Health | Winter 2016 by HEALTH Magazine

HEALTH S O U T H W E S T U TA H P U B L I C H E A L T H F O U N D AT I O N | W I N T E R 2 016

HEART DISEASE

PG. 8

Preventing Americaâ&#x20AC;&#x2122;s #1 Killer

BEFORE THE STORM

PG. 16

Community Preparedness & Resilience

MEDICAL MARIJUANA PG. 10 A Scientific Approach

SOUTHWEST UTAH PUBLIC HEALTH DEPARTMENT PROGRAMS Our mission is to PROTECT the community's health through the PROMOTION of wellness and the PREVENTION of disease.

B E AV E R

IRON

75 West 1175 North 260 East DL Sargent Dr. Beaver, Ut. 84713 Cedar City, Ut. 84721 (435)438-2482 (435)586-2437

NURSING SERVICES Baby Your Baby Breastfeeding Consultation Case Management Child Care Resources/Referrals Early Intervention Home Visitation Immunizations International Travel Clinic Maternal Child Health Mobile Clinic (rural counties) Pregnancy Testing Prenatal Resource Referrals Reproductive Health School Exemptions Education & Tracking School Health/Nursing WIC

HEALTH PROMOTION Bicycle Safety Car Seat Classes Certified Car Seat Inspection Points Community Training and Outreach Healthy Dixie Liaison Healthy Iron Co. Liaison Injury Prevention Safety Resources Physical Activity & Nutrition Resources Resources to Quit Tobacco Tobacco Compliance Checks Tobacco Education(retailers) Tobacco-Free Housing Data

WAS H I N G TO N

KANE

GARFIELD

620 South 400 East St. George, Ut. 84770 (435)673-3528

445 North Main Kanab, Ut. 84741 (435)644-2537

601 East Center Panguitch, Ut. 84759 (435)676-8800

ENVIRONMENTAL HEALTH Air & Water Quality Body Art Regulation Child Care Inspections Food Handler Permits Hotel Sanitation Inspections Pool Inspections Restaurant Inspections School Inspections Septic System Inspections Tanning Bed Sanitation Inspection/Enforcement Temporary Mass Gathering Permits Used Oil Utah Indoor Clean Air Act Inspection/Enforcement Water Lab

EMERGENCY PREPAREDNESS Bioterrorism Prep/Planning Community Training & Outreach Free Emergency Resources Hospital Surge Planning Mass Flu Vaccination Events Medical Reserve Corps Pandemic Prep/Planning Preparedness Buddy Strategic National Stockpile (SNS) Coordination

VITAL RECORDS Birth Certificates Death Certificates Disinterment Certificates Divorce Certificates Marriage Certificates

COMMUNICABLE DISEASES Disease Surveillance & Control Epidemiology Tuberculosis Program

PREVENT DISEASE

4 PLAGUE

The “Black Death” in the Southwest By Shana Chavez VA C C I N E P R E V E N TA B L E

SHINGLES 6 When chickenpox returns with a vengeance By Lori McGuire, RN LIFESTYLE

EDITOR David Heaton

PUBLISHER Jeff Shumway

FOUNDATION BOARD Chris White

David Todd Blodgett, MD Stirling

DESIGN

Kindal Ridd

8 HEART DISEASE

America’s #1 killer By David Blodgett, MD, MPH THE 411

10 MEDICAL MARIJUANA A scientific approach By David Blodgett, MD, MPH

P ROTECT DRUG ABUSE

12 VAPING & TEENS E-cigarette regulation By Kye Nordfelt

EMERGENCY MANAGEMENT

14 LOCAL DISASTER RESPONSE How Southern Utah works together Interview with Paulette Valentine COVER STORY

L ET T ER F R O M T H E H EA LT H O F F IC ER

BEFORE THE STORM 16 How social capital affects disaster recovery By Daniel P. Aldrich

VULNERABLE POPULATIONS

20 PREPAREDNESS BUDDY Welcome to the 12th issue of HEALTH Magazine, an effort we began over five years ago, dedicated to delivering essential, health-promoting information to the residents of southwest Utah. The Foundation and this publication support the mission of the Southwest Utah Public Health Department (SWUPHD), which serves Washington, Iron, Beaver, Kane, and Garfield counties. While our programs cover a wide range of needs, one aspect of public health we are focusing on in this issue is emergency preparedness and response, especially on the neighborhood and community level. We hope you will be inspired to not only prepare yourself and your family against unpredictable hardships, but to build relationships among your neighbors as well. Looking out for each other will make dealing with any disaster much easier. Sincerely,

Looking out for others By Lexie Little

PREPAREDNESS

21 WON’T YOU BE MY NEIGHBOR Strength in numbers By Clint Albrecht

P ROMOTE EMERGENCY

22 CAR KITS

Just in case By Kylaas Flanagan SELF-RELIANCE

24 GARDENING PREP WITH AL Pre-planting tips & tricks By Al Cooper

David W. Blodgett, MD, MPH SWUPHD Health Officer & Director

RESOLUTIONS

28 THE HEALTHY NEW YOU Realistic goal setting By Cambree Applegate HOW TO

The entire contents of this publication are Copyright ©2016 HEALTH (the magazine of the Southwest Utah Public Health Foundation) with all rights reserved and shall not be reproduced or transmitted in any manner, either in whole or in part, without prior written permission of the publisher. Health magazine hereby disclaims all liability and is not responsible for any damage suffered as the result of claims or representations made in this publication. Printed by Hudson Printing Company / Salt Lake City, Utah / hudsonprinting.com

Q U E S T I O N S O R C O M M E N T S ? Email info@swuhealth.org

30 GET INVOLVED

Community volunteer opportunities ON THE COVER

HEALTH S O U T H W E S T U TA H P U B L I C H E A L T H F O U N D AT I O N | W I N T E R 2 016

HEART DISEASE

PG. 24

Preventing America’s #1 Killer

BEFORE THE STORM

PG. 20

Community Preparedness & Resilience

MEDICAL MARIJUANA PG. 4 A Scientific Approach

Special thanks to our models; Trent & Tawna Ridd, Lacey & Tess Turley, & Grandma Allred. Also, thanks to Jewell Bringhurst for the use of her beautiful pioneer home.

lague is a very serious disease caused by the Yersinia pestis bacteria and affects both humans and animals. The bacteria are found in fleas and the animals they inhabit: rats, squirrels, prairie dogs, rabbits, and other small rodents. The disease is transmitted to humans through the bite of an infected flea or by direct contact with an infected animal’s body fluids or tissue.

By Shana Chavez SWUPHD Clinical Assistant

have been eight deaths reported from plague in the United States between 2000 and 2013. Currently, the U.S. has an average of seven diagnosed cases reported yearly, affecting people of all ages; from infants to the elderly. About half of those affected are between the ages of 12 and 45. The disease occurs in both genders, but the rate is slightly higher in men and is most likely attributed to their increased involvement in outdoor activities. The disease was once referred to Almost all cases reported are inas the “Black Death”. According dividuals living in rural areas. to the World Health Organization (WHO), the plague’s largest pandemic was responsible for Symptoms & Treatan estimated 50 million deaths ment across Asia, Africa and Europe Infected individuals usually deduring the fourteenth centu- velop flu-like symptoms within ry. The disease was introduced 2-6 days following exposure to to the United States in 1900 by the plague bacteria. However, rat-laden ships sailing from af- there are different forms of the disease, depending on the route fected areas. of infection, and symptoms may Plague continues its existence to- vary. day. Around 2000 cases worldwide are reported annually to the WHO, with a mortality rate of Bubonic Plague is the 8-10%. The Centers for Disease most common form, accountControl (CDC) estimate these ing for 80% of reported cases. numbers are probably much Illness usually presents followhigher because plague in devel- ing the bite of an infected flea. oping countries is not reliably The bacteria enter the body at diagnosed or reported to health the site of the bite, and then folauthorities. The disease remains low the lymphatic system to the endemic in areas of Africa, Asia, nearest lymph node where the South America, and the former bacteria multiply. The lymph Soviet Union as well as the west- node (called a bubo) becomes very swollen and painful. Other ern United States. symptoms include: sudden onset Between 1900 and 2012, the Unit- of fever, chills, headache, body ed States had over 1000 confirmed aches, weakness, nausea, and or probable cases. The last urban vomiting. If not diagnosed and outbreak in the U.S. occurred in treated early, bacteria may spread Los Angeles in 1924 – 1925. There to other parts of the body.

