Guarding against viral misinformation this flu season

By Joseph P. Iser, MD, DrPH, MSc
Chief Health Officer
Southern Nevada Health District

Dr. Iser.jpeg

As a clinician and a public health professional, I see every day how technology can help providers give patients useful information, better care, and drive better outcomes. As doctors, we use online toolkits to help treat our patients, eReferrals to provide more efficient access to smoking cessation resources, and electronic health records can make everything more accessible for both providers and patients. In my role as the Chief Health Officer of the Southern Nevada Health District, I’ve also come to see what a valuable public health tool technology and social media can be. In our agency, we use Twitter, Facebook, and YouTube throughout the year to educate and motivate our community on public health issues from violence, to STDs, and of course, the flu. We created a new video earlier this year about the importance of the flu vaccine and have a Twitter account dedicated to information about the flu.

The internet, social media platforms, and both mainstream and alternative news sites have made health and public health information readily available. These sources can provide a wealth of well-researched information and data from credible agencies, organizations, and credentialed individuals. Unfortunately, misinformation and rumors are sometimes as easily accessible on these same platforms and can be prominently featured and widely circulated.

Experts and published studies have stated some conflicting views about the degree to which social media platforms influence people’s opinions on everything from immunizations to the political landscape — but no one disagrees that they have an impact. What we do know is that the more people are exposed to information, even false information, the more it will be seen as credible. When using social media platforms, people’s preconceptions will drive their viewing choices, as well as the algorithms used by these mediums.

 This is relevant to us as local health officials because we play an important role in keeping our communities healthy by inoculating them against misinformation. Patients looking for an excuse not to get vaccinated can quickly find a reason, couched in scientific terms, on the internet or use the hashtag “#noflushot” on Instagram to view posts that support their position.

 There are persistent myths that exist about flu vaccine, and vaccines in general, that those of us in public health and health care should always be prepared to address. We never want to diminish or belittle these concerns. However, users should be informed if they have information that is inaccurate and may adversely affect their health, the health of their family, and of our entire jurisdiction.

 We can work together to dispel common myths that circulate every flu season by emphasizing a few simple key messages:

  • Getting the flu shot cannot give you the flu. The erroneous belief that the vaccine can make you sick is one of the most common and persistent myths my agency takes on. It’s also one of the main reasons cited by people for not getting vaccinated. Health care professionals can help to dispel this myth by asking all patients who can be vaccinated if they have received their flu shot this season, encouraging them to get vaccinated if they haven’t already done so, and providing them with accurate information about the safety of the vaccine and its potential side effects. It is important that patients understand the flu shot will not give them the flu. In very rare circumstances, the vaccine, and more likely FluMist, which is made from a weakened strain of the virus, may cause headache, low-grade fever, and muscle aches, but none of the flu vaccines will cause the flu.

  •  Flu shots are for everyone – not just the elderly, sick people, and children. The flu can impact anyone at any age. There are groups designated more at risk for complications from the flu; however, every year people in all age groups are adversely impacted by the flu. It is important that people of all ages, who are eligible, get vaccinated to decrease hospitalizations and to protect those around them.

  • The flu shot is effective. Some people believe they shouldn’t get the vaccine because it is not 100 percent effective, but getting vaccinated each year is the best protection from the flu and can reduce the risk of complications if a patient does become ill. During the 2016-2017 season, vaccination was estimated to prevent 85,000 flu-related hospitalizations. Every season the flu vaccine is developed based on projections about which influenza strains will be most prevalent during the upcoming season. The effectiveness of the vaccine varies each season and for each strain contained in the vaccine.

In addition to myths and misinformation, there are updates to the recommendations and information each year that public health organizations share with their communities. Over the past few seasons, the Advisory Committee on Immunization Practices (ACIP) has made revisions to its recommendations regarding the use of live attenuated influenza vaccine (LAIV) and for people with egg allergy of any severity. Current recommendations state any licensed, age-appropriate vaccine can be used, and this includes individuals with a history of egg allergy. The full ACIP recommendations can be found here.

Public health organizations are a trusted resource for their constituents. In today’s environment, ensuring everyone has the right tools to stay healthy also means helping to provide accurate information and access to the appropriate resources and tools to support their needs.

