Encouraging Employers to Promote Health at Work
By Rose Hoban
In many rural counties, the 10 largest employers – the hospital, the school, local government, manufacturers – will employ about 25 percent of all the local workers.
Now health care advocates are looking to tap those 10 largest employers to promote community health.
This “Power of 10” is an idea Chapel Hill-based Prevention Partners is promoting to business leaders all over the state. The group gathered Triangle employers to pitch their ideas and strategies this week at a meeting in Raleigh.
“Public and private employers are starting to build policies and environments to help employees be as healthy as they can,” said Meg Molloy, president and CEO of Prevention Partners, a not-for-profit organization that works to improve employee health and, with it, the fortunes of businesses.
Prevention Partners is the organization that helped all of North Carolina’s school districts and then hospitals go tobacco-free in the early 2000s. Now the organization is working to reduce the incidence of obesity, diabetes, heart disease and stroke in North Carolina through their “WorkHealthy America” program.
The idea to disseminate Prevention Partners’ knowledge across all 100 counties came from former Secretary of Commerce Sharon Decker, who met with Molloy in 2012.
“We talked about the notion that if North Carolina had healthier employees, we’d have healthier businesses and a stronger economy,” Decker said. “We could attract more companies if our health care costs are lower.”
Decker said Prevention Partners was the right group to get these ideas out there because the organization has a lot of experience helping businesses get healthier and has data and research on how to do it most effectively.
“Prevention Partners brings the technical support,” Molloy explained. “We help benchmark the science; we show people what to do and how you do it.”
Molloy said one example of an easy workplace policy to improve health is to promote breastfeeding among new mothers.
“We encourage businesses to have a mothers’ room and have policies that are clear to a woman’s supervisor and herself that she has time to use the mothers’ room to express, store and refrigerate breast milk,” Molloy said.
The basics for creating such a room are simple: a chair with arms, a dormitory-sized refrigerator for storing milk and a sink for handwashing.
Stephanie Emerson from Asheville-based accounting firm Johnson Price Sprinkle PA told the meeting how Prevention Partners helped her employers build a culture of health, first through helping people get to the local YMCA.
“We didn’t have anything in a policy or a procedure,” Emerson said. “Some things you might already do, but just make those a formal program; make those part of the everyday life and the culture of the organization.”
She said the company did small things that made a big difference.
“During tax season, you used to see cakes, but those things went away,” Emerson said. “Now I look back at the last six years of transformation. Not that it was a horrible group of unhealthy people to begin with, but now [health] is the culture.”
She said her employers have incorporated wellness initiatives into the strategic plan for the company.
“We used it as an opportunity to do something really great for our employees, because our employees are our number-one resource,” Emerson said.
Molloy said they’re aiming at getting the 10 largest employers in each county involved in improving workplace wellness by the year 2025. Prevention Partners also has strategies for small- and mid-sized employers to help them improve their employees’ health.
“We help benchmark the science, we show people what to do,” she said. “How you do it may vary based on the size of your company, your budget.”
Study: Flavored Tobacco Popular Among Tobacco-Using Teens
By Ariella Monti
Flavored tobacco seems to have hooked young smokers.
According to a Centers for Disease Control and Prevention study, about 70 percent of middle and high school students who have used a tobacco product in the past 30 days have used at least one flavored tobacco product.
Like studies before it, the CDC report finds that e-cigarettes are one of the top tobacco products used by teens. Data from the 2014 National Youth Tobacco Survey show that in the past 30 days, 63 percent of current tobacco users used a flavored e-cigarette. The same number also used a flavored cigar. Flavored hookah tobacco was used by 61 percent, and 59 percent had used flavored smokeless tobacco. Menthol cigarettes hold strong at 54 percent, and 42 percent used flavored tobacco in pipes.
Overall though, 18 percent of all high school students reported using at least one flavored product in the past 30 days. About 6 percent reported using only non-flavored tobacco products. E-cigarettes were the most commonly used flavored tobacco product among high school students, at about 9 percent.
