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Home My WebLink About2003-November File Copy i Jefferson County Board of Health Agenda Minutes November 20, 2003 • JEFFERSON COUNTY BOARD OF HEALTH Thursday,November 20,2003 2:30—4:30 PM Main Conference Room Jefferson Health and Human Services AGENDA I. Approval of Agenda II. Approval of Minutes of Meetings of August 21,2003 and October 16,2003 III. Public Comments IV. Old Business and Informational Items 1. MCH Update 2. Cruise Ship Update V. New Business • 1. EnviroStars Presentation 2. Healthy Jefferson 3. Bioterrorism Draft Plan 4. Influenza Season A/SARS Preparedness 5. Evaluation of Existing On-site Sewage Systems Sub-Committee Update 6. 2003/2005 Youth Yellow Pages Project Summary VI. Activity Update VII. Agenda Planning VIII. Next Meeting: December 18,2003,2:30-4:30 PM Main Conference Room Jefferson Health and Human Services • JEFFERSON COUNTY BOARD OF HEALTH MINUTES 411 Thursday, October 16, 2003 Board Members: Staff'Members: Dan Titterness,Member- County Commissioner District#1 Jean Baldwin,Health&Human Services Director Glen Huntingford,Member-County Commissioner District#2 Larry Fay,Environmental Health Director Vacant-County Commissioner District#3 Julia Danskin,Nursing Services Director Geoffrey Masci, Chairman-Port Townsend City Council Thomas Locke,MD,Health Officer Jill Buhler,Member-Hoipital Commissioner District#2 Sheila Westerman,Member-Citiren at Large(City) Ex-officio Roberta Frissell,Member-Citizen at Large(County) David Sullivan,PUD#1 Vice Chairman Commissioner Huntingford called the meeting to order at 2:30 p.m. All Board and Staff members were present, with the exception of Chairman Masci and Member Buhler. There was a quorum. APPROVAL OF AGENDA Member Frissell moved to approve the Agenda as submitted. Member Westerman seconded the motion, which carried by a unanimous vote. • APPROVAL OF MINUTES Given that the copies of the minutes in the agenda packets were incomplete, approval of the August 21, 2003 minutes was tabled until the November meeting. It was noted that the Board did not hold its regular meeting in September. PUBLIC COMMENT Dale Wurtsmith was present to find out if there had been any resolution to the issue of permanent Operations and Maintenance licensure, which he brought before the Board at its August meeting. (See later in minutes: Operations and Maintenance Licensure) OLD BUSINESS AND INFORMATIONAL ITEMS Cruise Ship Sewage Releases—Follow-up Letter from Department of Ecology: Mr. Fay noted that the agenda packet included Ecology's response to the Board's letter expressing concerns about the potential negative impact to water quality by the cruise ship industry. The State Board of Health also received a response. Member Westerman asked to clarify whether there was one or two discharges, since Ecology's letter refers to two May dates: May 3 and 11. Mr. Fay said there was one discharge, but he is uncertain of the exact date. She expressed concern about the time it would take for Ecology to write a Memorandum of Understanding(MOU)with the Northwest Cruise Ship Association and suggested the Board write a letter acknowledging receipt and recommending the issue be resolved sooner than March 2004. Health Board Minutes - October 16, 2003 Page 2 Member Frissell referred to the response she received to her personal correspondence with Carnival • Cruise Lines (the parent company of Holland America), in which they referred to their discharge guidelines. Alternate Member Kolff asked whether the Board might suggest having the opportunity to give input or provide recommendations into that MOU, which might change the letter being suggested by Member Westerman. Instead of pushing them to move more quickly, the letter could thank them for moving forward and state the Board's interest in providing input into the draft MOU or being represented at the MOU's creation to ensure local concerns are addressed. Mr. Fay noted that Ecology, the Port of Seattle,U.S. Coast Guard and the Puget Sound Clean Air Agency are working with the Northwest Cruise Ship Association and that Jefferson County participates in a different air quality body than the Puget Sound Clean Air Agency. If there are issues, the Olympic Regional Air Control Authority(ORCA) might need to be engaged. He agrees it is appropriate to ask to be involved since the County is directly affected. Dr. Tom Locke commented that the State Board of Health is pursuing this issue and he agreed to request an update. The potential health impact is the main concern. Commissioner Titterness moved that the Board direct Dr. Tom Locke to request an update from the State Board of Health,then confer with Larry Fay on sending a letter to the Department of Ecology on the Board's behalf. The Board requested that it receive a copy of the letter. The motion was seconded by Alternate Member Kolff and carried by a unanimous vote. Breast and Cervical Health Program(BCHP) Report—Quilcene: Julia Danskin reported that the Breast and Cervical Health Program at the Health Department serves women aged 40-65. This program, funded by the Center for Disease Control,provides mammograms and annual exams to low-income women in this age group. With outreach and education funding associated with this grant, staff(Margie Boyd and Jennifer Doyle) in coordination with the Soroptimist International arranged a Women's Health Fair in Quilcene to conduct breast and cervical cancer screenings. Jean Baldwin recognized both Margie and Jennifer at the meeting by reading letters of appreciation she and the Board of Health had written regarding this extra project that resulted in providing 16 mammograms and 4 women's health exams. The project also involved the assistance of many trained volunteers. NEW BUSINESS Regional Communicable Disease/Bioterrorism Response Duty Officer Protocol: Dr. Tom Locke reviewed that this topic of establishing a"duty officer"position was discussed last month and arose out of regional bioterrorism planning and health officer coverage involving Kitsap, Clallam and Jefferson Counties. The proposal for this shared responsibility was included in the packet. Beyond health emergency response, this system would provide increased regional communicable disease control capacity. While there is not a high enough volume of emergencies in any one jurisdiction to justify having call schedules on a county-by-county