MoRPH Volume 1 Issue 1

MoRPH Minds of Rutgers on Public Health

Fall 2012

Volume 1 IsSUE 1

In This Issue

Social Media and Risk Communication

1

Indoor Tanning and Its Link To Cancer

2

Recent Storms and Risk Communication

2

Mobile Health as a Program Prevention Method for Diabetes

3

Importance of Surge Capacity During Katherine Ficalora Public Health Response

Social Media and Risk Communication

R

isk Communication is not a new concept—it is, at its basis, a major part of public health and all forms of prevention. Risk Communication, however, is changing with the progress of technology and the advent of social media as well as social networking sites.

The advantages to using social media for Public Health that must be understood for effective risk communication.

Social media can be used to reach a target audience. This is its most important benefit. For example, certain issues such as motor vehicle accidents, substance abuse, and sexually transmitted disease are on the rise for the younger population demographic. Social media usually attracts many young users, informing the youth on this issue is made easier by using social media.

Social media also helps to manage the always-low Public Health budget. The United States spends around $7,000 on healthcare per person, which is more than any other country. For every dollar spent on healthcare, 1 cent is spent on prevention programs.

Social media services are essentially free, and they have the potential to loosen up budgets for public health education.

One of the biggest benefits that comes from social media is the ability to see an almost immediate public reaction to risk communication measures. Conversation changes the public’s role from an audience to an active participant. Evaluation of risk

communication programs is made easier, and adjustments can be made more effectively.

There are drawbacks to using social media for public health risk communication that must be understood as well.

There is a lack of control over messages posted on social media websites. By studying Twitter, it has been found that that users of the website only give a fleeting amount of attention before moving on to the next. If a message is not perfectly crafted, or attention grabbing, it may be easily lost and ignored by the audience. In addition, websites like Twitter and Facebook limit the amount of characters that each message can contain, leaving little room necessary risk communication guidelines.

Excluding groups is a possibility when using social media. For example, younger populations are easier to target since they are the primary users of social media. Outside of that population, social media use is very low, and it would be harder to target other age groups. In addition, different social networking sites are popular in different areas.

Social media is one of the simplest, yet informal forms of communication, and many users distrust the information found of social medial sites. This is because of its ability to be consistently changed. In addition, studies have shown that there is a sharp decline over the trust of large organizations and government institutions.

3

Implementing Electronic Records in Public Health

4

Rise of Heroine Use Amongst Young Populations Suburbs

5

The Implications of Hookah Usage In Young Adults

5

The NJEHA and the Industrial Recovery Act

6

Building Community Resilience

6

Did you know that over 20,000 people currently like the APHA on Facebook?

1

Indoor Tanning and its Link to Cancer IT NEVER Christopher Sichel HURTS TO BE Three types of skin cancers have ultraviolet (UV) exposure. UV radiation steadily increased in incidence within is usually broken up into three different the U.S. population. In recent data, basal categories: UVA, UVB, and UVC. UVA PREPARED cell carcinoma (BCC), melanoma, and is around 315-400nm, UVB is around

What to include in a basic emergency preparedness kit in case of sudden natural disasters:

Make sure all Important Papers are in Order

These include birth certificates, passports, social security cards, insurance policies, house deeds and personal contacts

Water

1 gallon of water per person for at least 3 days (this includes sanitation and drinking)

Food

Nonperishable food supply for at least 3 days. Examples of things to pack would be fruit, vegetables, cereal bars, trail mix and canned food.

Sanitation and Hygiene Supplies

Paper towels, hand sanitizer, moist towelettes, toothbrush/paste, travel sized toiletries

First Aid Supplies

This includes bandages, medical tape, heat and cold packs, antibiotic cream, soap or hand sanitizer, and basic medications.

Flashlight and Batteries

Mag-lite flashlights are recommended as they are durable and have a long battery charge

Portable Radio and Extra Batteries A battery-powered radio is important to have in case the power goes out so that important announcements and updates can still be heard

Cash

It’s always good to have cash **Make sure to update the kit every few months in case items need to be replaced due to expiration, or other circumstances such as addition of family members, new/expired paperwork.

squamous cell carcinoma (SCC) have been heavily associated with UV exposure.

Melanoma is a type of skin cancer in that accounts for 5% of all skin cancers and those cells are found in the epidermis and top layers of the dermis, but can spread to distant sites. BCC is a non-melanoma skin cancer and is most common form of skin cancer, and starts in the lowest part of the epidermis. It usually develops later in life, grows slowly and is rarely deadly.

SCC is a non-melanoma skin cancer and is less common than basal cell cancers. It usually occurs on sun exposed areas and can spread to the rest of the body.

Assessing risk factors for skin cancer can help us understand where to make policy interventions and what policies may be the most effective. A couple of risk factors for skin cancer include exposure to the sun through work and play, a history of sunburns early in life and a history of indoor tanning.

Although many risk factors are present for skin cancer, we will focus on

280-315nm, and UVC is around 100280nm. The UV index is an important tool in understanding UV exposure. To put the UV index in context, the FDA recommends that the first week schedule of indoor tanning not exceed a 0.75 minimal erythemal dose (Pichon).

Incidence data indicates a steady increase in both males and females for skin cancer. Data indicates that skin cancer is not much of a threat to races other than whites. The data indicates that age is an important factor to include in assessing UV exposure, and that as age increases in adolescents, so does the use of tanning beds. This is particularly important because melanoma risk increases with accumulating intermittent sun exposure and solarium use in early adulthood. Looking at evidence relating UV exposure and its relation to skin cancer can better help us understand the implications of incidence, mortality, and prevalence data on our population.