Septicemic Plague spreads through the bloodstream. It

may present following a flea bite or after direct contact with an infected animal. This form may also develop from untreated bubonic plague. Symptoms include fever, chills, weakness, abdominal pain, shock and possible bleeding into skin and other organs. Advanced infection may cause necrosis (death) of skin or other tissue.

Pneumonic Plague is typically caused by infection spread-

ing to the lungs from untreated bubonic plague. It is the only form that can be transmitted human-to-human (by inhaling infectious droplets). Symptoms include fever, headache, weakness, rapidly developing pneumonia, shortness of breath, chest pain, cough, and possibly bloody mucous. This form, although less common, is the most serious and fatal. Confirmed diagnosis is made through laboratory testing of fluid from infected lymph nodes, blood, or sputum(mucous). Treatment involves antibiotics and supportive therapy.

Prevention

Avoiding flea bites and contact with high-risk animals, especially in plague-endemic areas, is important in preventing infection. The following precautions are advised: • Reduce rodent populations around your home or work area by removing clutter, old wood piles, shrubs, and cleaning up other areas rodents might occupy. Rodent-proof your home and sheds by sealing openings where rodents may gain access. • Wear gloves when handling or skinning animals to prevent direct contact. • Use repellents containing DEET and/or permethrin when engaging in activities where rodent-flea exposure is more likely; such as camping, hiking, and working outdoors (follow product directions carefully). • Examine pets (especially cats and dogs) regularly and treat with flea-control products as needed. Seek care for sick animals (some plague cases are associated with domestic cats that have eaten infected rodents). • Do not allow dogs or cats who roam endemic areas to share your bed. Although plague is a serious and potentially fatal disease, it is treatable if diagnosed early. Seek immediate medical care if you develop symptoms and inform your doctor of any recent travel, animal exposure, or known flea bites. Receiving prompt medical attention and proper treatment is essential in preventing complications or death. Visit www.cdc.gov/plague for more information.

HEALTH

Surviving the Plague

By Dave Johnson During spring break in 1992, when I was sixteen years old, some friends and I set off on our first unsupervised camping trip. We were obsessed with learning about the mountain man lifestyle and were confident that we were ready to live off the land. Having had experience hunting squirrels with my grandfather in Hurricane, Utah and noticing an abundance of these rodents near our campsite, we started shooting squirrels to eat. We skinned them, tanned their hides to bring home for later use, and tried cooking the meat, which was pretty nasty. My first night back home I started feeling like I was coming down with a cold, along with an uncomfortable feeling in my armpit. I awoke the next morning with my jaw and fists clenched and every muscle in my body shaking violently. I could feel a lump where my armpit hurt. When my father - who was a physician - got home, I told him about my illness. He didn’t think too much of it until he saw the lump. My sister, who was a pre-nursing student at BYU, had just finished a microbiology course and said “Dad, this looks like the plague!” He turned to me and asked if I’d eaten anything strange while camping. I admitted skinning and eating the squirrels. Not in a good mood, he drove me to his office and read off symptoms from a medical book as I answered yes to all of them.

the size of a golf ball- aspirated for testing. After a few days of lying in bed with the worst muscle pain I’d ever had, the cultures came back. They were growing Yersinia pestis, the causitive agent, for bubonic plague. Samples were sent to the CDC and they contacted our local Health Officer, who also happened to be my father, to ask questions and ordered the immediate removal of the squirrel skins from our homes. I was treated with the drug of choice at the time for plague, streptomycin, through twice-daily injections for ten days. I was never contagious, like pneumonic plague can be, but it was the sickest I’ve ever been. I made a full recovery with no lasting effects other than being the fodder for many jokes about my choice of food. I was the fifth person to contract bubonic plague in twenty years in Nevada, and one of 18 cases in the United States that year, which was actually an unusually high number. Fortunately, bubonic plague can be cured if treated early enough, although people still die from it. It’s rare and not hard to prevent. Of course, most people don’t try to eat ground squirrels. Dave Johnson, MD, a family physician by training, runs a chronic wound healing clinic at a hospital in Carson City, Nevada.

I was quickly admitted to the hospital, put in isolation, and had the lump-or bubo, now

PLAGUE cases in the U.S. were unusually high in 2015. There were 11 cases, all contracted in five western states, and three fatalities. SWUHEALTH.ORG

WINTER 2016

PREVENT

o you remember having chickenpox as a child? That itchy, blistery rash that you tried not to scratch? A rite of passage for most children, and a part of you forever, the virus that causes chickenpox takes up permanent residence in the nerve tissue near the spinal cord and brain. It then goes into

By Lori McGuire, RN SWUPHD Nurse

a dormant state. In some people, usually in older age, the virus breaks dormancy and becomes a disease called shingles. The term shingles comes from the Latin word cingulus, which means girdle or belt. This refers to the belt-like appearance of the rash that typically wraps

around one side of the body. Humans have been suffering from shingles since the Middle Ages, when it was often confused with smallpox and other rash-forming illnesses. In the mid-18th century, shingles was distinguished as a separate illness from smallpox, and in the early 19th century it was determined that shingles was

HEALTH carried in the nervous system. In the early 20th century, physicians began to suspect a link between chickenpox and shingles when they noticed that cases of shingles were often followed by cases of chickenpox in younger household members.

There are antiviral drugs that can reduce the pain of the shingles rash and can shorten the length and severity of the disease. These Shingles is caused by the varicella-zoster virus. This virus drugs must be prescribed is a member of the herpesvirus family (this is why shingles by a physician and need to is sometimes be started at referred to the beginas herpes The CDC recommends that persons ning of the zoster). Af- aged 60 and older get a dose of the shingles rash stage to ter a period vaccine, whether they remember having be effective. of dormancy chickenpox or not. Antiviral in the nerve medications tissue, the virus can reactivate, sometimes decades later. Psycholog- can also reduce the risk of ical stress can cause an outbreak, as can a compromised developing PHN. immune system. Sometimes there is no known reason for the outbreak. The Centers for Disease Control (CDC) esti- For prevention, there is a mate that 1 out of 3 people in the United States will develop shingles vaccine available. shingles in their lifetime. Increased age is a risk factor for The CDC recommends that shingles; one half of all cases in the U.S. occur in persons all persons aged 60 and older get a dose of the shingles 60 years or older. vaccine, whether they reShingles will typically manifest as a painful, blistery rash member having chickenthat appears in a single stripe on either the left or right side pox or not. It is estimated of the trunk or face. Most people will experience pain, itch- that 99% of all Americans ing or tingling in the area 1-5 days before the rash erupts. aged 40 and older have had The rash itself will scab over in 7-10 days and typically chickenpox and are suscepclears up in 2-4 weeks. Shingles can be intensely painful; tible to shingles. the pain has been described as sharp, burning, throbbing, or stabbing. Some people will continue to experience this Studies indicate that the pain for weeks or even years after the rash disappears. This shingles vaccine reduces is a complication known as post-herpetic neuralgia (PHN). the risk of getting shingles PHN occurs more often in persons over 60. PHN is be- by 51% and reduces the lieved to be due to nerve damage caused by the virus. Oth- risk of PHN by 67%. The er complications of shingles include bacterial infection of vaccine appears to be most the rash and, if the rash occurs on the face, shingles can effective in persons aged 60 affect the eye and cause blindness. Very rarely, shingles – 69 years, although it still can lead to pneumonia, encephalitis (inflammation of the provides protection in older persons. There is no maxibrain), or death. mum age for the vaccine. Shingles itself is not contagious; however, people who are not immune to chickenpox can get chickenpox if they have Some people should NOT direct contact with the shingles rash. If you have shingles, get the shingles vaccine; you should avoid contact with pregnant women who have including anyone who has never had chickenpox and persons who are severely immu- a severe allergy to gelatin, nocompromised. Once the rash has crusted over, it is no the antibiotic neomycin, or longer contagious. If the rash is kept covered, the risk of other vaccine components. spreading the virus is low. Anyone who has had chickenpox Also, some persons who disease already has the shingles virus in their body. They have weakened immune systems should not be vaccannot “get” shingles from another person with shingles. cinated. Due to the introduction of the chickenpox vaccine about 20 years ago, chickenpox disease is not as common in America If you have questions about as it once was. Some researchers hypothesize that exposure the shingles vaccine or are into persons with chickenpox disease may actually reduce the terested in getting it, please incidence of shingles, as it may act as an immunity booster contact your physician or the and keep the virus suppressed. The effect of the chicken- Southwest Utah Public Health pox vaccine on shingles is still unknown; more time and Department inside research are necessary before any definitive conclusions (see front cover). can be made.