World AIDS Day 2018: Progress Continues, Disparities Remain

By Kim Rodgers, Communications Specialist, National Association of County and City Health Officials

World AIDS Day, observed annually on December 1, provides the opportunity to highlight our accomplishments, remember those who have lost their lives to HIV and AIDS, and refocus our efforts on what still needs to be done to end the epidemic. Local health departments are in the forefront of these efforts, working on initiatives to address the prevention and treatment of HIV and AIDS and support work towards a cure.

Child Development-Community Policing: How One Local Health Department Joins Local Police on The Front Line in The War on ACEs

By Stacey Butler, LCSW, Child Development-Community Policing Director
and Gibbie Harris, Director
Mecklenburg County Public Health

Gunshots ring out at a Charlotte, North Carolina apartment complex, and a five-year-old girl is struck in the leg by a stray bullet. Charlotte-Mecklenburg Police (CMPD) arrive on scene.  Recognizing the potential psychological trauma for the child and her family, they call the Child Development-Community Policing (CD-CP) on-call clinician. She responds within minutes, providing acute trauma intervention alongside her officer partner, who is beginning the work of helping the child and her family feel safe again. This officer-clinician team continues to visit the family over the next few days and weeks to assess progress and needs, providing targeted interventions, and helping reestablish a sense of safety both inside and outside their home.

Ten lessons we learned about how to deploy teams into post-hurricane settings

By Mitch Stripling, MPA, Assistant Commissioner, Bureau of Agency Preparedness and Response; Colin Stimmler, MA, Senior Director for Agency Preparedness and Response at the New York City Department of Health and Mental Hygiene

Disasters like Hurricane Michael show how severe the public health impacts from a coastal storm can be.  When disasters like this strike, many local and state health workers are often willing to help in another jurisdiction, but they aren’t quite sure how.  

New Report: Shortage of “Disease Detectives” in Local Health Departments Puts Cities at Risk

By Big Cities Health Coalition and Council of State and Territorial Epidemiologists staff

Epidemiologist, noun
epidemiologist \ˌe-pə-ˌdē-mē-ˈä-lə-jist
An expert scientist who studies, detects and tracks injuries and disease in our communities.

Epidemiologists serve on the front lines of public health, protecting Americans and the global community. When health threats emerge, these “disease detectives” investigate. They identify the causes, factors and patterns associated with illness, determine who is at risk, collect evidence to recommend preventive actions, and rapidly implement control measures. Epidemiologists also respond to major health hazards including emerging threats such as Zika and Ebola, as well as natural disasters such as floods and hurricanes. They also work on chronic issues facing communities including obesity, diabetes, cancer, HIV/AIDS and motor vehicle crashes.

Big Tobacco is marketing vapes to our kids, so our city took them on and won — it’s the FDA’s turn now

By Tomás Aragón, MD, DrPH, Health Officer and Director, Population Health Division, Derek Smith, MSW, MPH, Tobacco Free Project Director, San Francisco Department of Health

This blog originally appeared here in the Hill.

The FDA recently announced that it considers a new surge in teen e-cigarette use to be an epidemic, and will give e-cigarette manufacturers 60 days to prove that they are not marketing to kids. This is a very welcome move for those of us who have been pushing to prevent teen tobacco use. Our city recently took on the makers of e-cigarettes and won. The FDA should take San Francisco's lead and do everything it can to protect kids from Big Tobacco.

"Big tobacco sees vaping as their future," these are the words of Patrick Reynolds, an anti-tobacco activist and executive director of Foundation for Smokefree America. He is the grandson of R.J. Reynolds, the man behind a namesake tobacco company largely responsible for the fact that millions of Americans continue to be hooked on cigarettes.

Reynolds, like many local health departments, sees that a new generation is consuming new and different tobacco products at alarming rates. Electronic cigarettes (e-cigarettes), are the main driver of this trend. They contain nicotine and harmful toxins, making them especially dangerous to youth, who are more susceptible to addiction because their brains are still developing. Cities like mine are taking action, because federal authorities have thus far failed to do so, leaving children and teenagers vulnerable to the effects of these deadly products.

“Vaping” is a new mode of nicotine delivery that includes e-cigarettes, e-pens, e-pipes, e-hookah, and e-cigars. “Vape” is a misnomer, as many assume the resulting product contains water vapor, when it indeed is an aerosol much like smog, and contains propylene glycol, a chemical base used in theater fog machines.