basis, there is a need for a public health professional presence 24 hours a day, seven days a week. This system would provide a single point of contact for emergency rooms,medical providers, first responders and the public in the three-county area. Another • advantage is that it would require these counties to meet a long-time goal of creating standardized response protocols. The local Health Officer would continue to be available as a back-up (either Dr. Locke or Dr. Scott Lindquist can be reached 24/7). Asked whether this position is a requirement for Health Board Minutes - October 16, 2003 Page 3 receiving bioterrorism funding, Dr. Locke said while it is not required, it is generally expected that each county would have a 24/7 response capability and a system for contact. This region is the first in the state to propose sharing this position. Julia Danskin noted that all Health Departments having someone available 24/7 for emergencies is a Washington public health standard, and Jean Baldwin has been fulfilling this role for Jefferson County for several years. Dr. Locke gave examples of the importance of timely public health contact. David Sullivan spoke favorably about having a single contact number. Jean Baldwin noted that a University of Washington physician who also consults with the nation of Japan on communicable disease issues, would hold a series of regional Staff trainings supported by bio- terrorism funding. Funding would also be used to get information to the medical community about reportable conditions, the emergency contact number, and available public health resources. The intent is to use funding for activities that could be continued beyond the bio-terrorism funding. There would also be more work on active versus passive surveillance,which will involve liaison with the hospitals and clinics. Commissioner Huntingford expressed some concern about far-reaching impacts of this commitment, which goes beyond "beeper time."Dr. Locke responded that this is essentially the formalization of a system that is already functioning informally. The lack of fees/charges and the fact that this is a volunteer activity from County to County simplifies liability and risk pool issues. Economic impacts include paying the people who are on call,which would be modest for Jefferson County since its • population is roughly 10% of the region. Kitsap County, on the other hand, would be impacted more heavily because on-call time is directly proportional to their population size. Mr. Fay said this provides an opportunity to share and work together on the creation of the protocols that the County needs to have anyway. Looking at the flow chart printed in the agenda packet, Member Westerman asked who would be in contact with the local public health worker. Dr. Locke agreed that the chart should reflect the expected flow that the Duty Officer would contact the local public health worker. Dr. Locke noted that a formal agreement between Jefferson and Clallam Counties and the Kitsap Health District would likely be a matter for the County Commissioners and their legal advisors. Port Townsend Water Supply Status: Larry Fay reviewed that during last year's dry fall and low reservoir level, the City and Mill developed a clear plan around low water conditions with trigger points, thresholds and specific actions. In September 2003, Staff from City Public Works, the Mill and Environmental Health met to review the plan. The City and Mill had come up with additional water conservation efforts not previously identified, including the renting of cooling towers, which might save up to two million gallons a day by cooling and reusing water in various aspects of Mill operations. This year, the City had to shut down the diversion from the Big Quilcene River about a week earlier than last year due to low flows at which point the Mill also implemented plan measures significantly reducing water consumption. He then sketched out the results of implementing new water conservation measures. Even though severe drought conditions forced the City to begin drawing from the Lords Lake reservoir much earlier, the reservoir was left higher than the year prior. He believes that watershed and forest management work done in that basin has gone a long way toward protecting water quality. Health Board Minutes - October 16,2003 Page 4 Alternate Member Kolff added that the Mill's additional internal water conservation measures were a significant contribution, as was their shutting down the Mill for maintenance. He also noted that there is i excellent watershed planning occurring in the County. Water Resources Inventory Area 17 now has a draft Watershed Plan for water quantity, quality,habitat, and which would eventually include instream flow. Evaluation of Existing On-Site Sewage Systems: Mr. Fay reviewed that under the On-Site Sewage Code,the transfer or sale of property or application for a building permit would trigger an inspection of a septic system (also documented in a Staff memo included in the agenda packet). An additional level of inspection is needed when a building permit is for an expansion that includes the construction of bedrooms, or when the permit is for an expansion and there is little or no documentation about the septic system on file with the County. He noted that applicants often question the reasoning behind the need for a septic inspection, for example, when applying for a permit to add a garage or re-roof a house.By putting an inspection requirement on an application for a project that has no apparent connection to the septic system, the County might be encouraging the public to not apply for a permit. Board input was then solicited on a draft matrix to explain to the public when an inspection would occur and what would be involved. Linda Atkins then explained the risk thresholds for the range of inspections. Member Westerman asked to clarify what is meant by an operational check versus a full assessment as well as a first and second level review. Mr. Fay noted that an operational check is a functional inspection of the system(whether or not it is working), whereas a full assessment looks at the capacity of the system and how that capacity relates to the building proposal being submitted. The latter involves two steps: Level One(file review for system documentation) and Level Two (field work to verify the system). Staff noted the need