ALL

SWUHEALTH.ORG

WINTER 2016

PREVENT

D I S E AS E By David Blodgett, MD, MPH SWUPHD Director & Health Officer

≈80%

don’t smoke

≈40%

maintain a healthy body weight

≈22% exercise ≈17%

eat veggies and fruit everyday

≈6% all of the above Americans participating in heart healthy activity

HEALTH

y intention with this series of articles is to help you understand the nature and magnitude of the problem that chronic diseases place as a burden on society and on the individuals that suffer from them. Additionally, I want to make sure that you have the information you need to help prevent these illnesses in your life. Heart disease is the largest killer in America today. More than 600,000 people die from heart disease every year. There are a number of separate illnesses that fall under the broad category of heart disease. These include Coronary Heart Disease (CHD), Hypertension (HT), and Heart Failure (HF), among others. Heart Disease is the underlying cause of death in one out of every four deaths in the United States. Every year since 1900 (except 1918, during the great influenza pandemic), heart disease accounted for more deaths than any other cause. The Framingham Heart Study, the largest study ever conducted on heart disease; indicates that at the age of 40, the lifetime risk for heart disease is 1 out of 2 for women and 2 out of 3 for men. Additionally, 22% of all deaths from heart disease occurred prematurely, meaning those in question died before the age of 75. If all forms of heart disease

were eliminated, life expectancy would rise by nearly 7 years. For comparison, if all forms of cancer were eliminated, life expectancy would rise 3 years.

In the last issue of HEALTH Magazine, I talked about diabetes and suggested four keys to healthy living. It shouldn’t surprise you that those same factors are also the best things you can do to It is estimated that heart dis- prevent heart disease. Here ease costs the US over $500 they are again: billion in health care costs with about 6.5 million hos- • Don’t smoke. About 20% pital admissions annually. of Americans still do. Heart disease is a bad ac- • Maintain a healthy weight. tor. It accounts for a large About 40% of us have proportion of the death and been able to do this. disability that we see in our • Eat five cup-sized servsociety and in the lives of ings of vegetables and those we love. If we don’t fruits every day. About do anything to prevent it, 17% do this. the data suggests that most • Exercise regularly; meanof us will experience some ing 30 minutes for most sort of heart disease in our days of the week. 22% of lifetimes. us do this. The good news is that there are things you can do to pre- Unfortunately, only 6% of us vent heart disease. Studies do all of these. That leaves have identified five major lots of room for improveindicators of those that are ment, but whether others do at low risk for heart disease: this or not, you can! • Total cholesterol of less It is true that there is a strong genetic component involved than 200 mg/dL in heart disease as well. A • Untreated blood pres- premature (before age 50) sure of less than 120/80 heart attack in a parent or • Not smoking currently sibling doubles your chance for heart disease, regardless • Not having diabetes what other factors are • No major abnormalities of present. In this context, takon an electrocardiogram ing action to prevent heart • No excessive alcohol use disease can still reduce your risk, and in fact may be even People who fit into all of more important. these low risk categories had a 73-85% lower risk of I hope I’ve made it obvidying from heart disease, ous that heart disease is a a 40-60% lower chance of big deal, although we can dying from any cause, and do much to avoid it if we lived six to ten years longer. choose to be engaged in

managing our own health. I sometimes wonder at how people process risk in their lives. The risk of developing heart disease looms large for all of us, and yet many of us pay it little heed and allow years to go by with poor diet, little exercise, and so on. I contrast this with the furor we experienced in 2014 over Ebola in this country. Here is a disease that few of us had ever heard of, yet almost overnight it seemed to become an imminent danger to all of us; thanks in part to the political, media, and public frenzy. People took drastic steps to protect themselves; preparedness items flew off the shelves, people wouldn’t go outside, health care workers were shunned. It was almost comical if it weren’t so tragic. In reality, the risk of anyone reading this article contracting Ebola then (or now) is virtually zero, but the risk of developing heart disease is very high and very real. So, how we internalize and interpret the risks in our lives is important. Our decisions that affect our health are based on information we believe to be true, so finding valid sources becomes vital and that can be a challenge. The purpose of this article, and this magazine, is to focus on evidence-based information that will help you live a longer and healthier life.

“If we don’t do anything to prevent it, the data suggests that most of us will experience some sort of heart disease in our lifetimes.” SWUHEALTH.ORG

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PREVENT

By David Blodgett, MD, MPH SWUPHD Director & Health Officer

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n the days when opium, cocaine, and other plant-derived narcotics were routinely used in medical practice - often with disastrous effects - marijuana was also investigated for its medicinal qualities. An 1890 study indicated “marked disturbances in motility, convulsions, and the induction of epilepsy, which is not rare.” One of the great advances of modern medicine is the standardization of processes used to evaluate compounds that have the potential to help treat or cure disease. Thousands of promising substances are filtered through this procedure before truly effective medications are identified and made available to the general public. This process remains critical as a protection against false claims and the negative impacts that damaging medications can have. Does marijuana contain beneficial compounds that could heal a variety of diseases, many of which have been regarded as having no cure? The surprising answer is... “maybe”, but certainly not to the extent claimed by many advocates. The endocannabinoid system in the body has receptors that respond to two compounds found in marijuana: cannabidiol (CBD) and tetrahydrocannabinol (THC). This system is widespread, affecting many systems in the body, so the impact of CBD and THC

H3 C H3 C

can be profound. We know Research continues, but any this is true because of the potential benefits have not negative effects of marijuana. yet been proven. However, the adverse - sometimes Active research is currently devastating - effects of marunderway to study whether ijuana have been well docthere could be positive im- umented, as illustrated repacts from these compounds cently in the New England as well. The National Insti- Journal of Medicine: tutes of Health (NIH) currently has 213 projects relat- Short Term Effects: ed to CBD, and an additional • Impaired short-term mem13 are analyzing other mariory including difficulty juana compounds for potenlearning and retaining tial medical use. There are information already standardized extracts • Impaired motor coorand synthetics of THC and dination, including imCBD available on the market paired driving skills, today, with a prescription. leading to accidents No one is being denied the • Altered judgment legitimate use of these poten• Paranoia and psychosis, tially beneficial compounds. especially at higher doses Some claim that since marijuana contains potential- Long Term Effects: ly helpful components, it should be legalized as med- • Addiction icine. The problem is, you • Altered brain developdon’t smoke medicine. In ment order for a substance to be • Poor educational outa legitimate medicine, you come, with increased must be able to know how likelihood of dropping much of the substance you out of school are getting, and smoking • Cognitive impairment, does not allow that. Variwith lower IQ ations in the plant being smoked and how the smoker • Diminished life satisfaction and achievement inhales make it impossible to know from one hit to anoth- • Symptoms of chronic er how much “medicine” you bronchitis have ingested. This makes • Increased risk of chronic the debate about “medical psychotic disorders inmarijuana” a farce, especially cluding schizophrenia when many proponents use the “medicine” label simply It is likely that marijuana also to encourage legalization of negatively impacts the centheir recreational use of the tral nervous system, along drug. with the cardiovascular, re-

spiratory, immune, reproductive, and neuro-psychological systems of the body. There is still much to be discovered about both the negative and positive attributes of marijuana, yet I find it interesting that some of us simply believe that the potential benefits already exist, while assuming none of the potential harms do. The tragedy of this logic was explained by Dr. Ed Gogek in the New York Times: “Indeed, marijuana activists use phony science...for years they claimed pot was good for glaucoma and never apologized when research found it could actually make glaucoma worse. They still insist weed isn’t addictive, despite every addiction medicine society saying it is. They’ve even produced their own flawed scientific studies supposedly proving that medical marijuana laws don’t increase use among teenagers, when almost all the evidence says just the opposite.” The consequences of marijuana use is bad enough in adults, but can be catastrophic for children and teenagers. The data mentioned by Dr. Gogek shows that when marijuana is legalized or legitimized, the perception of harm decreased among adolescents and use goes up. We’ve seen this trend in our own district: high school seniors in southwest Utah reported regular use of marijuana at a rate of

HEALTH

5.3% in 2013, which nearly doubled to 9.6% in 2015. 25% of high school seniors report having tried marijuana. The younger a person starts to use marijuana, the more damaging and long-term the impacts become, and the likelihood of using other drugs increases. No major public health organization endorses the concept of medical marijuana. In fact, they all universally reject the notion that smoking marijuana for medicinal purposes is valid. Both the CDC and the National Institute for Drug Abuse have called marijuana use a national public health crisis. Here’s a sample of what the scientific community is saying:

The American Cancer Society states “The ACS is supportive of more research into the benefits of cannabinoids. Better and more effective treatments are needed to overcome the side effects of cancer and its treatment. The ACS does not advocate the use of inhaled marijuana or the legalization of marijuana.”

