Health | Spring 2023

SOUTHWEST UTAH PUBLIC HEALTH FOUNDATION SPRING 2023

CHILD DEVELOPMENT

PG. 12 COLON CANCER SCREENING

PG. 24 WHY WE SLEEP PG. 8

Letter from the Health Officer

Welcome to our spring 2023 issue of Health Magazine. We are grateful to those that have provided feedback and support for our efforts to produce this magazine. The theme of this issue is helping yourself and others to prevent disease and injury in our quest to be healthier.

We know that behavior change is very difficult for most of us. I think most people understand that there are things they want to change to be more consistent with their health goals - but that’s easy to talk about, harder to put into practice.

One secret to eating a little better, getting a little more sleep, or exercising more is to include others in your plans so they can help you in your efforts. Sometimes just knowing that there is someone else who’s going to ask you how you’re doing with your goals will make it more likely to happen.

We are social creatures; whether we smoke or not, when we go to bed, how we eat, and how we feel about being physically active are influenced in some way by those we associate and live with. How we choose to live healthwise affects those closest to us, providing an opportunity to encourage and support each other.

Support systems can also serve as a prompt for a behavior you want to reinforce. You can tie a specific activity you want to incorporate into your life with something you value as a reward. For example, going to dinner with friends or family is something most of us enjoy and look forward to. Perhaps you could promise yourself that you won’t go to dinner unless you have exercised for 20 minutes that day, which prioritizes something that you might otherwise put off or forget about.

We will continue to focus our attention on specific behaviors that have shown to make the biggest impact on long term health; eating more vegetables and fruits, frequent exercise, not smoking, adequate sleep, and maintaining a healthy weight. We hope to be part of your support system as you take the steps to live and feel better.

Sincerely,

David W. Blodgett, MD, MPH Southwest Utah Public Health Department (SWUPHD) Director & Health Officer

We hope to be part of your support system as you take the steps to live and feel better.

SYMPTOMS & SCREENINGS

WHAT IS THE PROSTATE?

The prostate is a part of the male reproductive system. It is about the size of a walnut and surrounds the urethra (the tube that empties urine from the bladder), located just below the bladder and in front of the rectum. It produces seminal fluid, helps regulate urine flow, and plays a role in hormone production. As a man ages, the prostate tends to increase in size. This can cause the urethra to narrow and decrease urine flow. This is called benign prostatic hyperplasia (enlarged prostate), and it is not the same as prostate cancer. Men may also have other prostate changes that are not cancer.

WHAT IS PROSTATE CANCER?

Cancer is a disease in which cells in the body grow out of control. When cancer starts in the prostate, it is called prostate cancer. Prostate cancer is the second most common cancer in American men (skin cancer is the most common) and the second leading cause of cancer death for men in Utah (lung cancer is the most common).

Prostate cancer tends to grow slowly compared with most other cancers. Cell changes may begin 10, 20, or even 30 years before a tumor gets big enough to cause symptoms. Eventually, cancer cells may spread (metastasize). By the time symptoms appear, the cancer may already be advanced.

By age 50, very few men have symptoms of prostate cancer, yet some precancerous or cancer cells may be present. More than half of all American men have some cancer in their prostate glands by the age of 80. Most of these cancers never pose a problem. They may never cause symptoms or become a serious threat to health.

RISK FACTORS FOR PROSTATE CANCER

A risk factor is something that can raise your chance of developing a disease. Having one or more risk factors doesn't mean that you will get prostate cancer. It just means that your risk of the disease is greater. The following risk factors have been linked to prostate cancer.

• Age - Men who are 50 or older have a higher risk of prostate cancer.

• Race - African-American men have the highest risk of prostate cancer, followed by white men.

• Family history - Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease.

• Diet - The risk of prostate cancer may be higher for men who eat diets that are highfat with low vegetable intake.

SYMPTOMS OF PROSTATE CANCER

• Trouble passing urine

• Frequent urge to pass urine, especially at night

• Weak or interrupted urine stream

• Pain or burning when passing urine

• Blood in the urine or semen

• Painful ejaculation

• Nagging pain in the back, hips, or pelvis

Prostate cancer can spread to the lymph nodes of the pelvis, or it may spread throughout the body. It tends to spread to the bones, so bone

pain - especially in the back - can be a symptom of advanced prostate cancer.

PROSTATE CANCER SCREENING

Screening means testing for cancer before you have any symptoms. A screening test may help find cancer at an early stage when it is less likely to have spread and may be easier to treat. By the time symptoms appear, the cancer may have started to spread.

For decades, the gold standard test for prostate cancer screening has been the PSA (prostate-specific antigen) test, but doctors do not yet know whether prostate cancer screening lowers the risk of dying from prostate cancer. Therefore, large research studies with thousands of men are now studying prostate cancer screening.

Although some people feel it is best to treat any cancer that is found, including cancers found through screening, prostate cancer treatment can cause serious and sometimes permanent side effects, including incontinence and erectile dysfunction. Some doctors are concerned that many men whose cancer is detected by PSA screening are getting unnecessary treatment.

Since 2018, the U.S.Preventive Services Task Force recommends that men aged 55-69 discuss the potential benefits and harms of the PSA test with their doctor before deciding on whether or not to be screened. It is not recommended that men over age 70 get screened. PSA testing in the United States has been decreasing since it is no longer recommended as a routine screening test. Advances are being made in the development of better testing and treatment for prostate cancer. Although the cause of most prostate problems are unknown, certain habits have been associated with lower risk of enlarged prostate and prostate cancer. These include exercising, maintaining a healthy weight, managing blood pressure, and eating a plant-based diet with low intake of red meat, saturated fat, and sugar.

