NEW YORK. City hits 22 online e-cigarette retailers with suit for selling products to minors (SILive)

The City of New York has announced a federal lawsuit Wednesday against 22 online e-cigarette vendors that sold their products to New York minors. The complaint alleges online retailers do not have age verification systems in place to screen customers who may be minors and deliberately market their products to minors in violation of city law. Read more here.

NATIONAL. Obesity prevalence in large US cities: association with socioeconomic indicators, race/ethnicity and physical activity (Oxford Journal of Public Health)

The Big Cities Health Coalition (BCHC) provided "mini-grants" to graduate students for work related to the Big Cities Health Inventory (BCHI) Data Platform. The research undertaken by Michael Benusic, MD, CCFP, Master of Public Health Student at Johns Hopkins Bloomberg School of Public Health looked at the relationship between obesity and income - his research was published in the Oxford Journal of Public Health.

SEATTLE. Seattle Has Figured Out How to End the War on Drugs (New York Times)

On gritty streets where heroin, fentanyl and meth stride like Death Eaters, where for decades both drugs and the war on drugs have wrecked lives, the city of Seattle is pioneering a bold approach to narcotics that should be a model for America. Anyone caught here with a small amount of drugs — even heroin — isn’t typically prosecuted. Instead, that person is steered toward social services to get help. Find out more here.

NEW YORK. To Fight The Measles Outbreak, Health Departments Must Balance Civil Liberties With Civic Accountability (Health Affairs)

Eight months ago, it would have been hard to imagine that measles would become the next national public health emergency. Now, we see just how quickly an outbreak can grip the nation. 

In New York City—where measles cases surpassed 550 this week—our response is driven by balancing civil liberties with civic accountability: We believe strongly in the rights of everyone to make an informed decision about their own health and the health of their families. Yet, we are bound by the idea that the responsibility to protect the well-being of New Yorkers extends to every resident of this great city.  Find out more here.

LOS ANGELES. Climate Change, Wildfires, And How Public Health Leaders Can Rise To The Challenge (Health Affairs)

The largest near-term impacts of climate change on society come in the form of weather and climate extremes. Experts estimate that as many as 10,000 people lost their lives from natural disasters in 2018, compared to 50,000 in the prior 30 years combined. In Southern California, the region I call home, drought and warm temperatures recently brought a second year of historic wildfires, where the Thomas, Rye, and Skirball fires burned an area nearly the size of the city of San Antonio, Texas, and the Woolsey fire scorched an area roughly the size of the city of Denver, Colorado. The Woolsey Fire alone destroyed more than 1,500 homes and structures. The blaze forced evacuations of more than 295,000 people and resulted in prolonged power outages for more than 40,000 people. Read more here.

BOSTON. The 123rd Running of the Boston Marathon to Include Expanded Deployment of Everbridge (Business Wire)

The Boston Athletic Association (BAA) has significantly expanded the role of Everbridge’s Critical Event Management (CEM) platform to communicate critical event updates and safety information to all of its volunteers during the 123rd running of the Boston Marathon, taking place Monday, April 15th. This year, the BAA will use Everbridge to provide real-time notifications to its network of nearly 10,000 volunteers preceding the event and during race-day events including start times, route updates or disruptions, and race completion. Additionally, medical tent personnel from local hospitals and the Boston Public Health Commission will be notified of health emergencies via Everbridge-powered text messages. Find out more here.

NATIONAL. Next FDA chief must continue fight against teen vaping, local health officials urge (CNN)

By Shefali Luthra

In an almost uniform response to the impending exit of Food and Drug Administration Commissioner Scott Gottlieb, city and county public health officials are urging the Trump administration to go bigger in its response to adolescents' growing use of e-cigarettes.

The issue, they say, is reaching crisis levels and many worry the FDA's much-touted efforts are falling short.

Read more.

NATIONAL. How a Measles Quarantine Can Lead to Eviction (The Atlantic)

By Olga Khazan

In June 2014, Rex Archer, the director of health in Kansas City, Missouri, quarantined five families during a measles outbreak because several of the families’ members had contracted measles. The residents were told to stay in their home and avoid returning to work for several days.

Quarantine is a necessary, though difficult, measure that public-health officials sometimes take for people who are unvaccinated or at high risk of contracting a very contagious illness. In the case of measles, quarantine can last three weeks. Breaking quarantine can be a crime—one Wisconsin man was recently charged with a misdemeanor for going to the gym when he was supposed to be confined to his home.