A study conducted by Lazovich, (Continued on Page 8)

Recent Storms and Risk Communication

Veronica Fries

The New Jersey Office of Emergency Management stresses that the best way to prepare for a storm is to prepare before one is even detected. Preparation is broken down into three major parts: 1. Basic emergency preparedness for general types of disasters 2. Identifying the susceptibilities of the area one is in 3. Knowing how one will prepare for evacuation or in-home shelter Basic emergency preparedness can be simplified by being further broken down into three action phrases: “Get a kit”, “Make a Plan”, and “Stay Informed.”

“Get a Kit” refers to gathering one’s emergency supplies needed to sustain life for at least three days. “Make a plan” involved making an emergency plan for one’s family so as to help combat confusion before, during, and after the storm. The last part of basic emergency preparedness is staying informed, especially in high-risk times of the year that are prone to storms.

A diversity of sources, including news and radio stations, social media outlets,

emergency numbers, alert systems, websites, and phone applications, will lessen the chance of being disconnected from essential information in a crisis.

The second step of storm preparation is to identify if an area of shelter is considered high risk for any possible scenario. For example, in the case of New Jersey storms, the Barrier Islands and shore communities are considered vulnerable to storm surge waters, or waters that are pushed ashore ahead of a hurricane or tropical storm.

The third step to preparing before a storm is to know how and when to evacuate or shelter in-place. Either way, it is crucially important that laypeople remain inside and off the roads during a disaster emergency. Should evacuation take place, one should being essential items from their emergency supply kit.

A few unique issues of disaster management happened during recent storms.

There was a failure in pre-storm evacuation communication during hurricane Sandy. Governor Christie issued a mandatory evacuation on the 26th of October of all barrier islands, eventually

(Continued on Page 10)

2

Mobile Health as a Program Prevention Method for Diabetes

The staggering epidemic level at which diabetes has risen in the United States has become a source of concern for health professionals, public health officials, policy makers, and the public alike. Type I diabetes accounts for “5% of all diagnosed cases” and Type II diabetes accounts for roughly “90-95% of all diagnosed cases of diabetes” in the United States.

The young and the elderly are the most susceptible as prevalence rates are about seven times as high among adults aged 65 years or older as among those aged 20-44. It is also prevalent amongst the Hispanic and African American populations as compared to their Caucasian counterparts as a result of existing health disparities such as health literacy, access to healthcare and allocation mainly through healthcare utilization, quality of diabetes care, dietary habits, physical activity, perceived self-efficacy, and genetics.

With the national costs associated with diabetes exceeding $218 billion in 2007, public health officials are implementing

Hema Patel

prevention and management programs with a core focus on the lifestyle of the individual. A study conducted by the National Diabetes Prevention Program established that lifestyle modifications provide the greatest positive impact in reducing the likelihood of developing Type II Diabetes. Factors representing the lifestyle intervention included: inperson meetings to provide feedback on progress through prevention program, monitoring behavioral change, providing motivational information, monitoring weight loss, and long-term improvements in diet and physical activity to reduce subsequent weight gain after leaving the lifestyle intervention. A follow-up study discovered that participants who underwent the lifestyle intervention achieved a higher weight loss goal thus signifying the importance of lifestyle interventions as a public health prevention method to be used by diabetes prevention programs at the state and local level.

In an attempt to address these lifestyle interventions, successful behavior monitoring tools such as SMS

(Continued on Page 9)

Importance of Surge Capacity During Public Health Response

Disasters can be defined as being, “a non-routine event that exceeds the capacity of the affected area to respond to it in such a way as to save lives; to preserve property; and to maintain the social, ecological, economic, and political stability of the affected region” (Pearce 3). Disasters have the capability to cause large scale damage because of their unpredictability. Having a disaster preparedness plan that incorporates the vulnerability assessment will respond in a way to minimize the scale of the damage that the disaster would have originally caused. During an emergency, the need for victims to have access to health care services increases. Thus, surge capacity is a critical component in responding to disasters. Surge capacity can be defined as the ability to expand care capabilities in response to prolonged demand to a sudden increase in the number of patients requiring care.

Surge capacity can be expected to have either a progressive surge or a sudden surge. If it is a biological event such as pandemic influenza, the surge of patients can be expected to be progressive that

Fadila Noor

may last from days to weeks. However, if the event is a terrorist attack such as a bombing incident it is considered as a sudden surge because it generates many mass casualty victims needing attention and care immediately instead of needing it progressively (Adams 3).

To have an effective surge response, a system should be capable not just based on the amount of beds available during an emergency but based on various variables. Some important variables include staff, supplies/stuff, structure, and systems. Staff members are necessary in a healthcare facility. It is important to have these personnel trained with knowledge of emergency plans. Barriers affecting the ability or willingness of staff to report during or following a disaster should be considered when planning because a shortage in this variable can limit the providence of care. Structure is the physical healthcare facility for example, hospitals or laboratories. Size and spaces in these facilities should be examined to see if areas in the facility can be adapted for different needs. A system is a very important variable, without it the (Continued on Page 11)

FACTS V. MYTHS ON HIV

Fact:

HIV is transmitted through exchange of these fluids: blood, semen, vaginal fluid, breast milk Methods of transmission: Unprotected sex, needle sharing Approximately 34 million people are affected worldwide There is no cure for HIV or AIDS

Myth:

“HIV causes AIDS”

False. You can be infected with HIV but live without developing AIDS

“HIV is transmitted through saliva” False. Kissing, sharing food or drinks does not transmit HIV.

“HIV can be transmitted by mosquitos” False. They only exchange saliva with you, which does not contain the HIV virus.

“HIV only affects gay men” False. The disease affects everyone, of all ages.