to define what a basic operational check involves. Even though the intent is to get all systems documented,Member Westerman felt that there are certain places that are a priority to document. If it is a shoreline property or near an environmentally sensitive area(ESA), she would want a full assessment. Linda Atkins asked to clarify that the suggestion is that Staff should look more at whether or not it meets vertical separation, etc. which Member Westerman confirmed and added that people have to be educated that these are trigger points toward reaching the long-term goal of having all systems on an Operations and Maintenance(O&M) schedule. Commissioner Titterness pointed out that only a position that is perceived as rational in the greater community would be enforceable. Commissioner Huntingford agreed and used the example of how someone with a 40-acre parcel who would be required to establish a reserve area in order to install a propane stove might simply choose to do the installation without a permit. Linda Atkins clarified that the County has not required anyone to establish a reserve area for putting in a propane stove. She said it would be difficult to make generalizations based on the size of the parcel,recalling a 20-acre plat that was divided into four five- acre sites. Each lot probably had less than an acre of useable ground. Staff continued to show examples of scenarios. As to how to show in the matrix ESAs and shorelines, Mr. Fay said there might be a way to come up with guidelines to allow Staff to treat the critical areas information not as a regulatory standard,but as a flag to look at the particular situation more closely. He noted that Staff does this regularly on septic permits—for instance, if there is a wetland on the property. 4 He agrees with the statement that in the end, if what we are doing appears so weird and is so unreasonable to the public,we will not have accomplished anything. Health Board Minutes - October 16,2003 Page 5 In response to a question about the status of the access to property issues that he was going to take to the State, Mr. Fay said he informally encouraged those involved in rule development, as well as Staff of the Puget Sound Water Quality Authority, to ask the same questions of the Attorney General. He believes Dr. Locke has also talked with the State Board of Health, but he is uncertain anyone has made a formal request. Commissioner Huntingford wondered if we are getting into the same property issue with requiring an operational check as a condition of getting a permit. If the goal is to get more people on O&M, wouldn't it be simpler in some cases to grant the building permit, but require an evaluation within three years? Linda Atkins noted that there have been times when Staff has allowed an applicant to postpone the required evaluation of their system until the final approval of the building permit, which allows owners to get started. However, most often they reach the time for final approval and the evaluation hasn't occurred and they are in crisis. If the issue is whether we can make it a condition of the building permit, then we might as well address that question up front. Larry Fay added that if, in a relatively early inspection, Staff finds a failing septic system or a direct discharge—which they do with some frequency—the individual could incorporate into their building plans and financing a repair and upgrade of the system. David Sullivan said he can understand getting everybody on the system, but that is costly—ongoing inspection can cost a couple of hundred dollars. The PUD charges a lot less,but is subsidizing some of it. Some citizens will object because they do not see what they get for their dollar. They won't say"well • I got to build that addition five years ago,"but would say"you came out and just looked at the system and you are charging me how much?"The more people added to the O&M program, the more the PUD would be subsidizing. They might eventually have to raise their rates, which would cause more problems. Member Frissell asked if there are other ways of putting people on the inspection schedule instead of tying it to permits. Mr. Fay said another is to first identify sensitive areas and focus the O&M inspections in those geographic areas. Member Frissell said she thinks separating the inspection initiation system from the individual building permits should be seriously considered. People would be hard pressed to complain about the rationale (shown in the matrix),which explains what needs to be done to get your permit. There would likely be much less objection to getting individuals on an O&M schedule if everyone is being asked to comply at the same time. Commissioner Mackey said the question is whether it would be equitable and fair. Some of the worst offenders are likely not going to be the same people with the disposable income to build a new shop or re-roof their house. Mr. Fay said the thinking was that over time, through building permits and sales, they would pick up a significant percentage of the systems and then at some point, the Department would have a manageable number to go in and pick up the rest. Member Westerman suggested first starting in sensitive areas. She commented that there would be cases that do not fit even the best matrix. • Commissioner Titterness pointed out that we have been going down this path for two years based on input from the community, this Board and the Planning Commission. If we now decide to change horses, we might lose credibility. Member Westerman questioned what would be wrong with admitting that it is not working—people comprehend the intention and fairness. Health Board Minutes- October 16,2003 Page 6 Commissioner Titterness and David Sullivan volunteered to work with Staff in giving this topic more thought, including fine-tuning the chart. Staff could then do additional work and bring it back to the subcommittee. Community Health Assessment Update—Preparation for October 29, 2003 Healthy Jefferson Meeting: As a follow-up to the Healthy Jefferson forum, Jean Baldwin proposed a meeting of a smaller steering committee comprised of Commissioner Titterness, Judy Morris, Kees Kolff, Geoff Masci and Roberta Frissell. Then on October 29, to ensure more community buy-in, a number of those previously on the Data Steering Committee, including some others such as the Port and School Board could help