The American Academy of Pediatrics (AAP) believes that

“[a]ny change in the legal status of marijuana, even if limited to adults, could affect the prevalence of use among adolescents.” While it supports scientific research on the possible medical use of cannabinoids as opposed to smoked marijuana, it opposes the legalization of marijuana.

The American Medical Association (AMA) has called for

more research on the subject, with the caveat that this “should not be viewed as an endorsement of statebased medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current

SWUHEALTH.ORG

WINTER 2016

standards for a prescription drug product.”

Dr. Christian Thurstone, a

professor of psychiatry at the University of Colorado and medical director of one of Colorado’s largest adolescent substance abuse treatment programs, said: “In the absence of credible data, this debate is being dominated by bad science and misinformation from people interested in using medical marijuana as a step to legalization for recreational use. Bypassing the FDA’s well-established approval process has created a mess that especially affects children and adolescents. Young people, who are clearly being targeted with medical marijuana advertising and diversion, are most vulnerable to developing marijuana addiction and suffering from its lasting effects.” Current evidence is compelling enough to support efforts that reject the idea of smoking marijuana as medicine, along with rejecting the idea that smoking marijuana for recreational purposes is acceptable or harmless. We should, however, support efforts to encourage research into the components in marijuana that might have medicinal value. Utah State Senator Evan Vickers, along with Representative Ed Redd, MD and others, are leading the fight for a common sense solution to this issue with a bill that would allow for specific compounds found in marijuana to be studied and used reasonably, versus legalizing the entire plant. If marijuana truly does hold answers to health problems that have not been treatable before, we need to find that out using the scientific method instead of allowing political interests to hijack the issue as a smokescreen for recreational use.

PREVENT

& TEENS By Kye Nordfelt SWUPHD Health Promotion Director

esults of the 2015 Utah Prevention Needs Assessment youth survey have been released and show a 300% increase in teens using electronic cigarettes, surpassing alcohol as the most commonly abused drug among youth. From 2013 to 2015, the 30-day use rate of e-cigarettes among high school seniors increased from 3.6% to 14.3%, with about 31% of 12th graders reporting having experimented with the drug delivery device. “This 300% increase in electronic cigarette use is unprecedented,” says Logan Reid, Director of Prevention at Southwest Behavioral Health Center. “I don’t remember the data ever showing such a sharp rise in the use of one drug in such a short period of time. And the scariest part about this trend is that youth are smoking more than just nicotine through these devices.”

E-cigarettes are drug delivery devices turning teens into addicts

The main drug used in e-cigarettes is nicotine (a tobacco

product), one of the most addictive drugs on the planet. Nicotine can harm brain development in teens and set kids on a course for years of addiction.

uously, even at home or in school, without the telltale smell of tobacco smoke.

In reality, e-cigarettes are just a convenient drug delivery device, a high-tech “pocket bong”. In fact, local law enforcement officers are finding youth and adults using marijuana and other liquefied drugs in electronic cigarettes. In terms of prevention and detection, these devices are a nightmare. They’re easily concealed and can be used fairly inconspic-

Currently, e-cigarettes are largely unregulated, relatively inexpensive (not taxed as a tobacco product), and are advertised freely (while tobacco advertising is restricted). E-cigarettes are marketed in ways that are appealing to teens. They are attractive to youth by the very nature of their technology, are promoted as less harmful, and include a wide

E-cigarettes are not regulated to protect vulnerable teens

WE ARE A VOLUNTEER GROUP OF HIGH SCHOOL STUDENTS COMMITTED TO MAKIN

HEALTH variety of appealing flavors. They are easily accessed in areas with heavy teen traffic and have little ingredient information. Elected officials on all levels are considering taking action to better regulate these devices in order to protect minors

What teens and parents are experiencing

Abigail Dickie, a senior at Snow Canyon High School and president of the Washington County Youth Coalition, says that kids talk about e-cigarettes all the time. “I have several friends who vape. They are really appealing to youth, and it’s scary how businesses market them toward us because there aren’t regulations on how they advertise, like there are on regular cigarettes.” Orion Parker, who also lives in Washington County, witnessed how his use of e-cigarettes influenced his seven-year-old son. Orion explains, “My son saw me using the device and asked

if he could try it. I told him arette - it was so easy for him to hide his use from me, as absolutely not and tried the smell was often not present. As he began using tobacco to make sure he didn’t see products, he totally changed, all of his values and friends me using it after that. One changed. I tried to protect him, but even at 14 he has had weekend, when I came no problem getting e-cigarettes.” She continues, “The othhome from a business trip, I picked E-cigarettes are now the most commonly up my son abused drug among youth in southwest from his Utah - it’s time to act! g r and m a’s , and she told me how my son had told her when he grows up he er thing I hadn’t realized is that e-cigarettes can be used wants to smoke that cool to smoke other things like marijuana. My son had denied e-cigarette just like his dad.” using any nicotine products and insisted that e-cigarettes Parker did not want his son were harmless, but I’ve since learned that isn’t the case. addicted to nicotine; he sub- Now there is a lack of trust between us and we’re worried sequently quit cold turkey about what he could be doing to himself.” and had a long chat with his son about the harms of to- How you can help bacco products. Over the past forty years we have witnessed a gradual decline in tobacco use. But now we are seeing nicotine usage Michelle (name has been skyrocket in the form of e-cigarettes. Increased consumpchanged), a Washington tion by teens is very troubling. Please work with us by getCounty resident, is a moth- ting educated on the impact of e-cigarettes on youth and er of four who is deeply talk to your local, state, and federal legislators about the involved in her busy kids’ importance of regulating these products in the same way lives, active in her faith, tobacco is. and like many parents, never thought her teenage son The health department is offering free e-cigarette presentawould use an addictive sub- tions for interested groups or organizations, covering the stance. “I was unaware that health risks of using these products and my son was addicted to nic- how to prevent further use by teens. Call or otine when he was arrested email Kye at 435-986-2593 or knordfelt@ for having an electronic cig- swuhealth.org to schedule.

NG A HEALTHIER, BETTER, AND SAFER COMMUNITY THROUGH DRUG PREVENTION! SWUHEALTH.ORG

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DI SAST E R R E S PO N S E An Interview With Paulette Valentine Division Director, SWUPHD Emergency Preparedness & Response

How does the local system for disaster re- What agencies are usually involved in disponse work? saster response? The community where an incident occurs takes the lead. Additional assistance is requested from outside agencies when local resources reach their limit. The tragic Hildale flooding in September was an example of how response efforts expand when needed. Washington County emergency services were contacted early on as town leaders realized the scope of what they were dealing with, followed by regional, then state support. As is typical for disasters of this size, an Emergency Operations Center (EOC) was set up to organize the work, along with a Joint Information Center, in which public information officers from various agencies worked together to handle local and international media inquiries.

What kind of scenarios do you practice? We’ve covered mass-casualty events, plane crashes, active shooters, and bioterrorism. In March 2016 we will conduct a full scale, region-wide exercise to practice handling a pandemic outbreak, where county EOCs will be set up and live “patients” will test hospital overflow plans.

There’s a wide variety of community partners that may play a part in any given disaster. Law enforcement, firefighters, ambulance, dispatch, hospitals, medical and mental health professionals, and churches, to name a few - not to mention the volunteers who show up. Each county has an emergency manager and we meet on a monthly basis to plan, train, and drill scenarios. We invite all potential responders, including all the organizations just mentioned, to do largescale exercises on occasion. These help us get to know each other and practice working together so we’re more unified when the real thing happens.

Regarding hospitals, what happens when they reach capacity? Hospitals would fill up rapidly in a health emergency such as a pandemic. The health department works with hospitals to make sure access to care is maintained. Most hospitals have good plans for handling the most acute and treatable patients while reassigning others to alternate treatment such as home health, skilled nursing facilities, or other extensions. There are also legal guidelines currently in development to accommodate circumstances where the number of patients exceeds the normal professional-to-patient ratio, so that medical staff can save lives in a drastic situation without fear of breaking any laws. When any hospital nears capacity, patients would be triaged before entering the facility, based on medical guidelines set up by the state of Utah in response to the 2009 H1N1 flu pandemic. Those who don’t qualify for the hospital would be referred to a Community Information Support Center before they return home. These are locations already established by most communities which will provide information on home treatment, along with supportive supplies such as hand sanitizer, disinfectant wipes, masks, gloves,

HEALTH and tissues. Each person will be asked if they have someone to look after them. If not, their preferred church will be contacted to follow up. If unaffiliated, the LDS Church has agreed to take care of them. This plan was actually activated in 2009 in our area as one hospital reached surge capacity and two patients were sent home to recover under the care of faith-based organizations.