“Flavored tobacco products are enticing a new generation of America’s youth into nicotine addiction, condemning many of them to tobacco-related disease and early death,” CDC Director Tom Frieden said in a statement. “Nicotine is not safe for the developing brain, and we must do everything we can to protect kids from a lifetime of tobacco use and nicotine dependence.”
The CDC says that sustained efforts to implement proven tobacco-control programs and policies are necessary to prevent all forms of tobacco use, including use of flavored tobacco products, among U.S. youth. For example, several local jurisdictions, including New York City, Chicago, Providence (Rhode Island) and Santa Clara (California), have acted to limit or restrict sales of flavored tobacco products in these communities.
Additional strategies to reduce youth tobacco use include increasing the price of tobacco products, adopting comprehensive smoke-free laws, implementing national public education media campaigns and raising the minimum age of purchase for all tobacco products to 21.
Source: CDC release
New Tool Helps Parents Find the Right Child Car Seat
By Ariella Monti
The National Highway Traffic Safety Administration has launched a tool that will help parents and caregivers find the perfect car seat for their children.
As part of a national campaign, the agency also added the ability to look up car seat recalls on its mobile app and is reminding parents to register their child’s car seat with the manufacturer so that they can be immediately informed of recalls.
To find the right car seat for their child, parents or caregivers enter the child’s age, height and weight into the tool, after which it will provide a result based on the NHTSA’s best-practices recommendation.
Before purchasing a car seat, parents can use the agency’s mobile SaferCar app to search for car seat recalls. Once purchased, parents should register the car seat with the company to ensure that they are notified immediately of any future recalls.
In 2014, more than 7.4 million car seats were recalled, but according to the NHTSA only about 40 percent of people on average get their car seats fixed. Comparatively, 75 percent of car owners get their car fixed after a recall. Unlike car seat registration, vehicle registration is required by law.
The agency also offers local car seat inspection stations – in North Carolina these are primarily fire and EMS stations – with certified child passenger safety technicians that can inspect your child’s car seat and show you how to install it properly.
Celebrating World Rabies Day with Cheap and Free Vaccines
By Gabe Rivin
By 9:00 a.m. Saturday, the cars started to line up. Drooping ears and long snouts rummaged around the cars’ back seats. And Gaston County’s animal care and enforcement staff, syringes in hand, began their morning’s work.
The event, a free rabies vaccine clinic for pets, was part of Gaston County’s celebration of World Rabies Day, an international event held each year on Sept. 28. The day, according to public health officials and others, helps raise awareness about rabies, a deadly virus that can be transmitted among mammals.
“It’s very important to publicize to let everybody know the seriousness of the disease,” said Sgt. J.F. Phil, a field supervisor for animal control in Gaston County’s police department, which worked alongside the county’s health department to run the rabies clinic.
Throughout North Carolina each September and October, county health departments offer free or low-cost vaccine clinics, often tying the clinics to World Rabies Day. The efforts, they say, help minimize rabies’ presence among dogs and cats, which ultimately protects human health.
In 2014, North Carolina reported 352 cases of rabies in animals, according to data from the N.C. Department of Health and Human Services. Though numerous wild mammals can carry the disease, raccoons are the primary hosts.
“In North Carolina, and pretty much all of the East Coast states, they serve as the reservoir,” said Carl Williams, the State Public Health Veterinarian at DHHS. “That’s why we talk so much about leaving wildlife alone and keeping your pets vaccinated.”
Rabies is primarily transmitted through saliva, when one animal bites another. The virus infects the central nervous system, attacking the brain and ultimately leading to death. But humans can be treated for rabies, before or after an animal bite, through vaccines.
Williams said rabies is a minor threat to humans in the U.S. compared with countries like India, which has a larger population of rabid, feral dogs. And North Carolina has reported only two cases of rabies in humans since 1955, a testament to the state’s services in public health and animal control, he said.
Helping low-income pet owners
In North Carolina, pet owners are legally required to vaccinate their dogs, cats and ferrets against rabies, a requirement that mirrors those in other states, Williams said. Under state law, counties must offer at least one rabies clinic each year.
Yet some counties go beyond the state’s minimum requirements.