Sources: Centers for Disease Control & Prevention, Mayo Clinic, Harvard Medical School, US Preventive Task Force

A SUMMARY OF DR. MATTHEW WALKER’S GROUNDBREAKING BOOK

by Luke Rowley of Four Minute Books

As humans, we spend a remarkable amount of our lives sleeping. How much? About one-third of our life. So if you live for 75 years, you will spend a staggering 25 years of your life snoozing. But as the world grows busier and more technology-filled, sometimes we consider sleep a hassle. It seems people try to get the least amount of sleep possible to be able to maximize their busy days.

But we shouldn’t underestimate the power of sleep, because it’s crucial to our health and well-being. In his book Why We Sleep: Unlocking the Power of Sleep and Dreams, Matthew Walker teaches just how vital getting adequate sleep is and what the consequences of sleep deprivation can be.

As a professor of neuroscience and psychology at the University of California-Berkeley and director of the Sleep and Neuroimaging Labo-

ratory, he definitely knows his stuff. Here are 3 awesome lessons I got out of this book:

1. When you sleep less you increase your chances of heart disease and other health problems.

2. You are just as much of a threat to society as a drunk driver when sleep deprived.

3. Better sleep comes from following a few simple tips.

Grab a pillow and blanket and let’s learn the how’s and why’s of a great night’s sleep!

LESSON 1: SLEEP IS FOUNDATIONAL TO HEALTH, AND WITHOUT ENOUGH OF IT YOUR RISK OF DISEASE INCREASES SIGNIFICANTLY

Walker shares that he used to tell people the three pillars for good health consisted of diet,

exercise, and sleep. Now that he understands the huge importance of sleep, he tells people that sleep is the foundation that the others stand upon. We all know heart disease is a huge problem around the world. The cost of this increasingly prevalent health problem is a huge burden on healthcare systems. But Walker proposes that the real cure is pretty much free. He says people just need to get more sleep.

In a 2011 study looking at 500,000 people from various ages and ethnicities, researchers found that sleep deprivation increases the risk of a person getting or dying from heart disease by 45 percent. Another study looking at Japanese men for 14 years found that the workers who slept less than six hours every night were a staggering 500 percent more likely to suffer from cardiac arrest. Even when researchers account for factors that contribute to cardiovascular problems like obesity or smoking, the link remains strong.

Why is there a link, though? Because a lack of sleep causes a rise in blood pressure. This instance of increased pressure in the veins takes a toll, and eventually, damages the artery walls. This makes you more susceptible to heart disease. So if you want to lower your blood pressure and increase your chances of living a long and healthy life, it could be as simple as getting more sleep!

LESSON 2: IF YOU DRIVE DROWSY, YOU MIGHT AS WELL BE DRIVING DRUNK.

We all know of the tragedy that drunk driving can inflict upon not just the driver but also others. But did you know that driving while drowsy is equally as dangerous as driving drunk? So not only is sleep deprivation bad for your health, but it also can make you a threat to society if you get behind

the wheel. Getting less than seven hours of sleep per night will increase your chance of getting in an accident considerably.

When you sleep less than your body needs, it attempts to make up for the lack of sleep by going into a microsleep. Microsleeping is a short bout of sleep that only lasts for a few seconds. It’s the same as normal sleep, just much shorter. So during a microsleep, you don’t have control of motor function. If this is at the wheel, it can only take a two-second microsleep to cause you to drift into another lane and cause a major accident.

In an Australian study, researchers divided participants into two groups. One drank enough alcohol to increase their blood-alcohol concentration of 0.05, and the other didn’t sleep for a night. Both groups took a concentration test and results showed that those who didn’t sleep for 19 hours did just as poorly as those who were drunk. We all understand drunk driving is irresponsible. But next time you are tempted to drive late into the night, remember that driving when drowsy is also probably just as irresponsible.

LESSON 3: INCREASING SUNLIGHT EXPOSURE

DURING THE DAY AND LIMITING SPECIFIC SUBSTANCES IMPROVES SLEEP QUALITY.

Walker gives tips based on the latest research on how to improve your sleep. His first tip is to consider avoiding substances like alcohol and nicotine. Having that glass of wine before bed might feel like a great way to end the day and unwind, but science shows alcohol makes it hard for your body to go into a deep sleep.

It can also make it harder to breathe while you’re asleep. And often, people wake up once the al-

cohol wears off, disrupting sleep. Nicotine is an issue when it comes to sleep because it’s a stimulant. This is why smokers tend to sleep more lightly and wake up earlier because of morning withdrawal.

Another tip Walker has is to take a hot bath before bed. Taking a bath relaxes your mind as well as your body. The drop in body temperature that you experience when you get out of the bath causes you to experience a feeling of drowsiness, perfect for right before bed.

We should also try to soak up the sunlight at least a little every day. Natural sunlight helps your body establish and stick to a regular sleep pattern which is why it’s important to get enough. Keep curtains open while you sleep, so that the natural light of the morning sun wakes you rather than an alarm. Lastly, he advises making sure the room temperature where you are sleeping is relatively low.