What do we do well here in regards to preparedness and response? Overall, we have a great culture of personal responsibility combined with a willingness to help others. Our volunteer spirit is amazing. Utah ranks first in the nation for volunteering. Outside observers are also consistently impressed at how well our emergency response professionals work together during exercises and real events. We’re a little more isolated than metropolitan areas and are used to cooperating locally and calling for help when we need it.

MEET YOUR COUNTY EMERGENCY MANAGERS PETE KUHLMAN

Washington County WEB: washco.gov/emergencyservices FACEBOOK: washcosafety PHONE: 435.634.5734 EMAIL: eoc@washco.utah.gov

Where could we improve? I worry that there are still some of us who are well prepared ourselves but might be unwilling to share with others in need. Do we have any resistance to outsiders? What about tourists who may be stranded in our area during a disaster, or refugees from neighboring regions. Although personal preparedness is great, the willingness to share is the real test. The flip side of this issue is the mindset of people who don’t even have preparedness on their radar, or even worse, think “my neighbor or relative has food storage, I’ll just go to their house.” My mind would be more at ease if I knew everyone was budgeting for a little extra food and water storage. Wouldn’t it be better to know you were more of an asset than a liability in a disaster? It doesn’t take much to have at least a few weeks worth of extra food, containers of water, toiletries, and savings. The bills don’t stop coming in just because there’s an emergency. There’s a peace of mind that comes with knowing you could take care of yourself and your loved ones if something bad happened. I’ve had personal family emergencies in my life when we’ve had to live off what we had stored. It felt good to be self-reliant without having to ask the government for help. “Someone else will take care of me” is not a reliable or realistic philosophy.

How can we get involved in local preparedness efforts? Get trained with your local Community Emergency Response Team (CERT), which will help you be a better first responder when a crisis hits your area. If you have any interest in assisting us with public health emergency response efforts, join the Medical Reserve Corps (MRC), a federal volunteer program we administer locally. Follow your county emergency management websites and social media. Sign up with your county’s reverse-911 alert system, called Everbridge, to get automatic calls and texts for emergencies in your area. Since first responders are often whoever happens to be on the scene, get brushed up on first aid and CPR and stay current. Since crisis victims are often emotionally traumatized, become familiar with Psychological First Aid, a simple model of providing assistance for non-professionals.

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JOHN HIGLEY

Iron County

WEB: ironcounty.net/department/ emergency-management PHONE: 435.865.5332 EMAIL: jhigley@ironcounty.net

ALAN ALLDREDGE

Kane County

WEB: kane.utah.gov (click Everbridge logo to

PHONE: 435.644.4995 EMAIL: aalldredge@kanab.net TWITTER: @kanecountyEM

LES WHITNEY

Beaver County

PHONE: 435.691.2381 EMAIL: lwhitney@beaver.utah.gov

DENISE DASTRUP

Garfield County

PHONE: 435.676.1126 EMAIL: denisedastrup@gmail.com

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By Daniel P. Aldrich guest columnist

BEFORE THE

How “social capital” affects your recovery from disaster

e had moved to New Orleans in July 2005, fresh out of graduate school in Boston. My wife and I rented a home in the Lakeview neighborhood, just south of Lake Pontchartrain, and after six weeks felt settled in. We had a new house, new car, and had enrolled our children in nearby schools. Monday, August 29th would be the first day of my new job at Tulane University. That Monday never came, because Sunday morning, at 4 a.m., with a million other people, my wife and I and our two young children got in our van and evacuated just as the rain began to fall ahead of Hurricane Katrina.

spent several days wandering around in a daze as it began to dawn on us that we couldn’t go back. Our house had been destroyed along with our other car. Our computer, our paper records, books, pictures, and all of our stuff was gone. We had some interesting things to think about - what are we going to do next? I’m unemployed now, so how do we get by for the next few months? Having no private insurance, we applied for FEMA aid as soon as we possibly could with a borrowed fax machine and anxiously waited for help from the government. The response came six months later, and it was a no. After a big fight over paperwork, we finally received a check We drove about 14 hours to help cover the personal west to Houston, where we losses.

It was during the waiting period, however, that phone calls started coming in, some from people we’d never met before but linked through friends who wanted to help. Children sent us proceeds from a school bake sales. People in Detroit and in New York offered us places to stay. Tuition for the kids to go to school from a community in Tennessee. We were not popular celebrities and we didn’t have thousands of followers on Twitter. We were just normal people who soon learned that what was really going to help us, both in the short and long term, were these connections. I had a sort of light bulb moment when I realized I had the wrong set of expectations. I had believed that the government was this fix-all en-

tity, a sort of “white knight” that would swoop in immediately and save us after the disaster. But the reality for us was this: it was friends, friends of friends, family, and people from faith-based organizations and schools who came through for us after that disaster. That experience really changed my research. My background was in Japanese politics, but I was now fascinated by the degree to which our recovery after Hurricane Katrina was guided by our social connections. Was this normal? Was it the same in a poverty-stricken village in India or an urban homogenous, developed city like Kobe, Japan? As soon as life stabilized for us, I went to work researching this concept, spending a year

HEALTH and a half doing field work in Japan and India, talking to survivors and NGOs (non-governmental organizations), and collecting data. I was amazed at the similarity in stories from society to society and time to time. This project became my book, Building Resilience, published by the University of Chicago Press. Since then most of my work has been focused on understanding what it is that helps survivors around the world move forward and return to the rhythms of normal life after hardship, whether it be a tsunami, hurricane, earthquake, or other disaster. The devastating 1995 earthquake in Kobe, Japan not only left damage and casualties from the quake, but many fires started from ruptured underground gas lines. One such fire threatened the adjacent neighborhoods of Mano and Mikura. Narrow, debris-filled streets made it impossible for

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any firefighters to approach. The residents of Mano had worked together in the past and quickly organized a bucket brigade and put the fire out on their own. In contrast, the people of Mikura didnâ&#x20AC;&#x2122;t have that type of relationship. They were unable to work together and their neighborhood burned down. It didnâ&#x20AC;&#x2122;t have to do with how well-built things were or who had insurance, but how well had they cooperated in the past and how

well neighbors knew each other. Another example of the value of knowing your neighbors took place when the government of Kobe made an offer to the tenants of the hundreds of condominium buildings in the city. The city would come in and remove the tons of concrete, glass, and garbage from the grounds, but since this was private property, the unanimous consent of every resi-

PROMOTE

dent in the building was needed.

speak up and communicate. After Katrina, my wife and Many of the condominium communities were suddenly I had a moment when we caught short as they realized they had no names or contact sat down and said “What information for their neighbors who had evacuated. This are we doing? Are we going was before the internet was widespread. While some condo back to New Orleans or are groups were able to get all the names they needed because we going to build a new life? they had spent time networking and figuring out where Are our neighbors going everyone was, others were out of luck. It’s a stark example back? Will we have a place of the value of collective action, or the ability to correct a to buy food or gas?” Mayor problem that requires multiple people - in this case a whole Ray Nagin made all kinds of building of people - working together. There’s no way even announcements about going forward with moving back I’m a little worried about how much of t o g e t h e r, our lives take place online. We know few- but the reer of our neighbors’ names and spend less ality was we didn’t know time interacting with them. what was really going on until neighthe most active or intelligent person by him or herself can bors could get word to each do some things by themselves. Social scientists call this the other about who’s moving collective action problem. back, schools being open, aid distribution, and other In Building Resilience, I argue that social capital, which is a important information that fancy way of saying the connectedness we have with other wasn’t public knowledge. people, creates three mechanisms. One is this collective action ability, which is being able to work together as a group. A post-Katrina success stoThat takes familiarity and trust. Without trust, you’re not ry was the Mary Queen of going to guard each other’s homes. You can’t form a com- Vietnam (MQVN) parish munity patrol if you don’t trust your neighbor to be awake in New Orleans. This Vietduring his shift. Getting to know your neighbors’ names namese-American comand being able to get along in stable times will pay off in the munity had a high poverty crisis moments. rate, lower than average education level, and many Social capital also builds mutual aid, or informal insurance, spoke English as a second meaning if I need information, equipment, transportation, language, if at all. However, or a place to stay, we’ve met before and you trust me. You these people went to church know I’ll use your resources properly. Shaking someone’s together, sent their kids to hand for the first time after a disaster is never a good time school together, fought city to say “Hi, can I borrow something from you?” hall together, and shared a communal history. The peoThe third mechanism is what we call “exit or voice”, an eco- ple and community leaders nomic term meaning we either abandon the scenario or of MQVN shared a vision

of the future and what mattered to them. When the hurricane came, they evacuated together and kept in touch as they dispersed into shelters in other states. They visited each other and created a website to share information. So, when it was time to come back, it wasn’t piecemeal, it was organized and purposeful. MQVN was one of the first groups to return to the city and achieved a 90% business reopening rate. On the other hand, my neighborhood in Lakeview had little along those lines, and my family and I never returned. When I first started researching this field, I thought there would be obvious cultural and economic differences, but once you look at how we build ties, how we take risks or build trust, it’s almost always the same, whether in Japan or the United States. We fear social rejection so we tend to approach people who look and behave like us. This is called bonding ties, and it connects people who are quite similar in terms of ethnicity, culture, and religion. Bridging ties occur when people come together over shared common interests; such as sports and other activities, politics, or religion. Linking ties are rare and occur when you have an “in” with someone