“HIV means you can’t have a baby” False. Infected mothers can pass HIV to their child, but the risks can be lowered by speaking to your doctor and getting appropriate care and medication.

3

Implementing Electronic Reconds in Public Health

Stephanie Anastasio

Table 1: ESP Case Reporting in Massachusetts and Ohio from June 2006 to July 2011

The Public health institution relies immensely on the accumulation of accurate and complete health data in order to create and implement community initiatives and outreach programs that target disease prevention and the promotion of healthy behaviors.

With thousands of dollars being invested in the latest medical technology, little has been done to improve the collection and transmission of health records which aim to integrate the data collected by physicians with existing public health databases.

National legislation, such as the Health Information Technology for Economic and Clinical Health Act (HITECH), aims to provide incentives and resources to create a fully functional nationwide system of electronic health records (EHRs). This will provide a database of information that the public health field can use to gauge preventative measures, analyze chronic disease statistics, as well as employ surveillance techniques for communicable diseases.

With only 5% of primary care providers utilizing electronic record keeping systems, severe limitations arise from the use of paper records. This includes the

ability for only one person at a time to view them, illegibility, remote inaccessibility, and multiple volumes and storage sites for patients with extensive records.

Overall, EHRs have proven effective in the identification of research participants, treatment compliance, and evaluation of therapeutic effectiveness.

They are used to measure cholesterol compliance rates in the National Cholesterol Education Program (NCEP),

thus helping researchers identify high risk subgroups that public health officials can target in future primary and secondary policies and programs. They also make it possible to gather large amounts of participants quickly and efficiently.

EHRs are a considerable aid in public health surveillance, which is integral to public health as a whole, because it is the basis on which officials make decisions and monitor trends. EHRs, alongside (Continued on Page 8)

This year the Edward J. Bloustein School of Planning and Public Policy at Rutgers University celebrates its 20th anniversary. The school, named after the late Rutgers President, was opened in 1992 as a center of theory and practice for planning and policy. Since then, the school’s academic programs and research programs have been recognized as one of the best in the country. The school is home to a wealth of expert faculty,

including ex-govenor of New Jersey Florio.

As apart of the the 20th anniversary celebration, a grand reception took place in April at the Hilton East Brunswick Hotel to honor founding members of the Bloustein School.

The mission of the school is a rebirth of public-service ethic that focuses on good civic design in its broadest sense, meaning the focuses of the school’s ethic are interdisciplinary. The ethic

of the school, dubbed the “Bloustein Ethic” embodies worlds outside of academia, that is the local, state, national, and international levels of clientele.

The school offers a B.S. degree in Public Health. A student can pursue the degree as a direct-admit student (that is, a student who is enrolled as an undergraduate at the Bloustein School), but the option to pursue a Joint-Degree with SAS or SEBS is available as well.

Students must have taken and passed an introductory course in planning and public policy and a statistics course before being able to declare the major.

Six public health related certifications are offered through the Bloustein School.

They are:

Source: Michael Klompas, et al. “Integrating Clinical Practice and Public Health Surveillance Using Electronic Medical Record Systems.” American Journal of Public Health 102:S3 (2012): S325-S332. Print.

1. Long-Term Care Administration 2. Public Health Preparedness 3. Public Health Education 4. Addictions Prevention 5. Public Health Administration 6. Community Sustainability These certifications available to all majors and are presented with the completion of a Bachelor’s Degree. Any questions about the undergraduate public health program can be answered by coordinator Christina Miller.

4

Rise of Heroin Use Among Young Population in Suburbs Malgorzata Gegala

Drug use, primarily heroin, has increased tremendously among the young population in New Jersey, especially in suburban areas. There are various factors that contribute to this recent trend, including the availability of heroin, the ease of communication with the internet and the rise of prescription drug addiction.

The use of heroin brings about many public health issues, a major concern being the spread of infectious diseases such as HIV/AIDS and Hepatitis C. There are various efforts throughout America, such as developed government initiatives, which are brought about as preventative measures, and non-profit treatment facilities to help those trying to recover.

Because this is an incredible increase in the amount of young adults between the ages of 18 and 25 using heroin, it is important that more preventative programs be developed for teenagers in educational settings in the near future.

Heroin is a very addictive narcotic because of how fast it enters the brain and connects to the opioid receptors.

The use of heroin slows many functions of the body such as breathing and heart rate, providing them with a feeling of

“euphoria” which is caused when heroin is entered into the brain through the various routes of methods and then alters into morphine and joining to the receptors. Many dangerous side effects

“The CDC estimates that in the US about 1 million people are injective drug users.” arise from the use of heroin, such as the spread of infectious disease, kidney and liver disease, pulmonary problems, as well as skin infections from injections.

National Survey on Drug Use and Health (NSDUH), an annual survey carried out by the Federal Government that consists of about 67,500 people aged 12 years and older being interviewed every year, provides tremendous data on alcohol, drugs, tobacco and pain

killers use, which has increased from 1.4 million users in 2004 to 1.8 million users in 2011. This increase in pain killers is one of the main links to the increasing trend of heroin abuse, which shows in the data collected, stating that number of heroin users increased from the year 2007 to 2011 from 214,000 to 426,000.

During the recent years, increase in heroin use among young adults aged 18-25 has increased, compared to young adults in urban areas. Treatment admission in New Jersey admission increased from 691 patients to 1,817. Not only did heroin use increase in suburban areas, but injection as the mode of transmission also increased tremendously from 33.6% to 50.6% from the year 1993 to 1999.