WHY WE SLEEP REVIEW

Three words keep revolving around my mind after reading Why We Sleep: “threat to society.” I don’t like being negative, but after the research this book presents, that’s the best way I can describe sleep deprivation. The good news, though, is that this book gives some great actionable advice to improve your sleep habits! I recommend Why We Sleep to the 56-year-old with heart disease who is afraid of dying early and wants to pinpoint what may improve their health the most, the 32-year-old startup founder who is burning the candle at both ends thinking they’re getting ahead, and everyone who thinks they can get by with less sleep.

Used with permission; find this and other interesting book summaries at fourminutebooks.com

DAY CARE STANDARDS

By Kristi Sharp SWUPHD TOP STAR CONSULTANT

Combating obesity is an ongoing public health challenge affecting even those in the youngest age groups. Healthy lifestyle habits established early in life have a significant impact on behaviors throughout adolescence and adulthood, and may ultimately lower risks for certain chronic diseases.

At any point during a child's life, a situation may occur when they will be cared for by someone other than the parent, whether it’s a pre-K program or daycare when a parent has to be away for work or appointments. Making this choice never comes easily, so finding a quality pro-

vider can help ease any nervousness. It is important that standards of nutrition and physical activity provided by a parent are extended into settings outside of the home.

Utah is one of 16 states awarded funding through the Department of Health and Human Services to help teach obesity prevention in early child care and education settings. Utah’s program is called TOP Star (Teaching Obesity Prevention), which endorses child care programs that promote good nutrition, physical activity, and breastfeeding-friendly policies. This is helpful to families that are looking for a quality experience for their little ones.

Local health departments have certified TOP Star consultants who work with child care centers, child care homes, preschools, drop-in child care, family support centers, and gyms to improve health standards and policies.

Child care facilities may become TOP Star endorsed by completing a self assessment, 6 hours of staff training, and creating and implementing new or improved health

policies TOP Star practices such as serving whole grains, limiting use of screen time, having structured and unstructured play, and providing lactation accommodations for nursing mothers have been linked to reduced obesity risk for children. The endorsement is on a scale of one to five stars, with five being the highest, and is good for three years.

Once a program is endorsed, they will have access to many free statewide resources they can use in their facility and with parents, along with continued support from the local TOP Star consultant. A TOP Star endorsement also includes free online continuing education towards a Child Development Associate Credential (CDA) and Career Credit (CCQS) points that may be used towards licensing.

For more information on how to become a TOP Star endorsed program or to locate an endorsed child care facility near you, call 435-865-5153 or scan the QR code below.

IT IS IMPORTANT THAT STANDARDS OF NUTRITION AND PHYSICAL ACTIVITY PROVIDED BY A PARENT ARE EXTENDED INTO SETTINGS OUTSIDE OF THE HOME.

ON THE RIGHT

By Mindy Bundy, RN SWUPHD NURSING DIRECTOR

If you are a parent, you know the feeling of overwhelming love and joy when you see your infant smile for the first time or your toddler take the first steps. We celebrate by trying to get them to do it again as we grab our phones and take pictures or videos to share with friends and family.

These achievements are developmental milestones that mark expected progress in five key areas of child development:

• Gross motor skills: crawling, jumping, running

• Fine motor skills: picking up a Cheerio, writing, drawing

• Speech and language

• Cognitive and intellectual: counting, identifying shapes

• Social and emotional skills: smiling, playing with other children Regular screenings can let us know where our child is on the developmental journey, giving us either reassurance or the chance to detect delays early on. One in six children have one or more developmental delays, although these issues can often be improved and possibly eliminated with timely intervention.

THE FIRST FIVE YEARS OF YOUR CHILD’S LIFE ARE THE MOST IMPORTANT PERIOD OF DEVELOPMENT

It's important that these screenings and checkups take place so that the need for further evaluation and interventions can be implemented before the child enters school.

There are several screening tools parents can access to help track their child’s milestones and identify possible delays. These tools often include suggested play activities that promote the five key areas of development and target any that need improvement. Playing with your child is one of the best ways to promote strong relationships and help develop cognitive growth, emotional stability, and physical fitness.

If you notice your child is not reaching milestones or seems behind in activities compared to other children the same age, you should speak to your pediatrician. Remember, the earlier you catch delays, the better!

SCAN THIS CODE TO ACCESS ONLINE CHILD DEVELOPMENT SCREENINGS AND ACTIVITIES:

POWER OUTAGE PREPAREDNESS & RESPONSE

By Austin Smith SWUPHD EMERGENCY HEALTHCARE COORDINATOR

Power is a resource that is often taken for granted, but many circumstances can cause a disruption in the power grid. It could go out for minutes, days, or even weeks. Are you and your family prepared for an extended power outage?