Wake County hosts its own low-cost rabies clinics throughout the year, including an Oct. 3 clinic this year that coincides with World Rabies Day.
But the county also works to educate the public about rabies. On Oct. 5, as part of its celebration of World Rabies Day, the county’s animal center and human services department is hosting a public event, in which they will distribute brochures about the virus and the importance of vaccines.
“People really are at times confused about what exactly rabies is,” said Ricci Kearney, the volunteer and outreach coordinator with the county’s animal center. “Some people are even confused that it can be spread to humans as well. It’s such an important day to recognize, because it’s such an easy thing to prevent.”
At its Oct. 3 clinic, the county will offer vaccines for five dollars. Kearney said the low costs keep the vaccines affordable for some residents who otherwise couldn’t pay for them.
Vaccine prices vary at private veterinary clinics throughout the state. At Wake Forest’s Banfield Pet Hospital, for example, rabies vaccines range from $20 to $32. TotalBond Veterinary Hospital, in Davidson, charges between $19 and $24.40.
Along with its lower prices, Wake County also tries to make its vaccine clinics convenient for residents, Kearney said.
“Normally, it’s a long line of a bunch of barking dogs and meowing cats,” he said. “We have volunteers that go out to the line, and they complete the necessary paperwork for the public.”
The county’s work extends beyond rabies clinics. Animal center staff sometimes drive to areas with many low-income residents and go door to door offering to vaccinate pets.
Kearney said that rabies clinics are a great way to connect with residents who love their pets.
“You also interact with a lot of individuals who may be on hard times, who may not be able to afford a full-price vaccine at their vet,” he said. “To be able to come out and spend five dollars and know their pet is protected for a year or three years is just great.”
Phil, of Gaston County’s police department, struck a similar note about the importance of low-cost vaccines.
“Sometimes you see people have a hard time making it themselves, but you see that they take good care of their animals, even though they’re having to cut back from stuff for themselves,” he said. “Even people who can’t afford medical care for their animals, it’s good to be able to provide the vaccine for them.”
Update: An earlier version of this story said that Wake County planned to distribute brochures today. The event was subsequently postponed until Oct. 5 due to weather, and now has been postponed indefinitely.
Bull City Stand Down Serves Vets’ Health Needs
by Liz Schlemmer
Vietnam veteran Rodney Ford walked away from the Bull City Stand Down last week with a sleeping roll, a rucksack of clothes and toiletries and information about Agent Orange exposure screenings.
The event was one of hundreds held across the country. In Durham, the Stand Down occurs every third Friday in September in honor of National POW/MIA Recognition Day. The U.S. Department of Veterans Affairs works with local partner organizations to put on the fair aimed at serving the needs of veterans, especially those who are homeless.
Ford is living on the floor in the home of another Marine veteran in Durham, putting him among nearly 50,000 veterans estimated to be homeless each night, according to the U.S. Department of Housing and Urban Development.
In the concession stands of Durham County Memorial Stadium, barbers gave free haircuts and volunteers handed out sack lunches. The stadium’s locker room was open for showers.
A few dozen veterans stood in line to pick up backpacks filled with provisions. Any veteran who is homeless may receive a sleeping pad, blanket and heavy coat.
Booths at the Bull City Stand Down offered a range of aid – from legal services to housing to help refinancing a mortgage – but a large portion of the partner organizations were catering to veterans’ specific health needs.
Across the street from the stadium, the Durham National Guard Armory was packed with booths that addressed those needs.
Klint Floyd came for help in getting a driver’s license and a pair of glasses. At the Durham County Register of Deeds table, Floyd filled out a form to request his birth certificate, his first step in obtaining a license. Requests for locally archived certificates are free to veterans if the document is needed for other aid.
“The stand down is important because it brings a lot of services together and a lot of veterans in need, and you get it all at one place, at one time,” said former event chair Darryl Henick. “There are so many providers, and I thank all of them.”
The Bull City Stand Down is one of nearly 200 stand downs held annually across the country, including in Winston-Salem, Hickory, Salisbury, Fayetteville, Asheville, Havelock and New Bern.