The use of heroin is a major public health concern for various reasons, an important reason being the spread of infectious disease. According to the CDC, one third of AIDS cases are caused by injection of drugs as well as one half of recent Hepatitis C cases. The CDC estimates that in the US about 1 million people are injective drug users. The report shows that overall heroin use and injection have both increases among 18-25 year (Continued on Page 10)

The Implications of Hookah Usage in Young Adults

Nikhil Jain

Despite its negative implications, smoking tobacco has been an exceedingly popular habit for many centuries now.

Newer and trendier techniques of smoking have taken modern day tobacco usage by storm, introducing tempting and even seemly pleasurable ways that all people

can enjoy. This specifically can be linked to the ancient practice of smoking hookah, which has resurfaced exponentially in the past two decades.

Although it is advertised and interpreted as an innocuous less addictive form of tobacco, it holds an equal and sometimes greater

potency than normal smoking products like cigarettes, cigars, and pipe tobacco.

Hookah is a trending habit that is promoting tobacco smoking because consumers are not necessarily cognizant of what constitutes the danger in its usage, and there are many reasons why this is so.

Shisha, the flavor component, is a substantial factor in the appeal for smoking hookah because of the options it provides for users. There is a variety of shisha flavors that ranges from fruit flavors to dessert-item flavors like muffins and candies. This aspect of shisha has led its users to perceive it as being less harmful and addictive than tobacco.

In fact, shisha and hookah are just as harmful as tobacco and have just as much nicotine. A single session of hookah is actually found to be much more harmful than smoking a cigarette. It produces 36 times the tar, 1.7 times the nicotine, and 8.3 times the carbon monoxide.

Hookah’s social and cultural influence play a large role in its appeal. It has been around for hundreds of years and has its place in many religions. Many of those religions ban alcohol, which further encourages the use of hookah. In

(Continued on Page 11)

5

STAYING FIT DURING THE FROSTY MONTHS The transition from summer to fall and fall to winter is never easy. As short, frigid days and earlier nightfall pave the way for frosty temperatures, slippery snow and finger numbing winds can dampen the motivation needed to stay fit and active during the winter.

Here are some tips to keep active and fit during the cold winter months:

Get Wet

Regular swimming can help build endurance, muscle strength, and cardio vascular fitness.

Short Frequent Workouts Folks who exercise five days a week,

for only 20 minutes at a time, are 40 percent less likely to get sick than those who only exercise one day a week.

Try out a new winter sport

Cross country skiing, sledding, ice skating.

Find your inner Zen Yoga can help with everything from losing weight to lowering blood pressure.

Stay Hydrated

It is as important to drink a lot of fluids during the cooler months just as it in the warmer months.

Stock up on Probiotics

Yogurt helps improve immunity from colds, flus, and viruses which are prevalent in the winter.

Increase Vitamin D intake

Vitamin D deficiency due to decreased daylight hours can inhibit weight loss and even contribute to depression.

Consume the recommended daily doses of food sources such as fish, eggs and milk, and get at least 10 minutes of sun exposure each day.

Take advantage of seasonal fruits and vegetables.

Keep your feet warm Just keeping your feet warm could reduce your risk of catching an infection by up to 67 percent.

NJEHA and the Industrial Site Recovery Act

Samantha Klovert

The Industrial Site Recovery Act (ISRA) was created by the New Jersey Department of Environmental Protection in order to quickly and efficiently remediate contaminated grounds throughout New Jersey. The Environmental Cleanup Responsibility Act (ECRA) set the groundwork for the Industrial Site Recovery Act by creating a core set of guidelines and amendments that are still used today.

Grounds become contaminated when there is a lack of soil management, appropriate irrigation tactics, proper septic and sewage removal systems, and waste management. Industrial sites may also become contaminated when pollutants are spilled, buried, spewed from the air, or deposited by water.

Severe contamination leads to the creation of brownfields which are lands that have been vacated or underutilized due to the toxicity of the contaminants.

Due to the growing public health and safety concern that these brownfield sites pose, the New Jersey Department of Environmental Protection created the Industrial Site Recovery Act (ISRA). The ISRA works to promote environmental

safety in New Jersey by demanding expedited restoration and cleanup of contaminated sites by streamlining the regulatory process and establishing summary administrative procedures for industrial establishments that have previously undergone an environmental review.

The ECRA enacted a vital document entitled “negative declaration” which held industrial site owners and corporation operators accountable for the degree of contamination on their land if they decided to move. They were also made responsible for the cleanup process. Owners who failed to meet these standards were heavily fined. In order to ensure the full and competent restoration of polluted industrial sites, ECRA created follow-up strategies to fully assess the grounds’ contaminant levels by allowing owners submit a detailed plan on how to fund their sampling and cleanup. These plans ensured the discovery of contamination, assured funding for cleanup, and also assured that contaminated property is not abandoned to the State for cleanup.

Authorization delays, lag in (Continued on Page 6)

Building Community Resilience Anjani Patel

There are three of National Research community resilience.

main ideas Council for They are:

1. Facilitating factors and barriers to the formation of collaborations for building communicity resilience 2. Identification of the characteristics of effective, robust, and sustainable private-public sectore collaborations at the local and state levels 3. Encouragement of the widespread development of private-public sector collaboration for enhancing community resilience A resilient community has individuals that are educated before a disaster strikes in order to be prepared, empowered after a disaster to help out and facilitate what they have learned, and experienced enough after the disaster to change plans and techniques to be better prepared for disasters to come. The CDC has defined the goals of community emergency preparedness and outlined them in the following three phases:

1. Pre-event phase 2. Event Phase 3. Post-event phase

The pre-event is the most critical time because it allows the community to become prepared for the event and to know the tools and resources they have available to them when after the disaster.

It involves knowing the vulnerabilities of a community’s area, having a plan for every worst-case scenario, and choosing local leaders to guide a community during times of disaster.