prioritize the four biggest issues for this community—recognizing the limited resources of governments, private nonprofits and individuals. Subcommittees of this larger group would then consider how to accomplish and evaluate the work and within two months report to the first steering committee group. In February,the smaller steering committee group would then report to the Board of Health since there is City, County and Hospital representation. Operations and Maintenance Licensure: Larry Fay said that during the August meeting he had agreed to undertake tasks late this year or the beginning of next year. He communicated to Dale Wurtsmith that the Board would be coming back and addressing this matter in a few months. Gaikowski Complaint: Member Westerman asked for an update on this situation. Larry Fay said although this situation was brought to some closure, it has resurfaced again. He agreed to ask enforcement officer Molly Pearson to prepare a report on all compliance activities. ACTIVITY UPDATE/OTHER ANNOUNCEMENTS—None • AGENDA PLANNING/ADJOURN The meeting adjourned at 4:35 p.m. The next meeting will be held on Thursday, November 20, 2003 at 2:30 p.m. at the Jefferson County Health and Human Services Department conference room. JEFFERSON COUNTY BOARD OF HEALTH (Excused Absence) (Excused Absence) Geoffrey Masci, Chairman Jill Buhler, Member Glen Huntingford, Vice Chairman Sheila Westerman,Member Dan Titterness,Member Roberta Frissell, Member Judi Mackey,Member • • Board of Health Old Business Agenda Item # IV., 1 • MCH Update November 20, 2003 • County respondents who reported childhood histories of any abuse averaged significantly more poor physical health days, poor mental health days, and more days of impaired functioning than respondents without such histories (Figure 48). • Figure 48:Average Days of Poor Heath by History of Abuse,Jefferson County 7.00 ®Alt County Respondents ge Any abuse as chid D No abuse as chid 6.00 5.72 5.00 4.28 _ 4.73 • 4.00 3.83 _r6 2.88 3.25 3.00- , 215 2.00 1.83 1.00 �7-�„- 0.00 Poor physical health Fkor mental health impaired functioning Source: Jefferson County Health&Human Services,2001 BRFSS County respondents with childhood histories of sexual abuse reported, on average, significantly more days of poor mental health or poor functioning in the previous 30 days than county respondents without such histories (Figure 49). Figure 49:Average Days of Poor Heath by History of Sexual Abuse,Jefferson County g AU minty Respondents •Sexual abuse as chid g No abuse as chid • 7.00- 6.23 6.00- 5.60 5.00 428 4.14 4.00- 3.90 3.00 ;` 288 rs_r. 2.52 2.15 1.94 2.00 too. 0.00 s. „ Poor physical health Poor mental health irrpatred functioning Source: Jefferson County Health&Human Services,2001 BRFSS County respondents with childhood histories of seeing a parent or guardian physically abused reported, on average, significantly more days of poor mental health. All county respondents averaged 2.9 days of poor mental health, however respondents who reported seeing a parent or guardian physically abused averaged 5.0 days of poor mental health but those without such histories reported 2.0 days. • 2003 Health of Jefferson County 71 Standards for Public Health in Washington State Page 1 of 22 Ai i if r., - - , - , - - ts -- .:. _ e _ 0 rreasek t t ..,,,,,,,_, ,,.1 i 3,,.' , '-- ,-:I, li: :ts ;--:`,..,;,,,,- , : A You are here:DOH Home »Standards for Public Health Search I Employees Site Directory: • Newsroom Some files on this page require free readers. Download a reader. • About DOH • Programs a Services Standards for Public Health in Washington • DOH Web (A-Z) State • Alternative Fite Format A Collaborative Effort by State and Local Health Officials Information June, 2001 • 2000 PHIP Contents • 2000 PHIP - Summary Background CeSS f Q ti f f Understanding health issues • Protecting people from disease Assuring a safe, healthy environment for people Prevention is best: promoting healthy living Helping people get the services they need Background: Standards for Public Health in Washington State People depend on the governmental public health system to respond to public health threats and to prevent costly health problems that cause illness or death. Every resident and visitor,throughout the state, should be assured that the public • health system is working to protect their health at all times. Standards for Public Health in Washington State provides a common, consistent and accountable approach to assuring that basic health protection is in place. • Standards for Public Health in Washington State was developed in a collaborative process involving more than 100 public health professionals who work at state and local health departments.They shared their scientific knowledge and practical experience to define standards for the governmental public health system. r • Prevention is Best: Promoting Healthy • Living Standards for Prevention and Community Health Promotion • • Standard 1 Policies are adopted that support prevention priorities and that reflect consideration of scientifically-based public health literature. Local measures: 1. Prevention and health promotion priorities are selected with involvement from the BOH, community groups and other organizations interested in the public's health. 2. Prevention and health promotion priorities are adopted by the BOH, based on assessment information, local issues,funding availability, program evaluation and experience in service delivery, including information on best practices or scientific findings. • 3. Prevention and health promotion priorities are reflected in the goals, objectives and performance measures of the LHJ's annual plan. Data from program evaluation and key indictors is used to develop strategies. State measures: 1. Reports about new or emerging issues that contribute to health policy choices are routinely developed and disseminated. Reports include information about best practices in prevention and health promotion programs. • 2. Consultation and technical assistance is available to assist LHJs in proposing and developing prevention and health promotion policies and initiatives. Written procedures are maintained and shared, describing how to obtain consultation and assistance regarding development, delivery or evaluation of prevention and health promotion initiatives. 