POWER-DEPENDENT MEDICAL DEVICES

If you or someone in your household requires a power dependent medical device, it is highly recommended to have a plan in place prior to an emergency. Your plan should focus on a way to keep the device running in the home or an option to utilize a secondary location with a friend or family member during the outage. It is also recommended that you enroll

in the Special Needs Registry, which is a program that allows emergency agencies to see where citizens with access and functional needs reside. Registering does not guarantee immediate response to your front door, but it does give emergency services a broad picture of where resources will be needed. For more information, visit specialneedsutah.org

FOOD SAFETY DURING POWER OUTAGE

Another factor of power outages that often gets overlooked is food safety. The last thing you need during a power outage is a foodborne illness from something in your refrigerator. It's a good idea to keep appliance thermometers in your refrigerator and freezer to

help you make educated decisions about throwing out perishable food items. Refrigerators should be kept at 40°F or below, and freezers should be kept at 0°F or below. According to the CDC, food will stay safe in a refrigerator for 4 hours without power (if you keep the doors closed). If you expect the power to be out for longer than 4 hours, consider using dry ice, block ice, or even frozen water bottles out of the freezer to help keep the refrigerator cold. You could also move perishable food into coolers with ice if available. Freezers will keep food safe for considerably longer if the door is kept shut. A full freezer will keep food safe for up to 48 hours, and a half full freezer for up to 24 hours. Frozen foods can safely be refrozen or cooked as long as they remain below 40°F. Never “taste test” food that is questionable. When in doubt, throw it out!

CARBON MONOXIDE (CO) POISONING

Carbon monoxide poisoning is a serious hazard associated with power outages, particularly in the winter months. This silent killer is responsible for over 400 deaths in the United States every year. Carbon monoxide is produced by anything that burns fuel, such as gas-powered motors, furnaces, and fireplaces. When the power goes out, conventional methods of heating your home may also stop working. When trying to keep your house warm during a power outage, here are some methods you should never use because they will result in dangerous carbon monoxide levels:

• Never use a gas range or oven for heating your home.

• Never burn any type of charcoal indoors.

• Never use portable gas camp stoves indoors.

• Never use a generator inside your home, basement, garage, or less than 20 feet from any window, door, or vent.

• Never run vehicles inside a garage, even with the overhead door open.

• Never use portable flameless gas heaters indoors.

Detecting elevated carbon monoxide levels early is crucial to preventing injury or death. It is recommended that you have at least one battery-powered carbon monoxide detector in your home, preferably one in every sleeping area. These detectors can save lives as well as provide peace of mind knowing you will be immediately alerted to a potential problem.

STAY WARM AND SAFE

Setting your home up with a backup power source such as a generator or solar-charging batteries is a great way to prepare for a power outage. However, you don’t necessarily have to break the bank to stay warm and safe during a winter power outage. Here are some cost-effective methods for staying warm:

• Consolidate your living space by closing doors to all rooms not in use.

• During daylight hours, open the blinds to windows that are facing the sun. At night, close the blinds and curtains on all windows, and consider hanging a blanket over them to help prevent heat loss.

• If you do have a portable generator, ensure it is only running outdoors and at least 20 feet away from windows, doors, and vents.

• Install battery-powered CO detectors.

• Keep extra blankets and cold weather clothing handy.

• Break out the camping gear, sleeping bags, hand warmers, etc. Consider setting up a tent in the living room (the kids will love it!). Body heat from even 1 or 2 individuals in a small, self-contained environment will increase the ambient temperature.

Preparedness is key to surviving any emergency. It is highly recommended that every family have emergency supplies that will last for at least 72 hours. To view the recommended essential items to keep in your 72-hour kit, and other emergency preparedness resources visit swuhealth.org/preparedness-resources

CAR SEAT

By Savannah Nelson CERTIFIED CHILD PASSENGER SAFETY TECHNICIAN

Aproperly installed car seat can save your child’s life, yet around 60% of child car seats are installed incorrectly. If you are a parent or caregiver who transports children on the road, there are some basic guidelines that will ensure your little passengers are protected in case of an accident.

Make sure each child has a car seat model that fits the child and your vehicle, and use that seat until your child reaches the top height or weight allowed by the manufacturer. Never use a car seat that is borrowed or second-hand, or that has been through an accident. Car seats actually have an

expiration date, which is usually six years after the date of manufacture. That’s because the materials and integrity can degrade over time.

Install the seat rear-facing for as long as possible (up to 30-40 pounds); this is the safest position for infants and toddlers. Don’t worry if the child’s legs have to bend against the back seat, most little ones are quite comfortable in that position (think of the time they spent in that pose in the womb).

A car seat should be installed properly with seat belts so that it doesn’t move more than one inch from side-to-side

or back to front. The seat belt securing the car seat should be locked. Make sure the chest clip stays at armpit level and that the harness webbing can’t be vertically pinched together.

Once a child has reached the maximum weight allowed for a rear-facing, followed by a forward-facing car seat (usually at least age 4 and 40 pounds), switch to a booster seat with a seat belt until the child is at least 8 years old. Of course, buckle up using seat belts no matter how old you get, which is required by Utah law.

If you’re not sure how to install your child car seat or just want to make sure you’ve done it right, the health department offers free car seat checks. There is a Certified Child Passenger Safety Technician located in Washington, Iron, Kane, Beaver, and Garfield counties who can check or help you install your car seat. It takes about half an hour, and we recommend you bring your child with you so the seat can be properly fitted and positioned. To make an appointment, visit swuhealth.org/carseats and click the link. You can also learn more about car seat and seat belt safety at clickit.utah.gov.

“After serving 10 years as a Highway Patrol officer, I can absolutely say that properly installed car seats make all the difference in a crash. I’ve seen situations where accidents occurred at freeway speeds and you wouldn’t think anyone would have walked away looking at the damage to the vehicle, but they would be up and around by the time we arrived at the scene because they’d been properly restrained in seat belts or car seats. They might just have bumps and bruises as the extent of their injuries.