The event phase involves decreasing the time needed to help the vulnerable population, assessing the damage, and communicating accurate and timely information to the public. Communities should have a functioning evacuation center and have good connections with disaster responders on all levels of government. In order to have a successful event phase, there needs to be a successful pre-event phase first.

The last phase is the post-event phase.

The CDC’s preparedness goals for this phase are simple. They are about trying to restore all of the health care services

(Continued on Page 6)

6

(Industrial Site Recovery Act Continued from Page 6) deadlines and unprecedented costs are some of the many problems that arise in the cleanup and restoration of brownfields. In an attempt to tackle these problems, the New Jersey Department of Environmental Protection implemented policies to guarantee that industrial sites would be restored to safety at an acceptable level at the time of sale, transfer, or closure.

They also created a financial assistance program, by providing $50 million in loans and grants to aid small businesses in the restoration. A one year amnesty period was included to give owners and operators a year to complete these tasks without penalties or fees. The ISRA improved upon the ECRA in many other ways as well.

While the ECRA set a generic, standard cleanup tactic for all sites, the ISRA set cleanup standards based on what the land would be used for. The Act removed regulations that made it very difficult for the health of surrounding communities. owners to operate their companies while The Site Remediation Reform Act, maintaining safety precautions. Because introduced in June 2008 and signed into of this, the Act allowed businesses law on May 7, 2009, aims to improve the to separate contaminated areas with ISRA and recycle more brownfield sites caps or fences, instead of having to throughout New Jersey and demand faster remove the contamination completely cleanup of contaminated sites. The biggest

Restored brownfield sites are improvement of the Reform Act is the lucrative in more ways than one. It allows bifurcation of responsibilities between the for the creation of jobs that are essential for New Jersey Department of Environmental the growth and development of the state. Protection (NJDEP) and a Licensing They also create open spaces and protect Board. The New Jersey Department of

(Community Resilience Continued from Page 6) A community is made up of people to the community and also trying to get the community to a pre-event stage and that interact with each other based on their restore homeostasis in the community. social, religious, ethnic, or socio-economic The United States Department of backgrounds. When a disaster strikes the Human Health and Services defines 8 levers that communities must keep in mind in order to remain resilient. They are “When a disaster strikes 1. Wellness 2. Education 3. Access 4. Self-sufficiency 5. Engagement 6. Partnership 7. Quality 8. Efficiency

the community everyone is affected but they react in different ways.�

community everyone is affected but they react in different ways. Building community resilience does not start after a disaster it

Environmental Protection works directly with owners and operators and the contaminated sites while the Licensing Board oversees Licensed Site Remediation Professionals (LSRP).The LSRP program issues licenses to competent and qualified experts who work on the restoration of the brownfields. They also work alongside the NJDEP to examine key vital documents, thus, ensuring the highest level of competency. The success of the program mandates all sites to have an LSRP.

has to be an on-going process that being in the pre-event stage and continues to the post-event stage. At every stage there are certain goals that need to be meet in order for the community to be more resilient towards disasters. In order for the community to be able to more resilient there must be certain levers that need to be activated and when they are pushed in the right direction the community can move the resiliency machine and be able to rebuild the community. If all these levers can be integrated into the community’s emergency preparedness plan this will make the community resilient to any future disasters.

7

State Indoor Tanning Laws for Minors (National Conference of State Legislatures)

(Tanning Continued from Page 2) Vogel, Berwick, Weinstock, Anderson, Warshaw, looked at indoor tanning and its association to risk of melanoma.

Conclusions drawn from this study indicated that in a highly exposed population, frequent indoor tanning increased melanoma risk, regardless of age when indoor tanning began. This study also sheds light on the differences in indoor tanning devices and their associated risk of melanoma. Results showed an increased risk of melanoma with use of each type of tanning device as well as with each period of tanning use, suggesting that no device could be considered “safe.” A study was conducted

by Whitmore, S. Elizabeth, Warwick L. Morison, et al. in order to determine the (Electronic Records Continued from Page 4) surveillance techniques, facilitate the timely notifications of diseases (Table 1).They allow public health officials to closely monitor health indicators that were previously impossible to do with paper records.This real time tracking will help public health agencies develop and evaluate interventions including outbreak responses and health screening campaigns. This information can help public health officials target programs and resources towards specific types of diabetes and the demographics associated with the diagnoses.

The implementation of EHRs can enhance disease prevention through population health and disease surveillance, which will in turn promote healthcare cost savings (Table 2).

Despite the implementation of the Health Insurance Portability and Accountability Act (HIPAA), which protects patient health information, insurance companies, and managed care organizations gaining access to their private information. In an effort to curb this issue, healthcare providers

effects of tanning salon exposure and molecular alterations. The purpose of this study was to determine specifically tanning salon exposure and its relationship to DNA alterations and p53 protein expression in epidermal keratinocytes and/or circulating peripheral lymphocytes. Conclusions drawn from this study indicated that short-term recreational tanning salon exposure causes molecular alterations that are believed essential in the development of skin cancer. The importance of this study is that even in a short-term (2 week period) study on the effects of tanning salon exposure; it indicates that there are serious health implications that need to be addressed. There is significant evidence to show that tanning and UV exposure

should authorize personnel with logins and passwords, encrypt patient identifiers before files are transferred to epidemiological studies and health departments, educate users on EHR privacy and consequences, monitor audit logs, require employee electronic signature, and adhere to consistent disciplinary actions.

In an attempt to create a statewide network of EHRs, New Jersey has

is related to melanoma, BCC, and SCC. According to the National Conference of State Legislatures, more than 30 states regulate indoor tanning for minors.