3. Priorities are set for prevention and health promotion services,and a statewide implementation plan is developed with goals, objectives and performance measures. 4. The statewide plan is evaluated and revised regularly, incorporating information from health assessment data and program evaluation. Table of Contents Standard 2 • Active involvement of community members is sought in addressing prevention priorities. Local measures: 1. The LHJ provides leadership in involving community members in considering assessment information to set prevention priorities. 2. A broad range of community partners takes part in planning and implementing prevention and health promotion efforts to address selected priorities for prevention and health promotion. • 3. Staff members have training in community mobilization methods as evidenced by training documentation. http://www.doh.wa.gov/standards/default.htm 9/8/2003 . Standards for Public Health in Washington State Page 16 of 22 State measures: • 1. The DOH provides leadership in involving stakeholders in considering assessment information to set prevention and health promotion priorities. 2. A broad range of partners takes part in planning and implementing prevention and health promotion efforts to address selected priorities for prevention and health promotion. 3. Information about community mobilization efforts for prevention priorities is collected and shared with LHJs and other stakeholders. 4. The statewide plan for prevention and health promotion identifies efforts to link public and private partnerships into a network of prevention services. 5. DOH staff members have training in community mobilization methods as evidenced by training documentation. Table of Contents Standard 3 Access to high quality prevention services for individuals, families, and communities is encouraged and enhanced by disseminating information about available services and by engaging in and supporting collaborative partnerships. Prevention services may be focused on reaching individuals, families and communities. Examples of prevention services include chronic disease prevention, home visiting by public health nurses, immunization programs, efforts to reduce unintentional injuries and • violence, including sexual assault. Local measures: 1. Summary information is available to the public describing preventive services available in the community. This may be produced by a partner organization or the LHJ, and it may be produced in a paper or web-based format. 2. Local prevention services are evaluated and a gap analysis that compares existing community prevention services to projected need for services is performed periodically and integrated into the priority setting process. 3. Results of prevention program evaluation and analysis of service gaps are reported to local stakeholders and to peers in other communities. 4. Staff have training in program evaluation methods as evidenced by training documentation. 5. A quality improvement plan incorporates program evaluation findings, evaluation of community mobilization efforts, use of emerging literature and best practices and delivery of prevention and health promotion services. State measures: 1. The DOH supports best use of available resources for prevention services through leadership, collaboration and communication with partners. Information about prevention and health promotion evaluation results is collected and shared statewide. 2. Prevention programs, provided directly or by contract, are evaluated against • performance measures and incorporate assessment information. In addition, a gap analysis that compares existing prevention services to projected need for services is performed periodically and integrated into the priority setting process. http://www.doh.wa.gov/standards/default.htm 9/8/2003 • Standards for Public Health in Washington State Page 17 of 22 3. DOH staff members have training in program evaluation methods as evidenced by training documentation. • 4. A quality improvement plan incorporates program evaluation findings, evaluation of community mobilization efforts, use of emerging literature and best practices and delivery of prevention and health promotion services. Table of Contents Standard 4 Prevention, early intervention and outreach services are provided directly or through contracts. Health promotion activities may be focused on the entire state or community or on groups within the community. Examples of health promotion activities include educational efforts aimed at increasing physical activity, reduction in tobacco use, improved dietary choices. Local measures: 1. Prevention priorities adopted by the BOH are the basis for establishing and delivering prevention, early intervention and outreach services. 2. Early intervention, outreach and health education materials address the diverse local populations and languages of the intended audience. Information about how to select appropriate materials is available and used by staff. 3. Prevention programs collect and use information from outreach, screening, referrals, case management and follow-up for program improvement. • Prevention programs, provided directly or by contract, are evaluated against performance measures and incorporate assessment information. The type and number of prevention services are included in program performance measures. 4. Staff providing prevention, early intervention or outreach services have appropriate skills and training as evidenced by job descriptions, resumes or training documentation. State measures: 1. Consultation and technical assistance on program implementation and evaluation of prevention services is provided for LHJs. There is a system to inform LHJs and other stakeholders about prevention funding opportunities. 2. Outreach and other prevention interventions are reviewed for compliance with science, professional standards, and state and federal requirements. Consideration of professional requirements and competencies for effective prevention staff is included. 3. Prevention services have performance measures that are tracked and analyzed, and recommendations are made for program improvements. 4. Statewide templates for documentation and data collection are provided for LHJs and other contractors to support performance measurement. 