On the other hand, unfortunately, I’ve seen a lot of other accidents where car seats weren’t properly installed and children were injured or killed. A seatbelt can do more harm than good if not fastened properly or tight enough to the car seat, especially where the shoulder and lap belt should meet and thread through the unit. A car seat that wobbles around can result in severe injuries from the forces incurred in a crash. Because of those incidents, when I noticed an improperly installed car seat during a routine traffic stop, I would let the driver know and help them reinstall it the right way.

Another point: sometimes kids will be buckled up but adults in the front might feel like they don’t have to or don’t mind taking the risk of getting a ticket for not wearing one. The problem is, unrestrained people in an accident become missiles inside the car and can injure or kill those who are buckled properly.”

-Daniel Nielson, former Utah Highway Patrol trooper

Healthy Recipes

The recommended minimum intake of vegetables and fruits for American adults is 5 servings per day, yet a recent Harvard study revealed that we (including Utahns) are only eating 1 serving of fruit and 1 ½ servings of vegetables daily on average. The CDC just released a report showing that half of young children in the US are eating no fruits or vegetables on some days in a given week.

Increasing vegetables and fruit in our daily diet is essential for living and feeling better. Here are a couple recipes that make it easy to eat a variety of colorful, delicious fruits and vegetables in one dish. You can adjust or create variations however you want!

Inspired by acai bowls that have become popular over the past decade, this refreshing, nutrient-dense fruit bowl provides a serving of fruit for each ½ cup with no added sugars. Use as a breakfast, lunch, or dessert!

BASE

• 1 cup frozen fruit (mix or match strawberries, mixed berries, peaches, unsweetened acai packets, dragon fruit chunks, etc.)

• 1 frozen banana (for creaminess)

• ½ cup unsweetened coconut milk (or other plant milk such as almond, oat, etc.)

Add ingredients in blender and mix to thick consistency, makes 1 or 2 servings

TOPPINGS (your choice, thaw beforehand if frozen)

• Blueberries

• Blackberries

• Raspberries

• Strawberries

• Mango

• Pineapple

• Peaches

• Kiwi

• Banana

• Almonds

• Unsweetened coconut flakes or chips

• Uncooked oatmeal (or granola with no added sugar)

• 1 tablespoon scoop of almond or peanut butter (unsweetened)

First served at a Texas country club in the 1940s, cowboy caviar makes a healthy salsa, relish, or cold salad by itself. Each ½ cup equals a serving of vegetables!

• 2 cans beans, drained (mix or match black beans, kidney beans, black eyed peas, etc.)

• 1 can corn, drained (or 1 cup frozen corn)

• 1 small onion, diced (any color)

• 1 bell pepper, diced

• 4 Roma tomatoes, diced (or 1 can diced or crushed tomatoes)

• 1 avocado, diced

• ¼ cup cilantro, chopped

• Juice of 2 limes

• 1/4 cup olive oil

• 1 tablespoon vinegar

• Salt & pepper to taste

Combine ingredients in a medium bowl and gently toss. Refrigerate for 30 minutes to allow flavors to blend.

By Mitchell Christensen SWUPHD ENVIRONMENTAL HEALTH SPECIALIST

water around as it drained and create a whirlpool. But it always left me thinking, ‘Where does it go next?’. Now, years later, I know the answer to that question and many others having to do with water resources, especially since working in the Environmental Health division of our local health department. Besides inspecting restaurants, swimming pools, schools, body art facilities, tobacco sales, and testing for radon, we prioritize keeping our residents healthy by checking water sources, testing water samples, and ensuring that septic

groundwater.

SOURCES

At least once a year, we work with state officials to check water sources and storage tanks that are used to give life to our local communities.

We start by selecting sites from a list of public water systems provided by the state Drinking Water Program. After contacting the operator of the system and arranging a time to meet, we review any reports of problems that may have been observed during previous inspec-

tions. Then we look for documentation verifying that those issues have been addressed properly. We take a look at how their water testing results compare to the standard, making sure that tests have been taken across the system. This helps to confirm that the entire watercourse is staying clean. Finally, everything gets checked in-person and on site, including climbing up the water tank for inspection. Each community’s water supply equipment must be in working condition and the seals on the tanks must be free of gaps.

Any problems are documented and the system operator is advised how to make repairs by a given date. The Utah Division of Drinking Water follows up for further correction if needed.

SAMPLES

Keeping our water safe also includes regular testing and review. Laboratory water testing gives us a more accurate picture of how the impact of human growth and activity is affecting water supplies in the long term. The water lab located at the St. George office of the Southwest Utah Public Health Department offers the following tests

HETEROTROPHIC PLATE COUNT: Tests a water sample for bacterial growth and indicates general cleanliness.

NITRATE TEST: measures level of nitrates (NO3), which usually originate from fertilizers, septic systems, and animal feedlots. Nitrates are highly soluble in water and can cause serious illness or death in human populations, especially infants.

COLIFORM BACTERIA TEST: Detects levels of coliform bacteria (like common E. coli), which may indicate fecal contamination of a water supply.

Our water lab emails results within 24 hours of running a sample. These tests are performed on public water systems on a regular basis, and private wells are tested after they have been drilled. Also, over 40% of public swimming pools in the Southwest Utah five-county district use the Health Department water lab for their testing. By accurately measuring human impact over time, we can keep our water safe and protected as our population continues to grow.