These e-products are easy to consume and simple to conceal, making them especially attractive to teens, which the industry is banking on. Juul, an extremely youth-popular San Francisco-based nicotine delivery device, in particular, is rising in popularity because it is arguably the most discreet e-cigarette product on the market, which comes in enticing flavors. The tobacco industry is again luring youth with flavors such as Gummi Bear and Cherry Crush, with the goal of creating a new generation of smokers — just in a different product.

The battle against vapes is like déjà vu for many of us in the public health community, who successfully fought to eliminate youth-attracting marketing tricks like colorful packaging and candy flavors in cigarettes decades ago. Much of the danger is fueled by the product’s seemingly innocuous presentation. Despite their sleek packaging, e-cigarettes still contain cancer-causing chemicals and highly addictive nicotine.

However, the aerosol emitted doesn’t smell like traditional cigarette smoke does, and resembles water boiled from a teapot. The aerosol inside has ultra-fine particles that contain heavy metals and other substances that are inhaled deep into the lungs. While originally thought to be a “harm reduction” mechanism, i.e. better for people than smoking traditional cigarettes, little is known about their long term effects, and many studies show dual use with cigarettes and reduced likelihood of quitting. Further, vaping may be an entry point to other drug/tobacco use.

Research shows that these sorts of features are devastatingly effective in attracting children, and Big Tobacco knows it. The ease of concealing e-cigarettes doubles their appeal. It’s no wonder new surveys show that the number of kids lighting up is spiking across America.

In the last year, San Francisco stood up to these tactics, enacting a ban on the sale of menthol cigarettes and all flavors in e-cigarettes and other tobacco products. Initially the local public health community worked with elected officials who unanimously adopted the ban.

Big Tobacco quickly challenged the local law with a signature-collecting campaign and referendum, which voters approved by a 2-to-1 margin in June 2018. San Franciscans effectively finished work that the U.S. Food and Drug Administration (FDA) and U.S. Congress left undone when flavors in traditional cigarettes were banned just a few years ago. The tobacco industry did not go down without a fight, however, as R.J Reynolds spent almost $12 million to defeat the city’s measure.

These corporations are fighting so hard to protect these products because their marketing is working, with devastating effects. E-cigarettes entered the market over a decade ago, and since then we’ve seen their popularity rise dramatically, especially among kids.

We conduct the California Healthy Kids Survey, and between 2013-2015 the study included questions about smoking electronic cigarettes or other vaping devices for the first time. Researchers found that students were significantly more likely to consume tobacco with this new method than to smoke cigarettes, especially among younger adolescents.

  • Among 7th graders, 13 percent identified themselves as lifetime users of e-cigarettes

  • Among 9th graders, 26 percent smoked e-cigarettes

  • Among 11th graders, 32 percent use these products

These rates were three times higher than for traditional cigarettes in 7th grade, twice as high in 9th, and 1.5 times higher in 11th. Students in all grades are also twice as likely to vape on school property (4 percent to 5 percent) than smoke cigarettes.

These rates of tobacco use are simply not acceptable, and right now, the tobacco industry is winning, continuing to grow their youth customer base almost unchecked.

Because the FDA and Congress have not acted to ban the flavors that help to lure a new generation of smokers, cities are left to fight Big Tobacco on their own to protect kids in their communities. Policymakers in Washington, must act now to ensure every kid in America, no matter where they live, is protected from the tobacco industry’s billions of dollars in marketing targeted to youth.

Hurricane Harvey: In the Eye of the Storm

By Big Cities Health Coalition Staff

It’s been one year since Hurricane Harvey hit Houston and the surrounding area with record-breaking rain and devastating floods which inflicted injuries, infectious diseases, chemical exposures and mental trauma on residents. Public health officials from the Houston Health Department, a member of the Big Cities Health Coalition, were on the front lines in the lead up to the hurricane and its aftermath. Today, many are reflecting on the events of those four historic days in August 2017 and what lessons were learned, and can still be learned, from the disaster.

Let schools be places for learning—not “JUULing”

By Brian A. King, PhD, MPH, Deputy Director for Research Translation, Office on Smoking and Health, Centers for Disease Control and Prevention

Remember your high school bathroom? If it was anything like mine, the bathroom was a fairly foul-smelling place that you wanted to leave as quickly as possible.

But things are changing. Kids are flocking to school bathrooms across the country faster than the cafeteria on pizza day. School bathrooms have become places where students gather to socialize and use e-cigarettes—in particular, e-cigarettes shaped like USB flash drives that deliver a high level of nicotine.