5. DOH staff members have training in prevention, early intervention or outreach services as evidenced by training documentation. Table of Contents Standard 5 http://www.doh.wa.gov/standards/default.htm 9/8/2003 Standards for Public Health in Washington State Page 18 of 22 Health promotion activities are provided directly or through contracts. • Local measures: 1. Health promotion activities are provided directly by LHJs or by contractors and are intended to reach the entire population or at-risk populations in the community. 2. Procedures describe an overall system to organize, develop, distribute, • evaluate and update health promotion materials. Technical assistance is provided to community organizations, including"train the trainer"methods. 3. Health promotion efforts have goals, objectives and performance measures. The number and type of health promotion activities are tracked and reported, including information on content, target audience, number of attendees. There is an evaluation process for health promotion efforts that is used to improve programs or revise curricula. 4. Staff members have training in health promotion methods as evidenced by training documentation. • State measures: 1. Health promotion activities are provided directly by DOH or by contractors and are intended to reach the entire population or at-risk populations in the community. 2. Literature reviews of health promotion effectiveness are conducted and disseminated. Consultation and technical assistance on health promotion implementation and evaluation is provided for LHJs. There is a system to inform LHJs and other stakeholders about health promotion funding opportunities. 3. Health promotion activities are reviewed for compliance with science, professional standards, and state and federal requirements. Health promotion materials that are appropriate for statewide use and for key cultural or linguistic groups are made available to LHJs and other stakeholders through a system that organizes, develops, distributes, evaluates and updates the materials. 4. Health promotion activities have goals, objectives and performance measures that are tracked and analyzed, and recommendations are made for program improvements.The number and type of health promotion activities are tracked and reported, including information on content, target audience, number of attendees. There is an evaluation process for health promotion efforts that is used to improve programs or revise curricula. 5. DOH staff members have training in health promotion methods as evidenced by training documentation. • i Board of Health Old Business Agenda Item # IV., 2 fb Cruise Ship Update November 20, 2003 1 k. Jefferson County Health and Human Services :f • .615 Sheridan Street Port Townsend,WA 98368 ` ' Tel 360-385-9400, Fax 360-385-9401 November 14, 2003 To: Jefferson County Board of Health From: Tom Locke, MD, MPH,Jefferson County Health Officer Re: Cruise Ship Waste Discharge Update My apologies for missing the Board's November meeting. I have been invited to speak at a CDC conference in Atlanta on 11/20 on the important but obscure topic of newborn screening for cystic fibrosis. There have been a number of developments in the Cruise Ship infectious waste discharge issue. The State Board of Health is taking an active role in identifying the public health issues involved and applying pressure on the respective agencies with jurisdictional authority. A welcome addition to the process is Washington State's new acting Secretary for Department of Health's Environmental Health division,Janice Adair. Janice comes from Alaska's Department of Health where she was instrumental in the very contentious negotiations that lead to strict state and federal standards for cruise ship discharges in Alaska's sensitive waters. I spoke at length with Janice on November 13, 2003 and she will be glad to assist us. In our conversation I learned that the federal legislation that resolved Alaska's problem is . specific to Alaska and will not benefit us in Washington state. I also learned that Alaska's investigations found that both the blackwater(treated sewage) and graywater(all other waste water)from cruise ships were significant sources of bacterial contamination and that E. Coli counts in some graywater discharges actually exceeded those in blackwater. There are three potential avenues of increasing public health protection as relates to Cruise ship discharges that are being pursued: I)The memorandum of agreement being negotiated between the Department of Ecology, Port of Seattle, U.S. Coast Guard, Puget Sound Clean Air Agency, and the Northwest Cruise Ship Association. Their target date for completion is March of 2004. 2) Several legislators from the Puget Sound area have expressed concern about the issue and plan to hold hearings in the upcoming session of the Washington State Legislature. This could, conceivably, result in legislative action relating to this issue. 3) The State Board of Health is investigating use of existing authority to adopt administrative rules relating to Cruise ship discharges. The Board has broad authority to adopt rules related to control of communicable diseases. Marine water discharges involve a complex mix of overlapping local, state, and federal jurisdictions and may not have the desired force of law in many parts of Puget Sound and the Straits of Juan de Fuca. In summary,this issue is certainly on the radar screen of a number of agencies. I believe the cruise ship industry has strong incentive to be proactive in this area—the cost of compliance is relatively low and the potential for adverse publicity is high. I will keep the Board posted on developments. � z cod Jefferson County Health and Human Services • '� 615 Sheridan Street "j ,Port Townsend, WA 98368 '-'7'.V;;;.--.