HEALTH

in a position of power or authority, like having a friend on the mayor’s staff who can provide information or access not otherwise available. These forms of social capital are present in all societies, although in different amounts. You’ll see more bonding capital in a homogenous society like Japan, while bridging is more common in many American communities. Social scientists would also add home ownership, length of time living there, and responsiveness of local government to the list of what influences a person’s level of involvement in the community. Having open, transparent ways for citizens to have their voices heard is essential. We find that people get turned off fairly quickly when they don’t feel they are taken seriously by their leaders. Local governments should keep this in mind; once people don’t believe their government has their best interest in mind, then you’re really in trouble. Another barrier to connecting with others is our addiction to virtual life, where we stare at screens as a substitute for building actual human ties. Five hours on social media are five hours not having real conversations SWUHEALTH.ORG

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and nurturing real rela- block parties to get to know each other. Who is on oxygen? tionships, and you can’t get Is anyone confined to a wheelchair? Who has pets that will those back. I’m a little wor- need care? The truth is, the first responders are us. After ried about how much of our Katrina it took almost six days until people were able to lives take place online. We get food and water from the Red Cross. It took just as long know fewer of our neigh- for official responders to provide relief in the Kobe, Japan bors’ names and spend less quake. time interacting with them. After a disaster, a Facebook Before my own experience I had thought of myself as a page might be able to raise well-informed person. Then, over the next six months I money fairly quickly, but came to the realization that I had believed in the wrong what happens when power goes out and cell towers are down? I came to the realization that I had beThen your only help lieved in the wrong model for disaster is the people nearby relief. FEMA and other agencies provide a and if you’ve never met them before you great service but their mission and scope is won’t get the best re- limited and often bare bones. True personception when you’re al and community recovery doesn’t come asking to borrow from the top down, but their car or a generaFROM WITHIN. tor. When technology stops working, that’s the moment when geography becomes destiny. model for disaster relief. FEMA and other agencies provide You have to rely on what we a great service but their mission and scope is limited and call the “sneaker-net”; walk- often bare bones. True personal and community recovery ing to a neighbor’s house, a doesn’t come from the top down, but from within. That vistore, or a distribution cen- sion only comes from people who are willing to talk, work, ter. If you’ve already made and cooperate with each other. We are the ones to help and local connections and built that social capital, then it save each other. If disaster should strike your communiwill be easier to get mutual ty, may your story be one of people who had cohesion and aid and information. You experience working together beforehand, so that you will can quickly form a neigh- have strength when the storms come. borhood patrol or crew to remove heavy debris. Daniel is a full professor and Co-Director of the Resilience and It’s dangerous to become Security Program at Northeastern University. He specializes over-reliant on virtual con- in Japanese politics, nuclear power, and disaster recovery. His nections while ignoring the second book, “Building Resilience: Social Capital in Post-Direalities of day-to-day con- saster Recovery” (published in 2012 by the University of Chicasciousness. go), investigates how social capital facilitates recovery following disasters. Daniel lives in Boston with his amazing wife Yael Get to know the shut-ins in and their four children and has put a lot of time into getting to your community. Organize know his neighbors. PROMOTE

By Clint Albrecht SWUPHD Emergency Preparedness Specialist (Garfield County)

W O N’T YO U BE M Y

ave you ever walked into an office and seen a plaque that read, “A failure to plan on your part doesn’t constitute an emergency on mine”? This implies that a lack of planning can cause an emergency or potentially escalate the ill effects of one. So, could the opposite be true? The dictionary defines an emergency as, “An unexpected and usually dangerous situation that calls for immediate action.” What if, through preparation, a community could alter the definition of an emergency to this: “A dangerous situation where we are prepared for immediate action.”

green side (“I’m okay”) and red side (“need help”). During an emergency or disaster, families will hang the cards on the front door, indicating their status. Block captains will quickly assess their families and report to the district coordinator, who then reports to the city. Hurricane holds an annual drill on the Monday closest to September 11th every year. They record how many people were contacted and how long it took. Escalante’s preparedness committee identified potential disasters and plans were made to preIn many cases, the pare for them. Their extent of devastation assessment is strucYou can be years early as well as timeliness tured similarly to of recovery are deter- but not five minutes late Hurricane’s, with mined by the amount the city appointing a in your preparation for an emergency. of preparedness bepreparedness coorfore the event. This dinator who has an idea was reinforced eight-person commitby studying the aftermath of Hurricane Katrina. Research- tee; each of them are assigned a geographical area. They also ers found that whether the flood water was 12 feet deep or 6 have block captains in place who know the families they are inches, neighborhood preparedness was a better predictor of in charge of. The preparedness committee is in the process of recovery than water depth. gathering contact and resource information for each family that could prove useful in an emergency. Most people in southern Utah are familiar with 72 hour kits and personal/family preparedness. However, there are sce- Both cities have developed a quick and effective way to disnarios where families would need additional resources to seminate information to all of their citizens. In turn, it prohandle medical issues, fire, flooding, exposure to hazardous vides citizens with an avenue to inform the city of their situamaterials, and so on. What can be done as a neighborhood tion and needs through the block captains. A similar model and community to prepare for such emergencies? Two local can be adapted for use within any geographical area. Many towns, Hurricane and Escalante, have put plans in place with resources on how to set up neighborhood preparedness common elements which could be implemented anywhere. plans can be found online. There are surveys that help create a master list of community skills and resources available; Hurricane City recognized a need for creating a communi- including medical, mechanical, special equipment, vehicles, cation strategy that would alert all residents during an emer- and other assets that would prove valuable to local emergengency and allow the city’s emergency personnel to quickly cy response. assess the extent of damage in order to prioritize resources. They partnered with church congregations to separate Hur- Preparedness starts at home, but can be extended to involve ricane into geographical districts. A coordinator from each friends and neighbors with a simple program that could save district was assigned, along with block captains, who were lives and accelerate recovery. Take the initiative to get someeach responsible for four to six families. They maintain con- thing going where you live. Remember this saying: “You can tact information for each family, including any special needs be years early - but not five minutes late - in your preparation they may have. Each home was given a door hanger with a for an emergency.”

By Lexie Little H E A L T Specialist H SWUPHD Emergency Preparedness (Kane County)

P R E PAR E D N E SS

e have all heard how important it is to be prepared for an emergency and/or disaster. Some of you have an evacuation plan and a 72 hour kit, or even longer-term food storage. But what about special needs for the disabled, homebound, or elderly? Their situations often require extra precautions that need to be put into place when preparing for the worst. The Southwest Utah Public Health Department has put together a simple program, called Preparedness Buddy, that will help give extra peace of mind to those who need it most.

Step 1: Designate Your Preparedness Buddy:

Do you have a friend, family member, or neighbor who can make a commitment to check in on you when a disaster strikes? Once you have identified someone, talk with that person and make sure he or she knows how to contact you and is willing to come to your home to check on you, if needed.

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Step 2: Write Down Your Buddy’s Name and Phone Number:

Step 5: Write Down Anything Else Your Preparedness Buddy Needs To Know:

Add any other pertinent information you feel your preparedness buddy Write or print this informa- will need to know. tion onto a sheet of paper. Post it in a very obvious Step 6: Build Your place, or even in multiple 72 Hour Kit: locations, so it’s easy to find Have basic emergency for yourself and possibly a supplies in place to susrescue worker. tain yourself for at least three days. Include water, food, a change of Step 3: Write clothing, medications, flashlight, can opener, radio, hygiene items, and Down The a first aid kit. Make sure this kit is Medications stored in an easy-to-find location.