Upcoming stand downs in North Carolina:
Raleigh: Oct. 16 at South Wilmington Street Center
Greensboro: Sept. 25, 8 a.m-3 p.m., at Westover Church
Greenville: Oct. 23, 9 a.m.-2 p.m., at Eppes Recreation Center
Students Create Health Care Apps for Competition
By Dylan Field
A team of five undergraduate students and one Ph.D. student took home two awards, including the Grand Prize at the inaugural Triangle Health Innovation Challenge on Sunday afternoon. In addition to $9,500 in cash and credit, the winning team gets to present its work at the Health 2.0 NC Triangle event on Sept. 23.
The Triangle Health Innovation Challenge, a three-day event held at the Trent Semans Center for Health Education at Duke University, was organized by Duke and UNC-Chapel Hill students to bring together talent from around the region to solve pressing issues in health care.
Students, clinicians, entrepreneurs, engineers and designers were among the dozens of participants from around the Triangle who brainstormed solutions to 24 problems.
The device the winning students designed would allow physical therapists to monitor how often their patients complete prescribed exercises and whether patients do the exercises correctly.
Tannya Cai, an undergraduate researcher at Duke, said one of the device’s biggest benefits is that it would give real-time feedback to the patient that could help the patient avoid additional injuries.
Like the other contestants at the conference, Cai and her teammates – Maghana Shamsunder, Mihir Pershad, Dhruv Patel, Shih-Han Chang and Cameron Valadez – came up with the idea for their device and built it in two days.
“If patients don’t do their physical therapy at home, they are at increased risk for re-injury and they often don’t get better, because most physical therapy ends up being on your own time,” said Pershad, a senior biochemistry major at UNC-Chapel Hill.
During his team’s pitch, he estimated that 70 percent of patients fail to do their required exercises.
Other winning pitches included a breathing-exercise device for people who suffer from chronic lung diseases, a waiting room scheduling app and a real-time electronic health record app.
Fifteen teams made three-minute pitches for their products to a panel of judges. Then the student teams took questions from the judges.
The judges for the top three innovation prizes, as well as the Mosaic Health Solutions Prize, were P. Kay Wagoner, entrepreneur-in-residence at the Eshelman Institute for Innovation; Bobby Bahram, managing partner at Excelerate Health Ventures; and Eric Poon, chief health information officer at the Duke University Health System. Andrew Hooge from Validic was the judge for the Validic mHealth Prize.
Teams were judged on the impact their idea might have, how well they executed their idea, the business plan attached to the idea, the composition of the team and the pitch itself.
Local-Government Bill Changes Well-Water Permitting
By Gabe Rivin
A bill that received final approval in the General Assembly and will make several changes to the way county health departments permit water wells is on the way to Gov. Pat McCrory’s desk for signature.
House Bill 44 affects numerous areas of local government, including overgrown-vegetation ordinances and requirements for signs. It would also change county health departments’ criteria for permitting water wells.
In North Carolina, roughly 30 percent of residents rely on private water wells, according to the N.C. Department of Health and Human Services. Residents’ well water does not face the same health requirements as water from public systems, a potential threat that concerns some public health researchers.
HB 44 would touch on several health issues related to water wells:
- Can’t stay off the grid with contaminated water. Under HB 44, residents could still use private water wells in areas that offer public water services. But a local government could force residents to switch, given a few conditions. These conditions include the government’s finding that a well’s water is contaminated and that the well has failed and can’t be repaired.
- Keeping private and public services separate. The bill also would allow residents to use both well water and public water on their properties. But residents would not be allowed to send their non-potable well water to public sewers.
- Standard forms. In the past, local governments could petition state regulators to use locally tailored permitting forms; state regulators could allow the use of the forms, so long as they found that the forms would reduce threats to the public’s health. With HB 44, that option would be eliminated and local governments would have to use standard, state-developed forms.
Needle-Disposal Bill Gets Positive Review
By Rose Hoban
It happens every year at the legislature: Once lawmakers at the General Assembly have a final spending deal, bills that have been stuck in committee and that may have been used as bargaining chips during budget negotiations start appearing in committee meetings.