*4` Tel 360-385-9400, Fax 360-385-9401 November 14, 2003 Mr. Richard K. Wallace Manager, Water Quality Program State of Washington Dept. of Ecology P.O. Box 47600 Olympia, Washington 98504-7600 Dear Mr. Wallace: On behalf of the Jefferson County Board of Health, thank you for your letter of September 8, 2003 responding to the Board's concerns about cruise ship infectious waste discharges in the coastal waters surrounding Jefferson County. The Board appreciates your thoughtful response and explanation of the complex jurisdictional issues involved. The Jefferson County Board of Health has joined with the Clallam County Board of Health to express our concerns to the Washington State Board of Health and seek their assistance in pursuing a solution to this problem that is broadly protective of the health of • coastal residents. We understand that, in addition to the multi-agency workgroup you have convened to pursue a memorandum of understanding, there is significant legislative interest in this issue. The Jefferson County Board of Health supports the Department of Ecology's efforts to negotiate a MOU among the involved agencies and the Northwest Cruise Ship Association. The Board also feels that input from local health jurisdictions (especially those with extensive coastlines and sensitive shellfish populations) is very important in this process. In this respect, the Board asks that you include a local health representative in your workgroup. As Health Officer for both Clallam and Jefferson counties, I would be glad to serve in this capacity. Again thank you for your attention to this issue. Although no imminent health threat resulted from the Norwegian Sun's accidental discharge last May, the potential for such threats is very real. We appreciate Department of Ecology's leadership in convening the responsible local, state, and federal agencies with authority to effectively address this issue. Sincerely, Thomas Locke, MD, MPH Jefferson County Health Officer • Board of Health New Business Agenda Item # V., 1 EnviroSi-ars • Presentation November 20, 2003 • Environmental Health- EnviroStars Default Page 1 of 3 it4;')'- Jefferson County howimmim De la r me n is :. Home : County info :a Departments yffi Search Environmental EnviroStars Health QuicklLinks Food Permit What is EnviroStars? .1 Applications k`_:Online Food Inspections THE BASICS : Electronics Recycling Nationally recognized, the EnviroStars Program certifies businesses for reducing, recycling, and properly managing hazardous waste. The program k-` was created in King County, Washington in 1995 and has expanded to include Jefferson, Kitsap, Snohomish, Pierce, and Whatcom Counties in the Puget Sound region. The program became available in ADDRESS Jefferson County in 2001. 615 Sheridan Street Port Townsend, The goal of the EnviroStars Program is to give WA 98368 businesses incentives and recognition for reducing • hazardous waste, while giving consumers an objective PHONE way to identify environmentally sound businesses. Phone: 360.385.9444 Fax: 360.385.9401 Businesses certified byEnviroStars are given a two- Email: envhealth@co.jefferson.wa.us to-five star rating based on their demonstrated commitment to reducing hazardous waste. The higher HOURS the star rating, the more proactive the business has Monday- Friday been, and the more recognition they receive. 9:00 to 4:30 Businesses with three stars or more are featured in success stories sent to local media, highlighted in Wwosedends radio and print advertisements, and nominated for environmental awards. Sixj6) businesses are currently_certfiedby_ EnviroStars in Jefferson County. CUSTOMERS WANT TO KNOW Public concern about the environment is higher than ever before. Customers are starting to look beyond green products to find green companies. Research shows that a company's environmental reputation will rival quality and brand name as a • criterion used by consumers. By promoting your company's environmental practices, you can attract new customers, reinforce repeat customers, and boost employee morale. http://www.co.jefferson.wa.us/envhealth/envirostars/default.asp 11/12/2003 Environmental Health- EnviroStars Page 1 of 3 * Jefferson Counfy De pa tonne n is Home County Info Departments Seorth Environmental EnviroStars Health QuicklLinks Food Permit Applications FIVE-STAR k` Online Food Inspections Circle and Square Global Car Service k" Electronics Recycling 10953 Rhody Drive Port Hadlock, WA 98339 (360) 385-2070 Contact/owners: Reto and Jana Filli Auto Works 2313 3rd Street Port Townsend, WA 98368 ADDRESS (360) 385-5682 615 Sheridan Street Contact/owners: Steve and Cathy Tucker Port Townsend, • WA 98368 Satch Works Inc. PHONE 670 Ness' Corner road Phone: 360.385.9444 Port Hadlock, WA 98339 Fax: 360.385.9401 (360) 379-0706 Email: Contact/owner: Tom (Satch) Yarbrough envhealth@co.jefferson.wa.us HOURS Jefferson Transit 1615 West Sims Way Monday- Friday Port Townsend, 9:00 to 4:30 WA 98368 (360) 385-4777 Weekends Contact: Carla Meyer Closed 0 a a a a ffi a aa a a a a a 4 0 a a a a a s ****FOUR-STAR SOS Printing 2319 Washington Street Port Townsend, WA 98368 (360) 385-4194 contact/owner: Dan Huntingford Carr's Lube Express • 2099 Sims Way Port Townsend, WA 98368 (360) 385-6769 Contact: Jeff Morlan http://www.co.jefferson.wa.us/envhealth/envirostars/EnviroStars.asp 11/12/2003 • Board of Health New Business Agenda Item # V., 2 • Healthy Jefferson November 20, 2003 jjISON 66 PUBLIC HEALTH i^ �) Always Working for a Safer and IIINtivei HEALTHIER JEFFERSON 615 Sheridan Street,Port Townsend,Washington 98368 To: Jefferson County Board of Health From: Jean Baldwin, Health & Human Services Director Date: November 14, 2003 The attached materials provide information on Jefferson County Public Health's "Assessment into Action" initiatives. Healthy Jefferson is a community-wide initiative that grows out of these prior and continuing efforts. The vision for the Healthy Jefferson is: Mobilize Jefferson County residents to develop priorities, generate resources, and initiate actions that create a healthier Jefferson. On October 29, twenty-four Steering Committee members gathered to identify the three priority goals for Healthy Jefferson. These are the three goals they selected: • Strengthen and support safety net for families with children. • • Increase substance abuse continuum of care capacity (prevention, intervention, treatment) for all age groups. • Increase education/vocational opportunities that develop job skills and employment opportunities. Task Forces will meet to develop operations plans for these policy priorities. The Task Forces will: identify a short-list of measurable outcomes, identify existing Best Practices and other assets in the community, identify a short-list of Best Practices and other assets to be acquired when resources become available. The Task Force Leadership Teams will meet December 2nd to develop the work plans and work . materials for the Task Forces. The Steering Committee will review the work of the Task Forces and will bring the work and recommendations to the Board of Health in early spring 2004. We look forward to working with you on this community-wide initiative. Please feel free to contact me with any questions you may have. • Jean COMMUNITY ENVIRONMENTAL DEVELOPMENTAL SUBSTANCE ABUSE HEALTH HEALTH DISABILITIES & PREVENTION (360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9400 g°Na PUBLIC HEALTH: l � Always Working for a Safer and ilotts -ct-/ HEALTHIER JEFFERSON 615 Sheridan Street,Port Townsend,Washington 98368 Healthy Jefferson Steering Committee 9:30 a.m.