sunscreen or wear protective clothing when you’re outside—even when you’re in the shade.

Clothing

When possible, long-sleeved shirts and long pants and skirts can provide protection from UV rays. Clothes made from tightly woven fabric offer the best protection. A wet T-shirt offers much less UV protection than a dry one, and darker colors may offer more protection than lighter colors. Some clothing certified under international standards comes with information on its ultraviolet protection factor.

If wearing this type of clothing isn’t practical, at least try to wear a T-shirt or a beach cover-up. Keep in mind that a typical T-shirt has an SPF rating lower than 15, so use other types of protection as well.

Hat

For the most protection, wear a hat with a brim all the way around that shades your face, ears, and the back of your neck. A tightly woven fabric, such as canvas, works best to protect your skin from UV rays. Avoid straw hats with holes that let sunlight through. A darker hat may offer more UV protection.

If you wear a baseball cap, you should also protect your ears and the back of your neck by wearing clothing that covers those areas, using a broad spectrum sunscreen with at least SPF 15, or by staying in the shade.

Sunglasses

Sunglasses protect your eyes from UV rays and reduce the risk of cataracts. They also protect the tender skin around your eyes from sun exposure.

Sunglasses that block both UVA and UVB rays offer the best protection. Most sunglasses sold in the United States, regardless of cost, meet this standard. Wrap-around sunglasses work best because they block UV rays from sneaking in from the side.

Photo of a woman putting sunscreen to her young daughter.

Put on broad spectrum sunscreen with at least SPF 15 before you go outside, even on slightly cloudy or cool days. Don’t forget to put a thick layer on all parts of exposed skin. Get help for hard-to-reach places like your back. And remember, sunscreen works best when combined with other options to prevent UV damage.

For more information, check out the Sun Safety Tips for Families fact sheet. Article adapted from the CDC.