One of those meetings was Wednesday’s session of the Rules and Operations of the Senate Committee, where more than 300 bills are currently parked. That morning’s confab saw lawmakers working through 13 pieces of legislation, with amendments and replacement language in a number of the bills.
One such bill that’s been waiting for action is House Bill 712, which has been sitting in the rules committee since April.
The bill would allow the State Bureau of Investigation to work with the North Carolina Harm Reduction Coalition to create a pilot project to make it easier to dispose of used hypodermic needles and syringes that may have been dirtied by people using heroin and other injectable drugs.
“The problem now is that if you agree on a Saturday afternoon to go out and pick up old needles in the park to help your town clean up, you’re technically in violation because you’re in possession of a needle that may have residue in it,” Rep. John Faircloth (R-High Point) told the committee as he introduced the bill.
The bill would allow someone to avoid prosecution for turning in used needles with drug residue in them, whether they’re a person cleaning up a park or someone who has used the needle to inject drugs.
“We think this is a good way to protect the public,” Faircloth said.
The bill states that the measure is an attempt to reduce transmission of HIV and hepatitis, among other blood-borne diseases.
The two-county pilot would create secure places for needle disposals, along with providing information about drug-treatment counseling and referral services.
“Because heroin death have quadrupled in the past five years, North Carolina is facing a crisis of what to do with the syringes left over from injection drug use,” said the Harm Reduction Coalition’s Tessie Castillo. “These syringes are currently clogging our parks, trash cans and sewage systems, putting children, law enforcement and the public at risk for needle-stick injury and exposure to diseases.”
Faircloth, a former Greensboro police chief, has expressed concern about law enforcement officers who have to search people who might have hypodermic needles in their possession.
“I remember having officers sticking their hands into someone who they were serving a warrant and getting stuck,” Faircloth said this spring at a meeting on reducing heroin abuse. He’s led the charge on getting other harm-reduction bills passed, including one that allows for someone possessing a needle to surrender it to police without fear of prosecution.
Faircloth’s bill met no opposition in the rules committee and heads to the Senate floor.
“We are really excited about H 712,” Castillo wrote after hearing the bill had moved forward. “The [General Assembly] is finally recognizing the problem and taking steps to help communities collect these syringes and safely dispose of them.”
Budget Provision Takes Aim at Planned Parenthood
By Rose Hoban
Buried in page 163 of the 429-page final state budget bill is a seven-line provision limiting the use of state funds for “family planning services, pregnancy prevention activities, and adolescent parenting programs.” The provision doesn’t say the words “Planned Parenthood,” but that was the organization in the sights of budget writers, because the group also provides abortions.
If the state budget is passed and signed into law, Planned Parenthood will lose funding for programs in Fayetteville and Wilmington that have helped teens avoid getting sexually transmitted diseases, encouraged them to delay sexual activity and helped teen moms get through high school.
Melissa Reed, vice president for public policy for Planned Parenthood of the South Atlantic, said she had expected some targeting of her organization in the final days of the legislative session, but wasn’t expecting these particular teen-health programs to be in the crosshairs.
“The Adolescent Parenting program [in Wilmington] is fantastic,” Reed said of the program that’s been running for close to 16 years. “We work with teen moms. They’re already parenting, and we help them make choices to delay having a second child. We also provide them with case management so they can juggle the demands of parenting and high school.”
Planned Parenthood also offers a Teen Pregnancy Prevention Initiative program in Fayetteville. It receives $135,000 in state funding for the two projects.
The Planned Parenthood Federation of America has been targeted at the federal level this summer after the release of doctored videos that purport to show organization officials discussing selling fetal organs.
So Reed said she expected some kind of backlash on the state level.
Planned Parenthood no longer receives funding from the state government for family-planning activities and the organization hasn’t gotten any state funding for abortion services in years.
“Both programs have always been competitive, and our evaluations have been overwhelmingly positive,” Reed said. “We’ve had such a great relationship with the state and a proven track record.
“That’s the reason the state keeps funding us to do this.”