Policies vary from outright bans under the age of 14, 16, and 18 years of age to requiring parental permission for minors.

There are a significant number of states without indoor tanning policies or with mixed or multiple restrictions such as requiring parental permission for minors, limited exposure time, and providing eye protection. In New Jersey, legislature prohibits the use of indoor tanning beds by minors and also requires facility operators to post easily legible warning signs near the tanning equipment.

The FDA is particularly concerned with children and teens when it comes to UV rays (Food and Drug Administration).

FDA recommends that exposure in indoor tanning facilities should be three of fewer sessions during the first week and that the schedule not exceed a 0.75 minimal erythemal dose (Pichon). This is an FDA recommendation only, but the FDA does have some regulations regarding indoor tanning. Data suggests that indoor tanning facilities do not follow FDA recommendations; however compliance with regard to youths is relatively high, indicating that the use of policy can be effective in preventing youths from indoor tanning. Evidence is clear that UV exposure and UV exposure in indoor tanning facilities both have an association with melanoma, BCC, and SCC, and more needs to be done with policy in order for incidence rates to start steadily declining across the nation.

implemented the Jersey Health Connect which involves the exchange of more than 385,000 existing patient records by some of the state’s largest hospital networks.

By implementing electronic health records across the state of New Jersey, public health officials would be able to effectively utilize the existing Jersey Health Connect infrastructure.

Table 2- Cost Savings due to EHR related Preventative Measures

Source: Michael Klompas, et al. “Integrating Clinical Practice and Public Health Surveillance Using Electronic Medical Record Systems.” American Journal of Public Health 102:S3 (2012): S325-S332. Print.

8

(Mobile Health Continued from Page 3) SMS text messaging and mobile health are being utilized in diabetes prevention programs to improve behavioral outcomes and ultimately improve lifestyle interventions. These tools would help create a beneficial managing system that would account for individualized behaviors. The emergence of mobile health has become of particular interest to the field of public health because these types of solutions provide real time prevention and risk mitigation solutions directly to individual mobile users. In order for behavioral changes to occur and be successful, there has to be an individualized component to behavioral interventions. As such, many mobile health monitoring solutions are targeting the behavioral change on the individual level by personally tailoring the messages to the specific needs of the individual.

SMS text messaging can be individually tailored to help facilitate a space for public health professionals to actively track, monitor, and implement interventions for the diabetic population

ultimately reducing the high expenditure associated with diabetes. Individualized messaging therefore impacts behavioral change in patients to become more knowledgeable about prevention

“The emergence of mobile health has become of particular interest to the field of public health because these types of solutions provide real time prevention and risk mitigation solutions directly to individual mobile users.”

health and management. A research study conducted in present day used SMS messaging in clinical and medical care to serve as reminder for patients to improve adherence to medications and checkups. One of the conclusions established from the present study was, “of the 14 SMS reviewed interventions 13 demonstrated positive behavior changes…” This conclusion supports the concept that behavioral based interventions are positively impacted through the use and implementation of SMS messaging as a vehicle to promote individualized behavioral change.

With SMS messaging becoming the central way of communicating information in the United States, it is imperative that public health prevention programs incorporate this model to provide individuals information about diabetes prevention techniques and programs specific to them.

techniques and enabling patients to become more responsible for their own

9

(Heroine Use Continued from Page 5) olds in suburban areas compared to the same age group in urban areas, based on the clients entering treatment from 1993 to 1999. The primary increasing trend of heroin use is among the teens and young adult populations in suburbs all across America. The ease of accessibility to prescription painkillers is what is mainly causing such an increase in heroin use. The number of teenagers and young adults dying from heroin overdose has even increased tremendously in the age group of 15 to 24 year olds, from 198 deaths to 510 between the year of 1999 and 2009.

Many efforts are being put into place to help control and prevent further rise of overall drug use. One program, the New Jersey Prescription Monitoring Program, aims to decrease and prevent further abuse of prescription drugs by monitoring each prescription that is filled.

Collaboration between various national and state organizations and associations led to the “The Right Prescription for New Jersey” program. The plan of this program is to work with parents, having them talk with their children and teens about prescription drug abuse and to protect their medications in their homes.

Another preventative effort is the New Jersey Prevention Network (NJPN). This is “building capacity among professionals, fostering positive collaboration among providers, and strengthening the field of

prevention through the use of evidencebased practices and strategies.” Other actions such as needle exchange programs have been proposed and are available in some areas to provide users with sterile needles and syringes needed for their illicit drug habits. Many argue that needle exchange programs not only decrease the spread of infectious disease, but also greatly minimize the cost of otherwise having injecting drug users being treated far too late.

The young population is the future of our country and it is of great importance to prevent them from

(Risk Communication Continued from Page 2) requiring a mandatory evacuation on he was unwilling to send rescue workers October 28th. In Atlantic City, the effort to help evacuate the during the peak to evacuate residents was undermined by hours of the storm so as to not endanger the availability of placements in Atlantic the safety of emergency workers.

City shelters. In addition, Governor Christie A unique situation that has surfaced informed the mayor of Atlantic City that recently during Hurricanes Sandy and

making negative choices. Even though the stereotypical image of heroin use is usually of low income users in urban areas, data states that heroin use is increasing among the white population in suburban areas. Many organizations and associations have brought about great efforts concerning the various problems of heroin abuse, such as prescription tracking programs and sterile syringe exchange programs. It is preventative initiatives that will prevent the further increasing trend, therefore allowing for the greater chance of wellbeing for all.

Irene has been the extended loss of power and the need to charge battery-operated devices. Local offices of emergency management designated warming and charging stations throughout Super Storm Sandy. Obvious places such as libraries and coffee shops with power offered citizens outlets to charge various Kindles, cellphones, laptops, and other battery-depleted devices.