Read more.

NATIONAL. Government health officials meet Congress members (Homeland Preparedness News)

By Melina Druga

More than 80 local, state, and territorial health officials met Wednesday with Congress members with the goal of advocating for public health funding. 

The officials told Congress members that investing in public health agencies is critical to protect and promote health. Federal investment in public health has not matched the rate of inflation, the officials said, nor has it matched the health challenges affecting the United States.

Challenges include the opioid epidemic, improving immunization rates, infectious disease outbreaks, the need for more resources and employees at the local level, public health emergencies and extreme weather events.

The officials also are urging Congress to increase funding for the Centers for Disease

Control and Prevention (CDC) by 22 percent by fiscal year 2022.

Annually, $3.5 trillion is spent on health care, according to the Trust for America’s Health, but 3 percent is directed to public health.

The health officials included representatives from the Association of State and Territorial Health Officials, the Big Cities Health Coalition, the National Association of Local Boards of Health, and the National Association of County and City Health Officials (NACCHO).

NACCHO’s board of directors also met with CDC Director Robert Redfield and Robert Kadlec, assistant secretary for preparedness and response.

Read more.

NATIONAL. How a Measles Quarantine Can Lead to Eviction (The Atlantic)

By Olga Khazan

In June 2014, Rex Archer, the director of health in Kansas City, Missouri, quarantined five families during a measles outbreak because several of the families’ members had contracted measles. The residents were told to stay in their home and avoid returning to work for several days.

Quarantine is a necessary, though difficult, measure that public-health officials sometimes take for people who are unvaccinated or at high risk of contracting a very contagious illness. In the case of measles, quarantine can last three weeks. Breaking quarantine can be a crime—one Wisconsin man was recently charged with a misdemeanor for going to the gym when he was supposed to be confined to his home.

For the Kansas City families, it quickly became clear that the quarantine would take its toll. As Archer and his colleague Abby Edsall wrote in the November issue of the journal Health Securitythe families received food donations, but these were a mishmash of ingredients that didn’t form complete meals: peanut butter but no bread; a five-pound bag of dried cranberries; boxes of cereal without enough milk.

The health department persuaded the restaurants where the families worked to not fire them, but the families nevertheless faced steep consequences from avoiding work, according to Archer and Edsall. One family missed so many paychecks that they were evicted. Several people had their phones shut off after unpaid bills racked up. Ultimately, the health department had a collection among its own employees to raise money to donate to the quarantined families.

Much of this could have been avoided if the United States had a mandatory-paid-sick-leave policy, Archer and Edsall argue. The Family and Medical Leave Act of 1993 protects the jobs of some workers for up to 12 weeks for medical reasons, but it does not guarantee pay, and it doesn’t cover more than 40 percent of all American workers. Ten states and 33 cities have their own sick-leave policies, but still, 28 percent of American workers lack access to any kind of sick leave. The United States and South Korea are the only countries in the Organization for Economic Cooperation and Development that do not mandate paid sick leave.

The problem in the United States is especially pronounced among low-income workers, many of whom work in service jobs. In one survey, 63 percent of restaurant workers admitted that they cooked and served food while sick. Food-service workers are the source of most norovirus outbreaks. “We’re eating at restaurants where folks can have diarrhea and we don’t even know it,” Archer told me by phone. (In a statement, a National Restaurant Association spokesperson told me that the organization “supports companies having the flexibility they need to set HR policies and procedures that work for their individual businesses.”)

The question is one of growing importance as more and more measles outbreaks occur, and as contagious diseases such as Ebola make their way to the United States by air. About 1,500 excess deaths occurred during the 2010 swine-flu outbreak because people did not stay home from work.

“For residents caught in the crosshairs of an outbreak in a state or locality without paid sick-leave legislation,” Archer and Edsall write, “the cost of compliance can be loss of income, loss of job, loss of home, or the inability to care for and feed family members.”

NATIONAL. Big-City Health Officials Talk Opioid, Measles Epidemics (MedPage Today)

March 13, 2019

By Joyce Frieden

WASHINGTON -- The opioid epidemic, the measles epidemic, and the unintended consequences of marijuana legalization were some of the topics on the minds of big-city health commissioners as they convened here this week.