Doctor-Owned Hospitals Are Not Cherry-Picking Patients, Study Finds
By Jordan Rau
Physician-owned hospitals are often vilified in America’s health care system, accused of siphoning the most profitable operations away from other hospitals while leaving them with the sicker and poorer patients. Congress has banned new ones from opening.
But an independent study released Wednesday argues physician-owned hospitals have gotten a bad rap. The study, published online by the British medical journal The BMJ, concluded that overall, physician-owned hospitals are not cherry-picking patients or limiting themselves to the most lucrative types of procedures and operations.
Some of these hospitals specialized in a narrow set of procedures, but they treated only 20 percent of patients who went to physician-owned hospitals, the study found. The rest sought care at doctor-owned hospitals that offered a range of services similar to those at community hospitals.
“By and large, physician-owned hospitals have virtually identical proportions of Medicaid patients and racial minorities and perform very similar to other hospitals in terms of quality of care,” said Daniel Blumenthal, the lead author and a clinical fellow at Massachusetts General Hospital.
The 2010 federal health care law not only banned new doctor-owned hospitals but also limited growth of existing ones. Legislation introduced in May in Congress that proposes to lift these restrictions is opposed by the main industry group, the American Hospital Association.
The study disputes more than a decade of previous research into the topic. In 2005, Congress’s independent Medicare Payment Advisory Commission, or MedPAC, examined 48 specialty physician-owned hospitals and found evidence that they took the easier and better paying cases.
The inspector general of the Department of Health and Human Services reported in 2008 that specialty hospitals owned by doctors often lacked emergency rooms and around-the-clock staff who could respond to medical emergencies. Hospitals with emergency rooms tend to take care of more low-income patients and people with chronic ailments, like heart failure, which aren’t as profitable as elective surgeries.
Thomas Nickels, an executive at the hospital association, called the BMJ study “incomplete and somewhat flawed.” He noted that the researchers had not examined whether physicians were more likely to refer patients to their own hospitals. Such self-referrals are one of the main issues the AHA has cited in asking Congress to retain the health law’s restrictions.
“They refer patients to their hospital that they want and they don’t take others,” Nickels said. “These institutions are enormously profitable, and they’re profitable because they’re choosing what kind of patients to take.”
But the new study concludes it was a mistake to judge physician-owned hospitals by just looking at those that specialize in narrow types of services. Of the doctor-owned hospitals the researchers identified from data provided by the Physician Hospitals of America, a trade group, 99 were specialty hospitals, but the majority, 120, were general acute hospitals.
Those hospitals had sicker patients and more low-income and minority patients than did the specialty hospitals, even though both types were owned by doctors. Together, patients at physician-owned hospitals were slightly healthier than those at hospitals doctors did not own, but patients had similar death rates and faced the same numbers of chronic diseases.
“Overall, the differences, if they exist at all, are tiny,” said Ashish Jha, the study’s senior author and a professor at the Harvard School of Public Health. “There are much bigger differences between public hospitals and nonprofit hospitals, but we don’t go around banning all nonprofit hospitals.”
The study found that 6 percent of Medicare hospital admissions in the areas studied were at doctor-owned hospitals, suggesting that those facilities are not having a “meaningful impact” on the finances of other hospitals.
“Our work suggests that some of the major criticisms of [physician-owned hospitals], including that they select more profitable patients, provide lower value care, and threaten the financial viability of surrounding hospitals, may no longer be valid,” the study said.
R. Blake Curd, president of Physician Hospitals of America, applauded the study, saying it backs up what they have been arguing for years. “This is a great look at the physician-owned hospital industry as a whole,” said Curd, a hand surgeon in South Dakota. “You can’t paint us with one broad brush stroke, which is what the American Hospital Association is always trying to do.”
The legislation to lift the ban on new physician-owned hospitals is in the House, but Nickels said no companion bill has been introduced in the Senate. “There seems to be very little interest in the Senate to pursue it,” he said.
But Curd said he expected a Senate bill would be introduced and said lawmakers were receptive. “It’s fine for Congress to reevaluate the policy decision they made in 2010,” he said.