Minneapolis Health Department Supports a Young Food Entrepreneur

By Dan Huff, Director of Environmental Health, and Gretchen Musicant, Commissioner of Health, Minneapolis Health Department

This blog originally appeared here on The National Association of County & City Health Officials (NACCHO) Essential Elements Blog.

Jaequan Faulkner, 13, started selling hot dogs in front of his Minneapolis home in 2016, calling his establishment “Mr. Faulkner’s Old Fashioned Hot Dogs.” His food stand came back this summer bigger and better than before, and it grew popular with customers in the neighborhood.

Recently, his business came to the attention of local officials when someone complained that he did not have official permits.

To make sure people are safe from food-borne illnesses, all events that serve food to the public in Minneapolis must be permitted, and violators are subject to an immediate shutdown.

Our Top Takeaways from NACCHO Annual 2018

By Big Cities Health Coalition Staff

We just returned to D.C. from the NACCHO Annual Conference, a summer pilgrimage for public health enthusiasts, which took place this year in New Orleans. The theme of this year’s conference was Unleashing the Power of Public Health. Our time in The Big Easy was especially frenetic this year, with lots and lots of sessions that we found fascinating. Below is a collection of our top takeaways from some of the most engaging sessions we participated in. Tell us which moments you thought were most important in the comment box below, or on Twitter at @BigCitiesHealth.

Public Health and Medical Community Pledge to Decrease Gun Violence

By Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County

This blog originally appeared here in the Public Health - Seattle & King County blog Public Health Insider

Firearm-related injury and death, from suicide to accidental injury and homicide – is a major public health problem and a leading cause of premature death in King County and nationally. In 2016, 663 adults and 20 children died from a firearm injury in Washington state, including 144 adults and 7 children from King County.

Firearm-related injuries have very high personal and financial costs to individuals, families and society – and that’s why prevention is essential.  In 2015, the cost of firearm fatalities alone (not counting non-fatal injuries) in King County was almost $200 million from medical costs and lost productivity, and nationally the cost is in the hundreds of billions of dollars each year.

LGBTQ Pride and Public Health

By Ginger Lee, MPH, Bureau Manager, Collective Impact & Operations,
Long Beach Department of Health and Human Services

June is LGBTQ Pride month.  Pride is a time when lesbian, gay, bisexual, transgender, queer and questioning people join together to further strengthen community by celebrating joyously, with parades and other events.  Pride is also a time when the LGBTQ community remembers its history. And for public health professionals, Pride is a time to reflect on what we can do to address social conditions that negatively affect the health of LGBT people, and to strengthen conditions that support health within our LGBTQ communities.

Hepatitis Awareness Month 2018: Addressing Hepatitis A

By Meghan McGinty, PhD, MPH, MBA, Deputy Director of the Big Cities Health Coalition, and Michelle Cantu, MPH, Director of Infectious Diseases and Immunization, NACCHO

This blog originally appeared here on The National Association of County & City Health Officials (NACCHO) Essential Elements Blog.

The month of May is designated as Hepatitis Awareness Month in the United States and May 19th is Hepatitis Testing Day. During this month, NACCHO will highlight the role of local health departments (LHDs) in responding to this silent epidemic and work to bring increased attention to viral hepatitis. Through a series of three blog posts, NACCHO will focus on the most common types of viral hepatitis, which are hepatitis A, hepatitis B, and hepatitis C. This series seeks to raise awareness of the importance of vaccination for hepatitis A and B, testing for hepatitis B and C, and the availability of effective care and treatments that, in the case of hepatitis C, result in a cure for most people. Additionally, the series will highlight current events related to viral hepatitis – such as outbreaks of hepatitis A in jurisdictions across the country and soaring rates of hepatitis B and C associated with increased injection drug use that is being fueled by the opioid epidemic – and how LHDs are on the frontlines of responding to these worrying trends.

Chicago health commissioner: Big Tobacco is targeting our youth and we must stop them

By Dr. Julie Morita, Commissioner, Chicago Department of Public Health

The U.S. Food and Drug Administration recently announced a crackdown on e-cigarette sales to minors, but before then, the city of Chicago had already taken matters into its own hands. The City Council passed an ordinance to require tobacco dealers to post warning signs at their doors about the health risks of e-cigarettes and other tobacco products. These signs, once designed and distributed, will also contain quit-line numbers to help our residents beat a nicotine addiction. 