Like many other big cities, Columbus, Ohio has been hit hard by the opioid epidemic, Mysheika Roberts, MD, health commissioner of Columbus, Ohio, said at an event here sponsored by the Big Cities Health Coalition. "In Franklin County [where Columbus is located], we had a 581% increase in opiate overdose deaths from 2003 to 2017," she said, adding that about 450 people die from it every year. "The city has funded a comprehensive harm reduction program, conducted by one of our federally qualified health clinics; we provide naloxone training, HIV and hepatitis C testing, treatment referrals, and wound care."

Two of the city's more unusual efforts include several safe needle disposal boxes located throughout the city, which has reduced the number of needles discarded in parks and other public places, and a "surge notification system," under which the coroner's office, emergency medical services, police departments, and emergency departments alert other agencies via a conference call if they notice an unusually high number of people dying from overdoses or being transported to the hospital for overdose treatment.

"This helps us identify a concentrated area of overdoses," Roberts said. Two years ago, the notification system alerted officials to a high number of overdoses in a particular African-American community in Columbus. "We found a cocaine batch that had [been] contaminated by carfentanyl ... We were able to get on top of that quickly and made sure that people [in that community] had access to Narcan."

But funding such efforts continues to be a challenge, she added. "I know I'm not alone in that. We're going to continue to see more deaths in the community if we don't do something drastic to change things ... One area where we see a lot of [funds] draining is children's services; many children are becoming orphans" because their parents have died from drug overdoses.

The measles epidemic is weighing heavily on the mind of Rachel Banks, MPA, public health director of Multnomah County, Oregon, where Portland is located. "We're really focused on the measles vaccine exemption rate," specifically, the rate of "non-medical" exemptions where people seek exemptions for religious or philosophical reasons, she said, noting that the county is on its fifth recent measles outbreak.

In Oregon overall, 5.2% of children are unvaccinated due to a non-medical exemption; in Multnomah County, the rate is 6.1%. Similarly, Oregon has a statement measles vaccine exemption rate of 3.9%, compared with 4.3% for the county, she said, adding that the area's recent measles outbreak has increased vaccine uptake.

"We are concerned with disease spread and the impact on the healthcare system," said Banks. The county health system and the providers have used a joint plan to mitigate community exposures; that model has worked well. For example, "we had one outbreak in July 2018 -- we had three cases with no additional exposures after the first case, and stopped the subsequent spread, but it was very expensive and involved a highly skilled and trained staff."

There are two cost-related issues with the outbreak, Banks continued -- one is the cost of educating families seeking exemptions about the possible consequences, and the other is the cost of the outbreaks themselves. The policy solutions are clear: officials should take a balanced approach by supporting vaccines, while also working with affected families to convince them to take precautions to avoid spreading the disease.

Tomás Aragón, MD, MPH, public health officer for San Francisco, discussed the unintended consequences of marijuana legalization in his state. "In California, you can't consume cannabis in public, so people create consumption places," he explained. However, right now the prevalence of [cigarette] smoking is very low through decreasing demand and also through "de-normalization" -- making smoking not considered the cool thing to do. "So we don't want smoking to now start taking off, because they'll probably go beyond cannabis" and smoke tobacco too.

Clean indoor air and worker safety also could be affected by marijuana legalization, Aragón added, noting that under current state law, "workers are protected from second-hand smoke."

He is also concerned about the high potency of the marijuana being sold, some of which has a 90% level of its main ingredient, tetrahydrocannabinol (THC). "I feel like we're in the Wild West [of marijuana] ... I went to one retail place where the owner himself consumes cannabis 24/7 -- but only at a 25% THC level," said Aragón. Of the cannabis with 100% THC, the owner told Aragón, "I sell this stuff but I would never touch it."

Other health department heads discussed some of their successes. Virginia Caine, MD, director of the Marion County (Indiana) Health Department, where Indianapolis is located, said she recently testified before the Indianapolis City Council in support of a needle exchange program for the city. The day she appeared, Indiana's Attorney General, Curtis Hill, gave a press conference saying that needle exchange programs "enable drug addicts and make this a terrible epidemic for the young generation." Despite Hill's remarks, all 24 council members voted unanimously in favor of the program, Caine said.

HOUSTON. Houston earns praise for efforts to combat human trafficking (AP)

By Juan Lozano

Officials from more than 10 U.S. cities convened Tuesday in Houston to learn about its successes combatting human trafficking, a broad approach in which the city’s health department, restaurant inspectors and cab companies all help identify potential victims.

While human trafficking has typically been viewed as a law enforcement issue, the city in 2015 also began focusing on it through a non-law enforcement lens. That garnered praise from federal officials and interest from other cities wanting to mimic the strategies.