SEPTIC

Whenever a home is built on land not attached to a public sewer system, our Environmental Health

division is involved from the start to make sure groundwater is protected. Each septic system is unique to the property and requires approved planning and design to work properly.

Septic systems need the right soil conditions to adequately dispose of waste. Before a piece of land is developed for a septic tank, it must first be tested to determine what soil types and depths it has. Most of the time, ten feet is the minimum distance required for study. The best soils have a lot of loam in them. Loamy soils are rich in organic matter and should contain some parts of sand, silt, and clay. The idea is to get soil to dissolve waste particles in water that is not too fast or too slow. This gives natural bacteria in the soil time to break down nitrogen and phosphorus before they can contaminate groundwater.

Soil evaluation results, system designs, and other information is turned in with each septic application. An Environmental Health Specialist reviews each one to make sure it meets health and safety requirements. The septic tank must be large enough to hold the expected solid wastes and the septic field must include enough surface area to handle all the wastewater before it reaches any groundwater levels. If everything checks out, then a septic permit is issued. Once the system is built, we do a final inspection to be sure that everything was installed according to plan. If it passes final inspection, then the septic system is buried and ready for use. We also review plans, issue permits, and inspect repairs of existing systems that malfunction.

A septic tank should be pumped free of waste and refilled with water every three to five years. In order to do this, a specialty truck with a pump and storage tank is required. These pump trucks must obtain a permit from the health department and be inspected annually to prevent sewage leaks. Answers to most questions about septic systems can be found at swuhealth.org/ septic-systems.

The journey of discovery from wondering where bathwater goes to being directly involved in the protection of local water resources has been fascinating. Public health practices in regards to safe drinking water are one of the foundations of civilization, helping us live healthier, longer lives. For more information about water testing and septic systems, visit swuhealth.org and look for Environmental Health programs under the Services tab.

By Ali Elmen, MPH SWUPHD HEALTH EDUCATOR

OPIATES VS OPIOIDS

The terms opiate and opioid are often used interchangeably. While both drugs are narcotics, the difference is in how they are made. Opiates are substances derived from the natural poppy plant, such as opium, morphine, and codeine. Opiates are still used today, but on a smaller scale than opioids, which are synthetically created. Opioids can usually be found in most prescription pain relievers and some types of illicit drugs. Heroin is defined as an opioid because it is made synthetically, although it uses morphine in the process. The term opioid is generally used today when referring to this entire class of drugs, including opiates.

PRESCRIPTION OPIOIDS VS. ILLICIT OPIOIDS

Many of the effective pain relievers used medically are opioids prescribed by doctors to patients after a surgery or procedural event. Familiar prescription opioids include generic oxycodone (brand name Percocet), meperidine (Demerol), codeine (Promethazine), fentanyl (Duragesic), hydrocodone (Lortab, Vicodin), hydromorphone (Dilaudid), methadone (Dolophine), and Tramadol (Ultram). These are among the 500-plus opioids created by the pharmaceutical industry.

Fentanyl has been used for many years as a prescription painkiller and is considered safe when used properly. However, because of its proper-

ties, fentanyl is now manufactured illegally in large quantities and sold as counterfeit prescription pills or added to other drugs to increase potency and profits for drug dealers. Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine.

Heroin is a popular opioid that has no medicinal purpose and is highly abused. Since heroin and street fentanyl are unregulated, their misuse contributes to an alarming number of overdoses and deaths.

HOW DO OPIOIDS WORK?

We have receptors in our body that are responsible for telling us what hurts and how we respond to pain, which can include an increase in heart rate, respiration, and blood pressure. Opioids attach to these receptor sites and send signals that block pain, slow breathing, and calm the body. Used appropriately, opioid medication provides relief from pain caused by surgery, injury, and health conditions like cancer.

MISUSE AND OVERDOSE

When there is continued use of opioids, whether prescribed or illicit, a person can develop a tolerance where higher doses are needed to be effec-

tive or even just to feel “normal”. If a person experiences withdrawal symptoms when they stop taking the drug, they have developed opioid dependence. If misused by taking more than prescribed, without a prescription, or in combination with other drugs or alcohol, opioids depress the body’s respiratory system to dangerous levels, which can lead to overdose and death.

WHAT IS NALOXONE?

Naloxone is a medication that can reverse an opioid drug overdose. It can be administered by an injection or nasal spray and help save a life if given correctly and early enough.

Naloxone kits have been used to save thousands of lives and have become familiar tools for emergency medical services and law enforcement personnel. Easy-touse naloxone nasal spray kits are becoming more available for businesses, organizations, and civilians who may have contact with people who are at risk for opioid overdose.

Opioid misuse and overdoses impact every community. For more information and resources concerning opioids, naloxone kits, and training, please visit swuhealth.org/opioids .

SCREENINGS FOR COLON CANCER

By David Blodgett, MD, MPH SWUPHD DIRECTOR AND HEALTH OFFICER

Colon cancer (colorectal) is worth paying attention to. Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in the United States. Overall, the lifetime risk of developing colorectal cancer is about 1 in 23 for men and 1 in 26 for women. However, each person's risk might be higher or lower, depending on their risk factors.

There are some risk factors for colorectal cancer that you can impact: weight, physical activity, diet, smoking, and alcohol use. There are other risk factors you should be aware of but can’t do much about, including aging, family history of colorectal polyps or cancer, inflammatory

bowel disease, diabetes, race, and having treatments for other cancers. Interestingly, shift work, which disrupts sleep patterns, is being investigated as a possible contributor to colon cancer risk.