Give Women the Gift of Good Health

By Mysheika W. Roberts, MD, MPH, Health Commissioner, Columbus Public Health

As we celebrate all the women in our lives for Mother’s Day and National Women’s Health Month, we are reminded that despite the advances women have made in many areas, great disparities still exist when it comes to their health. 

Women make the majority of health care decisions for their families and are powerful partners by advocating and modeling healthy lifestyles and behaviors for their children, colleagues and friends. But when it comes to their own health, they are often left behind.

Supporting Older Adults in Houston: Ramps, Rails and Toilets

By Deborah A. Moore, Assistant Director, Human Services Division, Houston Health Department and Scott Packard, Chief Communications and Public Affairs Officer, Houston Health Department

When you think of Older Americans Month, toilets probably aren’t the first thing to come to mind. But at the Houston Health Department, commodes are a major component of one of the Harris County Area Agency on Aging’s most gratifying programs.

Allow me to take a step back to explain.

Multnomah County’s Community Powered Change

By Rachael Banks, Public Health Director, Multnomah County Health Department

After years of unacceptable disparities data, we knew we had to do something different.  In the summer of 2015, Multnomah County Health Department (MCHD), set out to create a community health improvement plan (CHIP) centered on things that are largely outside of the control of the individual. In response, MCHD released a request for proposals (RFP) for the coordination of a CHIP that was created in partnership with communities of color. Oregon Health Equity Alliance (OHEA) was selected as the contractor to lead the development and implementation process for the CHIP.

Throughout 2016 OHEA, with the support of MCHD’s Health Equity Initiative (HEI), intensive community engagement and outreach (forums and interviews) were conducted to gather input from a variety of communities including: African-American, Asian, Immigrant/Refugee, Latino, Native American, Pacific Islanders, and youth and elders of color. The outreach and engagement was followed by a tremendous amount of planning, analyzing and prioritizing areas over the next year. Through these engagement efforts, a framework was developed outlining 23 goals and over 150 strategies.

Sexually Transmitted Diseases (STDs) are Making a Comeback – Recognizing April as STD Awareness Month, We Highlight BCHC Activities to Address Vast Increases in (STDs)

By Chrissie Juliano, Director, Big Cities Health Coalition

STD Awareness Month is an opportunity to focus on raising awareness of a problem that affects millions of Americans every year. STDs in the United States are at record highs, despite years of dropping rates, with the latest CDC data showing chlamydia, gonorrhea, and syphilis infections rising to exceed 2 million reported cases nationwide.  The increases are dramatic - 4.7% for chlamydia, 17.6% for syphilis, and a whopping 18.5% for gonorrhea. In short, we’ve lost ground in this fight. Left undiagnosed or untreated, STDs can cause serious long-term problems. Importantly, they are largely preventable and treatable.

On Earth Day: Local efforts are making a difference on climate change

The world-wide scientific consensus is clear: climate change is real, it is being driven by human causes, and we must act now to avoid its worst effects. However, it also clear that leadership in the fight against climate change will not come from Washington, D.C. anytime soon. The EPA is being targeted for huge budget cuts, and the U.S. withdrew from the Paris Climate Accord. In a heartening trend, businesses, community organizations, non-profits, states, counties and cities are stepping up to fill this leadership vacuum. Within this growing coalition there is one player that is often overlooked: local Health Departments. We have a unique perspective and the community connections to play a significant role in helping our communities adapt to the effects of climate change while also fighting against its causes.

Making Public Health Visible

By Narintohn Luangrath, Special Assistant to the  Baltimore City Health Commissioner and
Dr. Leana S. Wen, MD, MSc, FAAEM, Baltimore City Health Commissioner

At a commencement ceremony several years ago, Dr. Linda Rae Murray, then-president of the American Public Health Association, recounted a famous saying: “When public health works, we’re invisible.” She followed that by urging the graduates to “refuse to be invisible, because […] we need to lend our strength and our science to broad social movements whose goal is to make things better.”

When public health is invisible, we only end up talking about it when things go wrong; people tend to think about public health agencies as entities that respond to infectious disease outbreaks or shut down a restaurant due to health code violations. We frequently think about health as healthcare, but what determines how long and how well we live is less about what happens in the doctor’s office and more about where we live, the air we breathe, and the availability of other resources in our communities. At the Baltimore City Health Department (BCHD), we believe that all issues – education, housing, employment, public safety, and beyond – can and should be tied back to health. We are committed to making the progress earned through public health visible, and to make the case for incorporating health-in-all policies across the City.