“It is a different way of doing things,” said Minal Patel Davis, special advisor to the mayor on human trafficking in Houston.

Officials with New York City, Atlanta, Dallas and San Francisco are among those attending the two-day meeting this week in Houston, which has long been seen as a hub for human trafficking due to its proximity to the U.S.-Mexico border and its diverse and large population.

A 2016 study by the University of Texas at Austin estimates that there are more than 313,000 victims of human trafficking in Texas. More than 234,000 are victims of labor trafficking, and nearly 79,000 are victims of sex trafficking.

At the time Davis was appointed to her job in 2015, it was the first municipal level position of its kind in the United States. Three cities — Atlanta, Chicago and Minneapolis — have since created similar positions through grant funding.

In Houston, Davis began working with the health department — training its inspectors to watch for signs of labor trafficking at the city’s 13,000 food establishments. Inspectors also handed out outreach cards to workers with the phone number for the National Human Trafficking Resource Center.

The city’s health clinics also included human trafficking awareness as part of its screening processes and a human trafficking case manager was placed at Ben Taub Hospital in Houston.

“City departments touch nearly all aspects of life. They are a great set of eyes and ears,” Davis said.

The city has also reached out to the local business and corporate community to raise awareness about human trafficking.

The parent company of Yellow Cab and Taxi Fiesta agreed to notify its drivers by email and text about possible signs of human trafficking with its customers as traffickers often rely on taxis for transportation.

In 2017, Houston passed a city ordinance that implemented a zero-tolerance policy for human trafficking in city service contracts and purchasing. The ordinance requires contractors that work with the city ensure that their supply chains as well as those of their subcontractors adhere with labor laws.

At Tuesday’s meeting, Mayor Sylvester Turner said the success of these various programs in Houston shows the city’s approach is working.

“The reality is, if we are not working to eradicate human trafficking in all cities, in all states and globally, you don’t win,” Turner said.

In October, Secretary of State Mike Pompeo recognized Houston as a national model for building anti-trafficking infrastructure at the municipal level during a meeting in Washington, D.C. of the President’s Interagency Task Force to Monitor and Combat Trafficking in Persons.

“The city now boasts one of the most comprehensive and forward-leaning anti-trafficking programs anywhere in the United States,” Pompeo said.

Ouleye N. Warnock, a senior human trafficking fellow with the city of Atlanta who attended Tuesday’s meeting, said her office is working to develop partnerships with the private sector to offer job opportunities for trafficking victims.

Warnock said she has also had to work to educate the public that human trafficking is not only about sex trafficking about also about forced labor.

Expanding funding to combat human trafficking is something that is being debated during the current Texas legislative session. Lawmakers are discussing providing an additional $60.8 million to establish an anti-gang and an anti-human trafficking task force, providing the Texas Alcoholic Beverage Commission $5.6 million to help spot human trafficking at bars and clubs and $500,000 to the Texas Department of Licensing and Regulation to help identify trafficking at salons and spas.

NATIONAL. Lawmakers urged to prepare for pandemics (Precision Vaccinations)

By Don Ward Hackett

A coalition of national organizations representing public health, healthcare providers, biotechnology companies, and researchers urged congressional leaders on December 6, 2018, to swiftly approve the Pandemic and All-Hazards Preparedness and Advancing Innovation (PAHPAI) Act of 2018. 

The PAHPAI clarifies the role of the U.S. Centers for Disease Control and Prevention (CDC) in preparing public health departments for disasters. 

And, this legislation delivers the tools to the CDC to improve biosurveillance capabilities to better detect new threats to Americans. 

And, taking lessons learned from Ebola cases, the bill helps develop specialized hospitals that are capable of responding to extraordinary outbreaks.

“This bill is a great step forward, but I hope we don’t restrict this legislation to perceived pandemic threats,” said Peter Jay Hotez, M.D., Ph.D., Dean for the National School of Tropical Medicine, Baylor College of Medicine.   

“Any new bill should include efforts to address and help the 12 million Americans I estimate living in poverty with neglected tropical diseases,” Dr. Hotez said, the author of Blue Marble Health: An Innovative Plan to Fight Diseases of the Poor amid Wealth. 

The bipartisan reauthorization bill, H.R. 6378/S. 2852, would strengthen America’s defense, preparedness and response to chemical, biological, radiological or nuclear (CBRN) attacks, natural disasters, and emerging infectious diseases. 