You Can’t Be Without:

On that same sheet of paper, include all your life-sustaining medications. Be sure to include the dosage and how often you take each medication.

Once you have completed these steps, be sure to go over the list with your preparedness buddy. Your buddy should know where your list is or have a copy.

If you might be vulnerable in a disaster, take some time to arrange your Step 4: Write Preparedness Buddy now. If you have a loved one who could use a Down The buddy but lives some distance from Medical you, spend some time to help find Equipment someone nearby who would agree to You Can’t Be Without: fill this role and walk them through Also include any essential the steps, if needed. medical equipment you use regularly. This could in- Any questions? Contact your local clude an oxygen concentra- health department for more informator, wheelchair, walker, or tion on emergency preparedness (see CPAP. inside front cover).

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FO R E M E R G E N C I E S By Kylaas Flanagan SWUPHD Emergency Preparedness Specialist (Iron County)

water & snacks flashlight

jumper cables

poncho

cash

blanket

hand warmers tow rope

folding shovel first-aid

reflection

car kit checklist

HEALTH

hen I was 16, I took a flight to see my father in Ohio during the holiday season. Unfortunately, I became stranded at my connection point in Cleveland when a huge snowstorm halted all flights going into Columbus. Thinking it would only be a two hour drive to the airport, my dad decided to make the journey by car to pick me up. On the way there, the conditions were terrible. He hit a patch of ice and ended up stuck in the median of the highway, waiting for a tow truck to help pull him back onto the road. He sat in the car for several hours, joining others in the same area who also needed assistance from the tow trucks running back and forth. I was stuck in an airport, but under far better conditions than my father, who could have really used a snack. We sometimes think that emergency kits are intended for significant disasters, but Dad’s experience would have been more bearable if he would have had a kit in his car. In either circumstance, being prepared for an unexpected crisis can result in peace of mind and minimized discomfort.

What should I have in my vehicle?

It varies from person to person. But most car kits should have at least these essential items: • Blanket • Hand warmers • First-aid Kit • Flashlight (and batteries) • Folding shovel • Water & a few snacks-- think granola or protein bars • Poncho or wind-breaker • Some cash in small bills Additionally, you might want to consider having these car-centric items: • Tow rope • Reflective material (cones, triangles, etc.) • Jumper cables You can find these car kits at your local hardware or department store for as little as $20 or as high as $80. The contents tend to be fairly similar, and supplementing them with other items your family needs is a great idea. For instance, I purchased a folding camp shovel for less than $10 and threw it in a crate in my trunk. In an emergency it can help dig me out of snow or get some dirt for traction. And it takes up the same amount of space as a novel. And having a book in the car isn’t a bad idea, either! If you don’t want to shell out $20 for a kit, you probably have most of those materials scattered around your house. Grab an old backpack (or head to your local thrift store), throw the materials into the bag, and toss it in the trunk of your vehicle. To make my kit materials more accessible, I use a plastic dorm-room crate that I found for around $3, but any sturdy box will do the trick. I use my kit all the time. This past summer, I grabbed the blanket and ate some granola bars to munch on while watching a metor shower, put out a campfire with my folding shovel at Red Cliffs, and often grabbed a water bottle from my trunk to quench my thirst while driving through the middle of nowhere. Just make sure to replace the materials you consume out of your kit - it doesn’t help to have a kit that doesn’t have the things you need in an emergency. If you think about it, the majority of our time is spent in one of three places; home, work, or in our vehicles. Spending a little time to make sure we’re prepared for an emergency in each of those places should be a priority.

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N E W YO U By Cambree Applegate Guest Columnist

ew Year’s resolutions get a bad rap. It seems that some of us make resolutions almost expecting they are going to fail, while others declare that “this year will be different”, but is it ever? Here are some simple ideas to get out of a resolution rut.

Measure your confidence

VAGUE GOALS SMART GOALS Having confidence that you will be able to accomplish your goal is vital. On “I want to eat “I will only eat out once a scale of 1-10 (10 meaning healthier” this month” that you have no doubt you “I will eat five servings will reach the goal), what is of fruit and vegetables your confidence level ? If it’s every day this week” below a 7 then you might re-work your goal to where Make long-term goals you feel more confident of Setting long-term goals success. “I want to get “I will park a block away can lead to accomplishing in better shape from work every day for great things that might have Make “SMART” goals this year” the next three weeks” seemed overwhelming at the beginning. Having an overPECIFIC: Know exactly “I will go for a 30-minall goal that you are continwhat you want to acute walk with a friend ually working towards lends complish. or family member three purpose and vision that can days a week this month” keep you on track. Make a EASURABLE: How goal you want to accomplish will you know when in a year, five years, even ten you’ve accomplished Change can be difficult, especially when it comes to changing years! your goal? our health habits. This year, millions of New Year’s resolutions will consist of some type of health goal. The excuse most often Make short-term goals used to set these good intentions aside is...a lack of time. Yet, TTAINABLE: Be honShort-term goals are where don’t we end up making time for the things we want the most? est with yourself and the real work gets done. And, the great thing about a healthy lifestyle is that it actually make sure that the They can be used to reduce adds time to our lives! goal is possible. long-term goals into tasks Try not to get frustrated when the results you want are not and objectives that are easier EALISTIC: Do you have happening as fast as you wish they would. Making small and to manage. You’ll arrive at the resources, knowl- simple changes in your lifestyle will make the process more your long-term aspirations edge, or capacity to pur- manageable and before you know it, getting three servings of sooner and the journey will vegetables a day or exercising three times a week will be a habit seem less daunting when sue your goal? instead of a chore. divided up into short-term IME-SENSITIVE: Give Cambree Applegate is a Health Educator and goals. Plus, your confidence your goal a completion Director of Safe Kids Utah for the Utah Departwill increase with frequent date. successes. ment of Health

S M A R T

cambree

HEALTH

Want To Be More Active? Be Creative!

Healthy Eating Tips

Who says exercise has to involve special clothes and sweat pouring down your face? If you can get up and get moving, you can call it exercise. Get creative throughout your day and find ways to challenge your body more than you might normally. Here are some ideas to get you started:

Often simple changes can make a big difference:

• Get up and be active during TV commercials - do things like dance, push ups, run up and down the stairs, jumping jacks, jump rope, lunges, sit ups, etc. • Have a snowball fight with the kids or get out and play tag. • Turn up some music and DANCE. • Fast walk - instead of walking at a snail’s pace, pick it up a notch! • Keep tennis shoes at work - when you have a break, bust them out and go for a quick walk. • Take periodic breaks - drop and do 10 pushups, or take some time to do some stretching if you can feel your muscles tensing. • Do weight lifting with everyday items - have to take the groceries inside? Load up and do a couple of arm curls, or hold them away from your body while you carry them inside to work your core muscles. • Make everyday things into a game - See how fast you can clean the bathtub, or race your kids to see who can rake the most leaves. • Periodically rearrange your room. Moving furniture is great exercise!

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• Don’t buy lots of junk foods If you see it, you’ll eat it. Buy smaller amounts and keep it out of sight or don’t buy it at all! • Keep a variety of produce around - Join a food co-op or a community-supported farm to increase variety and freshness of produce. • Cut up fruit and veggies for easy-to-grab snacks and keep them in plain sight on the counter or in the fridge. • Use recipes containing fruits and vegetables It may take several tries before a kid decides a food is good. Just keep offering them a variety of foods.

PROMOTE

PR E P By Al Cooper Guest Columnist

IT’S NOT TOO EARLY TO START PLANNING FOR THE UPCOMING GROWING SEASON

Planning & Persistence

suppose I am no different than many others who become annoyed with the ever-accumulating weight of unused coins in pockets and purses. My habit over the years has been to maintain neat stacks of that “surplus” on the top of a handy piece of bedroom furniture. I don’t know just how long it took me to notice that the piles of quarters were magically (but discreetly) diminishing between visits to my modest cache. Of course I have been married long enough to know what was happening, and in fact to take some secret pleasure in that sweet knowledge. The first surprise came one day when the subject actually came up - probably at the moment of some discussion on the subject of “household economics” - as my wife proudly informed me that she had $500 in quarters if we needed it. At a still later date when I asked and found that the “cookie jar account” had passed the thousand dollar mark, I began to take notice; there was a clear message here. Most important goals are not accomplished in “fell swoops”, but in steady and continuous effort. The arena of family and community preparedness and self-reliance is like that.

ward strengthening my own home and family and doing everything I can to help others. Just as October was the time for planting and mulching next year’s supply of culinary garlic, and early December was a good time to assemble starter packs for the winter kale and Savoy cabbage seedlings which will love the cool days and nights of the winter greenhouse, the calendar is filling up with reminders of things to do.