Colorectal cancer is the third leading cause of cancer-related deaths in both men and women, and it's the second most common cause of cancer deaths when numbers for men and women are combined. It's expected to cause about 52,550 deaths during 2023. Fortunately, deaths from colon cancer have decreased, influenced by screenings and improved treatments.

Clearly, colon cancer screening is an important part of routine health care. Colon

cancer screening is recommended for all adults beginning at age 45. The United States Preventive Services Task Force (USPSTF) lowered the age from 50 in 2021, as it appears that the age at which people develop colon cancer is getting younger.

Most people think that colon cancer screening means a colonoscopy, where a scope is used to visualize the lining of the intestine. However, there are other options available. You should talk with your doctor about your choices and which ones best fit your individual circumstances.

Remember, screening tests are used only if you don't have bowel symptoms. If you have signs and symptoms — such as abdominal pain, a change in bowel habits, bleeding, constipation, or diarrhea — then you'll need other tests to address those problems. Here's an overview of the most common colon cancer screening tests. All of them have been recommended by the USPSTF equally if you stay on the recommended schedules.

COLONOSCOPY

During a colonoscopy exam, a long, flexible tube (colonoscope) is used to visualize the lining of the intestines. A tiny video camera at the tip of the tube allows the doctor to detect changes or abnormalities inside the entire colon.

A colonoscopy takes about 30 to 60 minutes and screening is generally repeated every 10 years if no abnormalities are found and you don't have an increased risk of colon cancer.

The pros:

• A colonoscopy is one of the most sensitive tests currently available for colon cancer screening.

• The doctor can view your entire colon and rectum.

• Abnormal tissue, such as polyps and tissue samples (biopsies), can be removed through the scope during the exam.

The cons:

• Expensive

• The exam might not detect all small polyps and cancers.

• A thorough cleansing of the colon is required before the test, requiring a liquid diet and drinking laxatives for a day before the procedure.

• Diet changes are needed before the test, and medications may need to be adjusted.

• Sedation is almost always used, and it can take several hours to wear off.

• Because of the sedation, you'll need someone to drive you home.

• Rare complications may include bleeding from the site where a biopsy, polyp, or other abnormal tissue was removed, or bleeding from a tear in the colon or rectum wall.

• Cramping or bloating might occur afterward.

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MOST PEOPLE THINK THAT COLON CANCER SCREENING MEANS A COLONOSCOPY.

HOWEVER, THERE ARE OTHER OPTIONS AVAILABLE.

FLEXIBLE SIGMOIDOSCOPY

A flexible sigmoid scope of the lower intestines takes about 20 minutes and does not require sedation or bowel prep. An enema is used instead of emptying the entire colon. This test is usually performed every 5 years.

The pros:

• It is a direct visualization test.

• Moderately expensive.

• Sedation is not required.

• Bowel prep is much less extensive than other direct visualization methods.

• Complications such as bleeding are less common.

The cons:

• The exam might not detect all small polyps and cancers or those higher up in the intestine.

• Cramping or bloating might occur afterward.

STOOL DNA TEST

The stool DNA test uses a fecal sample to look for DNA changes in cells that might indicate the presence of colon cancer or precancerous conditions. The stool DNA test also looks for signs of blood in your stool. For this test, you collect a stool sample at home and send it to a laboratory for testing. Stool DNA testing is typically repeated every three years.

The pros:

• The test doesn't require bowel preparation, sedation, or insertion of a scope.

• You can eat, drink, and take medications normally before the test.

• The stool can be collected at home, avoiding disruption of work and daily activities

• Less expensive.

The cons:

• The DNA stool test is less sensitive than colonoscopy at detecting precancerous polyps.

• If abnormalities are found, additional tests might be needed.

• The tests can suggest an abnormality when none is present (false-positive result).

FECAL OCCULT BLOOD TEST OR FECAL IMMUNOCHEMICAL TEST

Fecal occult blood test (FOBT) and fecal immunochemical test (FIT) are lab tests used to check stool samples for hidden (occult) blood. The tests are usually repeated every year.

The pros:

• Stool sample collection can be done at home.

• There's no need to empty the colon ahead of time.

• There's no need for sedation.

• Very inexpensive

The cons:

• The tests fail to detect some polyps and cancers.

• Certain foods and medications might need to be avoided for several days before the test.

• If blood is detected, additional tests might be needed to determine the source.

• The tests can suggest an abnormality when none is present (false-positive result).

VIRTUAL COLONOSCOPY (CT COLONOGRAPHY)

During a virtual colonoscopy, a CT scan produces cross-sectional images of the abdominal organs, allowing the doctor to detect changes or abnormalities in the colon and rectum. To help create clear images, a small tube (catheter) is placed inside your rectum to fill your colon with air or carbon dioxide. Virtual colonoscopy takes about 10 minutes and is generally repeated every five years.

The pros:

• Unlike a traditional colonoscopy, a virtual colonoscopy doesn't require sedation or the insertion of a scope into the colon.

The cons:

• Expensive

• Like a standard colonoscopy, a thorough cleansing of the bowel is required beforehand.

• The exam might not detect all small polyps and cancers.

• Diet changes are needed before the test, and medications may need to be adjusted.

• Radiation exposure may be a concern. However, the level of radiation used during a screening CT scan is lower than the amount used in a diagnostic CT scan.