The groups added that “it would be a setback for our national health security to delay reauthorization until 2019.” 

“We believe that time is of the essence in reauthorizing these important authorities,” wrote members of AABB (formerly known as American Association of Blood Banks); AFSCME; the Alliance for Biosecurity; the American Academy of Pediatrics; the American Association on Health and Disability; the American Hospital Association; American Public Health Association; American Society for Microbiology; America’s Blood Centers; the Association of American Medical Colleges; the Association of Maternal and Child Health Programs; the Association of Public Health Laboratories; the Association of State and Territorial Health Officials; Big Cities Health Coalition (BCHC); the Biotechnology Innovation Organization (BIO); California Life Sciences Association; the Chicago Department of Public Health; the Council of State and Territorial Epidemiologists; Healthcare Ready; Health Industry Distributors Association; Infectious Diseases Society of America; the International Safety Equipment Association; Johns Hopkins Center for Health Security; Los Angeles County Department of Public Health; March of Dimes; the National Association of County and City Health Officials; the New York City Department of Health and Mental Hygiene; the TB Alliance; and Trust for America’s Health. 

H.R. 6378 and S. 2852 are under consideration in the U.S. Senate Health, Education, Labor, and Pensions Committee.

NATIONAL. A coalition of national organizations...this week urged congressional leaders to swiftly approve the PAHPAI Act of 2018 (Homeland Preparedness News)

By Kim Riley

A coalition of national organizations representing public health, healthcare providers, biotechnology companies, and researchers this week urged congressional leaders to swiftly approve the Pandemic and All-Hazards Preparedness and Advancing Innovation (PAHPAI) Act of 2018 before Congress adjourns for the year.

The bipartisan reauthorization bill, H.R. 6378/S. 2852, would strengthen America’s defense, preparedness and response to chemical, biological, radiological or nuclear (CBRN) attacks, natural disasters and emerging infectious diseases. The U.S. House on Sept. 25 passed H.R. 6378 and sent it to the U.S. Senate, which has been reconciling the bill with its version, the same-named S. 2852.

NATIONAL: FDA proposals target electronic, traditional cigarettes (Business Insurance)

By Gloria Gonzalez

The U.S. Food and Drug Administration has proposed new steps to limit access to flavored e-cigarettes by those under the age of 18 and ban menthol in cigarettes and cigars.

Technologies such as electronic nicotine delivery systems were developed as an alternative to cigarettes for adults, but new research from the U.S. Centers for Disease Control and Prevention show that e-cigarette use among youngsters is significantly increasing, FDA Commissioner Scott Gottlieb said in a statement on Thursday. From 2017 to 2018, there was a 78% increase in current e-cigarette use among high school students and a 48% increase among middle school students, with the total number of middle and high school students currently using e-cigarettes rising to 3.6 million, meaning 1.5 million more students are using these products than in the previous year, according to the new CDC research.

In response, the FDA’s Center for Tobacco Products will revisit its compliance policy as it applies to electronic nicotine delivery systems, including all flavors other than tobacco, mint and menthol, with a proposal to have these products sold in age-restricted, in-person locations and, if sold online, under heightened practices for age verification, according to the FDA’s statement.

“FDA Commissioner Scott Gottlieb got it right when he called e-cigarette use among youth an ‘epidemic’,” Chrissie Juliano, director of the Big Cities Health Coalition in Washington, D.C., said in a statement on Thursday. “And their action today is a step in the right direction. Most drug stores and gas station retailers will no longer be allowed to sell flavored e-cigarettes and additional restrictions regarding online sales should also help to stem the tide. This is a good start, but opportunities remain. These flavors are still available for sale on the internet to those over the age of 18, and brick-and-mortar specialty retailers will continue to sell highly addictive, traditionally flavored e-cigarettes to those ‘of age.’ Further, menthol and mint vaping products will also still be available.”

The agency will also put forth a notice of proposed rule making that would seek to ban menthol in combustible tobacco products, including cigarettes and cigars, according to the FDA’s statement.

“This closes a major regulatory loophole in the Tobacco Control Act and is long overdue,” Ms. Juliano said in the statement.

However, Gregory Conley, president of the American Vaping Association in Washington, said in a statement on Thursday: “No youth should vape and there is room for more rigorous enforcement to ensure youth are not accessing these products. However, this move by Commissioner Gottlieb will only serve to make it harder for adult smokers to switch to a far less harmful alternative.”