The winter months are prime-time for planning, preparing, and gathering supplies for the warmer months ahead, remembering that southwest Utah is a domain embracing several So, as we experience the end of one year and the beginning distinct and different cliof a new one, I for one intend to remember the power of matic zones; a reality which persistence in continuing to pursue worthwhile goals to- must be kept in mind.

HEALTH

JANUARY: This is a great time to consider your garden design and layout. Here are some popular options:

RAISED BED

Easier planting and maintenance. Less bending. Better weed control. Automatic watering an easy component. Lends itself to movable cage-type protection.

SQUARE FOOT

Works well with a raised bed, using a grid guide to plant by the square-foot. As individual plants mature and are harvested, a rotation system keeps production at a maximum and makes weed control easy. Water is not wasted on unplanted areas.

OPEN ROWS

Maximum use of a larger area. Greater production of long-growing crops. More maintenance. Consider plastic-tunnel cloche (transparent plant shelter to protect from the cold)

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PROMOTE

FEBRUARY/MARCH:

Now is the time to start thinking about getting seedlings or planting your own.

GREENHOUSE PLANTS, or started seedlings (usually from California) are best kept indoors or in a sunroom or greenhouse. After “hardening off ”, or gradually getting the seedlings acclimated to outdoor temperatures, they will have good root systems and can be planted early in the garden, although there is the danger of a late frost. When starting your own plants from seeds, you’ll have wider selection and specialty possibilities. It can be fun to study seed catalogs as early as November, and it’s never too early to plan your starting strategies and supplies. Here’s some seed-starting tips: • Use peat pots and compact seed pellets in plastic trays as a simple and inexpensive seed-starting system. Plan on replanting seedlings into larger size pots as they grow and develop root balls. • When selecting 2-tube indoor fluorescent light sets, consider combining one grow light and one regular bulb for a wider color spectrum. Searching for distant light makes for tall

and “leggy” plants. Serious seed-starters may want to invest in an electric tray heating pad designed to speed up the germination process. • When planting peat pot starts in the garden, make sure the peat material is fully covered by soil. It might be necessary to pinch some of the peat away, to prevent “wicking” of water needed by expanding root growth. • A must for the thoughtful gardener is a product known generically as “floating row cover”, a nearly weightless plant protector which permits moisture and airflow to penetrate; creating warmth while reducing wind and sun damage. Buy it by the roll and cut to size. I wouldn’t be without it. • Some proven seed sources are Territorial Seed Company (includes many heirlooms), Totally Tomatoes (hundreds of varieties), The Cook’s Garden (varieties not found anywhere else), and Oregon Trail Garlic. Google for catalogs.

HEALTH

GARDENING FOR THE FUN OF IT I think it is worthwhile to involve young children in the gardening ethic. It will serve them well in their own future family-keeping while reinforcing the whole ideal of family traditions. This is where “specialty” gardening adds interest for everyone; especially kids. I have had fun with:

Heirloom Tomato Garden:

Brandywine, Mortgage Lifter, Pineapple, German Johnson, Georgia Streak

Fun Projects:

When a Winter Squash like Hubbard or Buttercup still has a soft outer skin, carve a name or other image using The Italian Garden: a ballpoint pen. The vegetaSpaghetti Squash, Sweet Ba- ble will produce a permasil, Oregano, Eggplant, Zuc- nent healing rhind around it chini, Roma Tomato while ripening.

Garden of Color: As a young cucumber of a

Radish Mix, India Paint small or pickling variety beEggplant, Chioggia (Pin- gins to show growth on the wheel) Beets, Carrot Color vine, slip a half-pint canning Mix bottle over the fruit. Protect it from direct sun to avoid Native American “cooking” it. As the cucumGarden: Calico Corn (ornamental), ber grows it will fill the jar, Scarlet Runner Beans, But- adapting to the container’s tercup Squash, Baby Boo shape. Break the glass for a jar-shaped surprise. Pumpkin

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SOME FINAL ADVICE FOR THE FIRST-TIME GARDENER Don’t expect perfection in all things the first time around. Keep a “garden book”, outlining details of your experiences; good and not-so-good, and perhaps changes you know you should make. Not every variety of a particular choice may do well in your specific locale. Note things such as sun-angles, shady spots, wind effect and needed soil improvements. Above all, think of the health and attitude benefits that come with getting on your knees and touching the world of sun, soil, and fresh air. And you might just lose your taste for those store-bought “make believe tomatoes.” Al Cooper served for many years as an emergency management executive at both the county and state levels and was the second person to be inducted into the Utah Emergency Management Hall of Fame. Al is an author, blogger, and columnist. He is a lecturer on a wide range of topics; from preparedness and patriotism to history and culinary arts. He is perhaps best known locally as a radio personality with his long-running weekly talk show, Provident Living-Home and Country, which airs every monday at 4 p.m. on KSUB 590. Al and his wife are enjoying life on their 20-acre Rockville homestead. They have four children, ten grandchildren, and fifteen great-grandchildren.

PROMOTE

How can you get involved?

MRC

Volunteering in your community is a great way to get more connected and invested in where you live. Not only will you contribute to the overall resilience of your neighborhood and city, but there are personal benefits as well; research shows that people who volunteer have lower mortality rates, greater functional ability, and lower rates of depression later in life compared to those who don’t volunteer. Here’s some good ideas to get you started:

The Medical Reserve Corps (MRC) is a national network of local groups of volunteers engaging local communities to strengthen public health, reduce vulnerability, build resilience, and improve preparedness, response, and recovery capabilities. Are you a current or retired nurse, doctor, pharmacist, or mental health therapist? Or do you have any experience in medicine, public health, safety, logistics, or communications? While these skills are valuable, over half of the current volunteers who assist the Southwest Utah MRC do not have medi-

cal training, but their willingness to help is vital to the program. Volunteering with the MRC is a simple and effective way to use and improve those skills, while helping to keep your family, friends and neighbors safe and healthy. Besides training opportunities, you may be called upon to assist the Southwest Utah Public Health Department and other community partners with drills or actual emergency response. Call or email Megan at 435-986-2556 / mchurch@ swuhealth.org for more information.

Community Emergency Response Teams (CERT) have been established in many cities and counties in our area. CERT trains and organizes teams of volunteers that provide assistance to their communities before, during, and after disasters. CERT volunteers help others - including their own family and neighbors - following disasters when professional responders are not immediately available to help, and supplement and support the efforts of professional responders upon their arrival. Volunteers also support emergency response agencies by organizing and participating in local preparedness projects

and initiatives. The CERT program educates participants about how to prepare for hazards that may impact their communities and trains them in basic disaster response skills, such as fire safety search and rescue, team organization, and disaster medical operations. Utah has the 6th highest number of CERT teams in the nation, including 20 in southwest Utah! To find out about joining a team near you, visit fema.gov/ community-emergency-response-teams and enter your zipcode in the “Find nearby CERT programs” link, or contact your local County or City Emergency Manager.

Have you ever wanted to volunteer but didn’t know where to start? Is your non-profit organization overwhelmed with a project that could use some volunteers? JustServe.org provides a simple solution by linking community needs with people who want make a difference. Launched in California in 1992, JustServe expanded to several other states and is now up and running in Utah’s Washington and Iron counties. There are over 100 local volunteer opportunities posted on the JustServe.org website. Anyone who wants to volunteer can visit the website, enter the zip code, and choose where they want to help out!

One of the most important shots for your baby may be the one YOU get!

Parents and caregivers are often the ones who end up infecting their infants with pertussis (whooping cough). Babies are especially vulnerable since they are not fully immunized until they are at least 15 months old. They are also at greater risk for being hospitalized with seirous complications from pertussis. Even if adults have been immunized, whooping cough immunity can fade over time, The Centers for Disease Control (CDC) now recommends that adults get a â&#x20AC;&#x153;Tdapâ&#x20AC;? booster to prevent getting sick and spreading the illness to infants in the home. This is a single dose vaccine that protects against pertussis as well as tetanus and diphtheria.

FREE

TDAP BOOSTER

FOR ADULTS AGES 19-64 WHO ARE UNINSURED

Offer ends July 2016 - Just visit one of our clinics See inside front cover for locations

NON PROFIT ORG US POSTAGE PAID SALT LAKE CITY, UT 841 PERMIT # 6563

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