One of the major concerns throughout the aftermath of Hurricane Sandy was a shortage of fuel. Wait time for gas ranged from 1 hour to 7 hours. There were many reasons why gas was so difficult to obtain.

Poor road conditions prevented oil tankers from supply gas to gas stations. Many gas stations had no power. Many refineries and terminals were out of commission. It can be disputed that the emergency plan for fuel shortages was not robust enough.

There were many health concerns linked to the recent storms, some of which have been apparent long after the ending of the storm. Queens, New York has branded its own deep hacking as the “Rockwaway cough” or “Sandy’s cough.” Respiratory issues are emerging at an alarming rate as recovery efforts expand to include the cleanup of the debris left in Sandy’s wake.

10

(Social Media and Risk Communication Continued from Page 1) This makes the job of risk communication harder for larger public health organizations.

Social media has the potential to be used very effectively. It was only recently during the Fukushima disaster in Japan where social media played an important role in the perception and interpretation of risk. The Fukushima incident is only the beginning. Organizations who plan on using social media for risk communication need to work on making the information that they post more viable and trustworthy. Social media allows for quick and easy access to a large amount of people, but the targeting of audiences and the exclusion of others is an issue that needs work as well. In the end, social networking, if utilized properly, can lead to more effectively conveyed messages.

(Hookah Use Continued from Page 2) addition, hookah bars are typically very relaxing environments. The purchasing age of hookah is 19 years old. For the younger crowd of 18-24 years old, who constitutes the largest group hookah users, hookah bars provide an alternative site to alcoholic bars that allows them to partake in some kind of daring nightlife.

The biological hazards for Hookah are well known. Hookah causes cancer and the risk for second-hand smoke is high. A hazard that is unique to hookah is the uncleanliness of the mouth piece of the hookah apparatus which is shared by every user.

Moves to suppress Hookah usage

in New Jersey have been made through policy. The 2006 Smoke-Free Air Act deemed public hookah usage illegal.

The New Jersey Department of Health and Senior deemed smoking hookah as a part of the realm of smoking based on the hazards it causes to the users and those affected by second-hand smoke.

In 2007, there was a decision to nullify hookah lounges because they failed to adhered to the requirements of being a traditional tobacco establishments such as cigar bars. In addition, it was deemed the power of the health officials to enforce the 2006 Smoke-Free Air Act as a result of the state building terms with

the Appellate Division of the Superior Court of New Jersey. It is decided that there is no constitutionally protected fundamental right in running a hookah bar. Thus, enforcement of these laws are not in violation of the state’s constitution.

Besides action through policy, individuals must be provided the context of which smoking hookah relates to them, resources to validate their concerns and questions, and help they made need in recognition of an issue they or someone they know of has.

Unbiased and correct information must be provided to the public to help them decide if it is worth smoking hookah.

two way radios (Adams 5). Coordination involves integration of different facilities and agencies in an overall community response (Hick 60). This supports in a facilities capability and how it copes in performing adequate emergency operations and mutual aid relationships (Adams 5).

In conclusion, for times when there is a sudden significant increase in the influx of patients from casualty causing events, it is crucial for a health care system to be able to respond by accommodating and treating more than the regular number of patients. This response will vary depending on type of event, immediate availability of staff and supplies and the planning before the event based on vulnerability analysis and systems in place such as the Incident command system. Planning for surge capacity will improve ability to respond for disasters

and it should be understood that surge capacity is influenced by more than one factor. When there is a catastrophic surge all health care systems should be integrated and ready to provide treatment to those in need of medical care.

(Surge Capacity Continued from Page 3) the other variables cannot be managed well because of its importance in continuity of operations and community infrastructure.

It can be further broken down into command, control, communication, and coordination. Command is being able to manage the mass casualty event with an all hazards response plan using an incident management approach that can be adapted to any situation on any level and is therefore an all-hazard approach. It allows integration within a common organizational structure allows multiple agencies to respond to incidents in a coordinated fashion and is an effective process used to plan and manage resources. Control involves the facility trying to minimize any further damage from the situation, for example, a contagious airborne disease epidemic would have to be controlled by isolation of the patients and by changing ventilations system. Communication involves internal and external communications processes (Hick 60). When one system is disrupted for any reason like power outage or cellular tower loss it is crucial to have other communication methods in place like

11

NJ Health Association Updates The New Jersey Environmental Health Association (NJEHA) has been working to protect the state’s environmental safety and public health since 1954. It has been regarded as the state affiliate of the National Environmental Health Association since 1963. Originally known as the New Jersey Association of Sanitarians, the Association works directly with the public to promote the safety and health of the environment.

The New Jersey Environmental Health Association (NJEHA) works actively throughout the state to promote environmental safety and public health for its residents. There are more than four hundred members within the Association ranging from Registered Environmental Health Specialists, Health Officers, and other workers within the public health field. The NJEHA works mainly through an educational approach. The Association offers continuing education opportunities for individuals interested in environmental health.

These educational opportunities include educational meetings, sessions with expert professional speakers and legislature, and continuing education units.

The New Jersey Public Health Association, a branch of the American Public Health Association, founded in 1875, is an advocacy and voluntary organization consisting of public health officials who focus on all aspects of public health in New Jersey. Throughout the years, NJPHA has provided much reform and improvement for residents, such as advocating child abuse laws in 1974 and campaigning for HIV/AIDS. The two main focuses of the organization include advocating continuous funding for women’s health and continuous funding for the New Jersey Poison Control Center (NJ PIES).