• Since tissue samples can't be taken during the exam, a follow-up colonoscopy might be needed if an abnormality is detected.

• Cramping or bloating might occur afterward.

WHAT DOES ALL THIS MEAN?

Colon cancer screening is important; it can save lives. Sadly, only about 60% of us get our screenings. Fortunately, you now know there are many options that you can discuss with your physician to find one that works for you.

2022 ANNUAL REPORT

BOARD OF HEALTH

The Southwest Utah Public Health Department (SWUPHD) serves the approximately 278,000 residents of Washington, Iron, Kane, Beaver, and Garfield counties.

SERVING OUR COMMUNITY

CLINICAL SERVICES

• Immunizations administered (non-COVID-19): 11,285

• COVID-19 vaccine doses administered: 11,369

• International travel immunizations: 617

• TB (Tuberculosis) tests: 1,138

• Epidemiology investigation contacts (including COVID-19): 10,331

• Total deaths in 5-county district (2022): 2,632

• Total births in the 5-county district (2022): 3,886

• Vital Statistics certificates (includes birth & death certificates): 27,381

COMMUNITY HEALTH

• Certified car seat installation checks: 147

• Sponsored mobile dental clinic patient visits: 194

• Community engagement client referrals: 101

• Pregnant women enrolled in WIC: 508

• Clients enrolled in WIC: 3,887

• Breastfeeding coaching contacts: 437

• Vaping and tobacco education reach: 6,847

• Quit-line referrals: 210

• Community events: 28

• Community coalitions: 34

EMERGENCY PREPAREDNESS

• MRC (Medical Reserve Corps) registered volunteers: 550 (1,690 hours volunteered)

• Sponsored emergency preparedness trainings & events: 275 (7,900 participants)

• Full-Scale Strategic National Stockpile / Medical Countermeasure Exercises (Flu “Shootouts”): 7 Locations (1,460 Flu Shots Administered)

• COVID-19 Vaccine Doses Administered: 11,353

• Health Care Preparedness Coalition Meetings: 14

• AFN (Access & Functional Needs) Coalition Members: 241

• Participants taught Stop the Bleed: 115

• Opioid # of narcan distributed: 181

• People taught how to use narcan: 120

ENVIRONMENTAL HEALTH

• Total food service inspections and consultations: 4,757 (1,700 routine, 57 follow-up, 3,000 consultations)

• Food Handler Cards issued: 10,015

• Water samples analyzed (for swimming pools and drinking water facilities): 7,761 (6,332 pool, 1,396 drinking water, 33 other)

• Public pools & spas in district: 850

• Restaurants/food establishments in district: 1,202

• Total septic inspections and consultations: 6,322 (583 inspections, 5,739 consultations)

SOUTHWEST UTAH

PUBLIC HEALTH DEPARTMENT

2022 FRIENDS OF PUBLIC HEALTH

Every year, the SWUPHD selects members of the community who have demonstrated exceptional support and service to the field of public health.

JACOB BROWNING & JEANIE JOHNSON

Active Life Center, Washington County

Jacob and Jeanie, representing the Active Life Center, became an amazing asset during the COVID-19 pandemic when vaccine supplies began to arrive and Washington County needed a location where large numbers of people could efficiently get immunized. The Active Life Center volunteered their facility for weeks of large scale vaccine clinics, providing a useful, safe location for this essential effort.

CHERYL LINES & BRITTNEY JOHNSON

Create Better Health, USU Extension

Cheryl and Brittney are the Washington County ambassadors for the Create Better Health program, which strives to combat obesity and diabetes trends by helping people cook healthy meals on a budget, buy and prepare whole foods, understand food labels, practice safety in the kitchen, and much more.

ANDY GRIFFIN

890 KDXU Program Director

Andy, the well-known voice of the AM radio station 890 KDXU, continues to donate airtime to regular public health messaging for the community, with weekly health updates every Wednesday at 7:55am and hosting SWUPHD Health Officer Dr. David Blodgett monthly on the Andy Griffin Show (every first Wednesday at 9am). He takes an active, personal interest in health and preparedness issues.

Fees: 19%

Other: 1%

Contracts/Grants: 62%

County Contributions: 18%

2022 ANNUAL REPORT

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TUNE IN: WE'RE ON THE RADIO!

890 KDXU AM: Every first Wednesday@ 9am: The Andy Griffin Show hosts Dr. David Blodgett

890 KDXU AM: Every Thursday @ 7:55am: Health Update

590 KSUB AM: Every Wednesday @ 6:30am: Ounce of Prevention

100.3 FM (St. George Radio): Every Thursday @ 3pm: Health Update

TOP 10 SOUTHWEST UTAH CAUSES OF DEATH

1. Cancer

2. Heart Disease

3. COVID-19

4. Accidents

5. Alzheimer's Disease

6. Stroke

7. Lung Disease

8. Diabetes

9. Nutritional Deficiencies

10. Suicide

BEST OF STATE 2022

HEALTH Magazine won its fifth Best of State medal in the Community Development - Publication category, awarded at the July 2022 gala.

Pictured from left to right: David Heaton (Editor/SWUPHD PIO), Jeff Shumway (Publisher/SWUPHD Business Manager), Kindal Ridd (Art & Design/SWUPHD Graphic Designer), Cameron Mitchell (SWUPHD Deputy Director)