NJ PIES provides immediate services to residents of New Jersey, no matter how small or large the problem or concern. The center of this organization is located at the University of Medicine and Dentistry of New Jersey in Newark.

NJ PIES help to concerned residents and emergencies through its free 24/7 hotline. NJ PIES is also involved in various academic activities through peer reviewed journals and providing educational programs for students and health care professionals.

The NJPHA works with various members and organizations to provide, protect, and educate residents of New Jersey. One of the main goals of the association is to provide healthy and safe living conditions to residents and informing them on how to attain these conditions.

New Jersey Association of Public Health Nurse Administrators (NJAPHNA) was established in 1990 and ever since then has been providing a unified voice to Public Health Nursing throughout the state of New Jersey.

The mission of NJAPHNA is to promote, protect and preserve the health of New Jersey residents through education, and to strengthen the public health nurse workforce by improving public health nursing practices and standards of care. The association consists of executive committees that are comprised of: Infectious disease, Legislative, Chronic Disease, Maternal Child Health, Continuing Education, By-laws, Membership, Parliamentarian, Emergency Preparedness, Website and Elections. The current 2012 president of NJAPHNA is Marilynn Bernstein, who aims to promote, protect, and preserve public health, and increase awareness about the importance of the role in a community that public health nurses plays through the exchange of ideas.

Public health nurses use the knowledge from nursing, public health, and social sciences to protect health of communities by providing essential public health services and by carrying out the core public health functions.

The requirement to be a public health nurse is having a Nursing or Public Health Nursing Bachelors Degree with at least one year of experience and a valid license of being a professional nurse in the state of New Jersey.

12

The New Jersey Association of County and City Health Officials (NJACCHO) aims to unite health officials across the state to promote the knowledge of public health, sanitary conditions, and environmental sciences. They also aim to improve public health administration, encourage uniformity in public health through laws and ordinances, develop a network of allied health professionals in New Jersey, and protect the rights of health officers.

Peter Correale, president of NJACCHO, is working on the advancement of the association through initiatives. A major success has been the collaborative effort with Medical News Production (MDTV) to create “Public Health TV”. This public health online virtual television station will contain on demand health educational videos. NJACCHO hopes that “Public Health TV” will provide the public access to correct and informative resources.

NJACCHO aims to complement the field experience of health professionals with continuing education and training programs. In May 2012, NJACCHO provided a grant to the NJ Local Boards of Health Association (NJLBHA) to establish NJLBHA’s online member certification A major issue that New Jersey Society for Public Health Education has addressed this month is public health literacy. Public health literacy is a problem for both the public and public health educators. The society recently hosted the “Finding Your Recipe to Improve Health Literacy” seminar focused on ways to improve public health literacy. Professionals should focus on using plain language in video and print ads, to better ensure understanding by all. New media such as social networks can help disseminate information in an easier way to reach more of the population.

On major issue that touches public health literacy as well is social determinants of health. Minority groups often struggle to receive the same healthcare because of many factors. The seminar addressed the need to make all health messages culturally sensitive and appropriate.

Social determinants of health is the main focus of the NJSOPHE’s meeting this month on December 6th, to continue with the health literacy theme.

The New Jersey Local Board of Health Association (NJLBHA) was founded in 1992 and is comprised of members who seek to provide assistance and guidance to local health departments. They are responsible for ensuring the development and implementation of public health policies and programs within New Jersey’s communities.

The NJLBHA is now taking its communication to a higher level. Social media allows organizations like the NJLBHA to help reach its population in a quick and easy way. They are currently in the process of creating a Facebook page as well as a Twitter account. Those who “like” the Facebook page will be able to view NJLBHA upcoming events as well as important messages. By following them on Twitter, you will receive useful tips and advice regarding preventative measures, such as how to prepare for an upcoming extreme storm. They will also send out Tweets for upcoming public health events in New Jersey.

The Public Health Associations’ Collaborative Effort (PHACE) was created with the purpose to establish a group in which professionals can convene and address greater issues pertaining to public health and safety in New Jersey. Among the goals of the members, their primary mission is “to provide a forum wherein all public health disciplines are equally represented, via the leadership of the recognized New Jersey public health associations, to foster a single voice and face for the advancement of public health in New Jersey”.

More recently, PHACE’s efforts have been contoured towards the increased involvement of individuals in the undergraduate setting towards public health. In lieu of the recent integration between Rutgers University and a considerable portion of the University of Medicine and Dentistry, the organization is seeking for increased involvement from nursing students, public health majors, and other individuals in an allied or related academic concentration

13

Letter from the Editors

MorPH Contributors

We welcome all of our readers to Minds of Rutgers on Public Health. This issue has been developed and maintained by a group of Rutgers students engaged in the public health issues around them to hopefully achieve a growth in health awareness in the Rutgers community and beyond. In this edition, we have student written articles delving into various public health concerns in New Jersey and throughout the U.S. With this knowledge, we hope to have conveyed the purpose of public health: to preserve and promote universal health. In making this newsletter, we tried to be as factual as possible in our content while being creative and novel. If you have any questions or concerns or would like more information on the research conducted, please visit us at our website at www.ruhealthynj.com.

Stephanie Anastasio Katherine Ficalora Veronica Fries Malgorzata Gegala Nikhil Jain Samantha Klovert Fadila Noor Hema Patel Anjani Patel Christopher Sichel

MoRPH MISSION STATEMENT

2012

Research Team

Website Team Michael Campbell Aparna Shankar

Newsletter Team Enrico Cabredo Neha Patel Emefa Vowotor

Minds of Rutgers on Public Health is a group of undergraduate students who, through research, use of print and electronic media, and collaboration with professional liaisons, strives to educate and empower students and professionals alike in promoting better health outcomes.

14