-12:30 p.m. Wednesday, October 29, 2003 Jefferson County Public Health Conference Room 615 Sheridan Port Townsend, WA AGENDA 9:30-9:50 Check-in 9:50-10:05 Welcome & Healthy Jefferson Overview 10:05-10:10 Meeting Overview • 10:10-10:55 Prioritize Goals for a Healthy Jefferson: Break-out Groups Identify the three goals you think are the top priorities to achieve"Healthy Jefferson." 10:55-11:25 Report-backs from Break-out Groups Three priorities+key thinking points. 11:25-11:55 Response to Break-out Group Reports 11:55-12:05 Next Steps for Healthy Jefferson 12:05-12:25 Closing 12:25-12:30 Evaluation I COMMUNITY ENVIRONMENTAL DEVELOPMENTAL SUBSTANCE ABUSE HEALTH HEALTH DISABILITIES & PREVENTION (360) 385-9400 (360) 385-9444 (360) 385-9400 (360) 385-9400 Jefferson County Public Health Assessment In Action 1996 • Jefferson County Health and Human Services (JCHHS) and Jefferson General Hospital (JHG) publish "Community Health Report." • JCHHS/JGH partnership funds Community Health Assessment position. 2001 • "The Two Jeffersons"data presented by Chris Hale (Vital Statistics/Census 2000 Short Form). • Media coverage on "The Two Jeffersons" fersons" • Data Steering Committee convened by JCHHS includes:Jefferson County,Jefferson General Hospital, Board of Health, City of Port Townsend, WSU, Law and Justice Committee, and citizens. • JCHHS sponsors Behavioral Risk Factor Surveillance Survey (BRFSS). • Community partnership group identifies critical gaps in community services and initiates use of data in policy and decision-making, e.g. Best Practices (research-based programs). • JCHHS applies for additional monies based on identified needs. 2002 • BRFSS data analysis. • • JCHHS increases infrastructure in community health assessment capacity through City and County funding. • Census 2000 long form analysis. 2003 • Healthy Youth Survey data analysis. • Community presentations w/BRFSS and Census findings. • Publication and release of 2003 Health o f Je f ferson County report. • May 13 Data Summit. • Board of County Commissioners initiates "Priorities of Government." • Public Health #2 priority in "State of the County" Newsletter Survey. • Healthy Jefferson Steering Committee uses assessment data to identify priority goals, • Healthy Jefferson Task Forces create measurable outcomes, identify strategic assets (e.g., Best Practices), report back to Steering Committee. • Steering Committee endorses Task Force work. • Steering Committee reports to Board of Health. • JCHHS & Steering Committee mobilize community to respond. S Summary of Key Findings from the 2003 Health of Jefferson County • Education Nine out of ten county adults had a high school education or more in 2000. Three out of ten county adults has 4 or more years of college. Less than half of county 18-34 year olds reported some post-secondary education. Among county residents age 18-34: • In Port Townsend and Port Ludlow, more than half have some post-secondary education. • In Port Hadlock/Irondale, about I in 5 have some post-secondary education. • In Marrowstone, Quilcene and Brinnon, about 3 out of 10 have some post-secondary education. Housing Three quarters of Jefferson County residents owned their residence in 2000. Nearly I in 5 county homeowners spend 35%or more of their household income on housing. About 2 out of every 5 county home renters spend 35%or more of their household income on housing. Healthcare Access for All About one out of four county residents ages 18-34 do not have healthcare insurance. Maternal Child Health Four out of five Jefferson County women accessed prenatal care in the first trimester of pregnancy in 2001. Life Span Indicators Over half of the county residents are physically active. Nearly I out of 5 county residents had some kind of disability. Of those with a disability, nearly I in every 5 is living below 100% of poverty. Disabilities About I in 10 county males age 5-15 has some type of disability. Nearly half of the county females 75 and older have some type of disability. Maternal Child Health Four out of five county birth mothers are non-smokers. Over half of the county births are paid for by Medicaid. Tobacco Adult tobacco use in Jefferson County is generally lower than the state. Youth tobacco use in Jefferson County is higher than the state. Jefferson County adults are motivated to quit. Jefferson County households generally have clear rules about smoking in the home. Alcohol Jefferson County's drinking patterns are different from those of the state. 7 out of 10 county adult residents reported at least I drink of alcohol on the 30 days prior to being surveyed. I in 4 county adult residents drank on 20 or more of the 30 days prior to being surveyed. I out of 5 county adults are heavy drinkers (5+ drinks at one setting) 3 out of 10 county eighth graders reported at least I drink of alcohol in the past 30 days. I out of 5 county 8th graders are heavy drinkers (5+ drinks at one setting). Other Drug Use Nearly I out of 5 eighth graders reported marijuana use in the past 30 days. • About I out of 10 eighth graders reported using illicit drugs in the past 30 days. Adult Mental Health Four out of five county adults reported excellent, very good, or good overall health. Adult History of Childhood Abuse About I out of 4 county adults reported some type of abuse in childhood. Youth Mental Health Two out of five county 8th graders enjoyed being at school. One out of four county 8th graders met the clinical screening criteria for depression. Families with Children Younger than 18 In Jefferson County, I out of 6 children younger than 18 lives below 100%of poverty; I out of 3 children lives below 185%of poverty. In Port Townsend, Port Hadlock/Irondale, Brinnon, and Quilcene, about I out of 5 children live below 100%of poverty. Three out of five children in female-headed households live below 185% of poverty. Three out of ten births occur to unmarried mothers in Jefferson County. One out of two births to Jefferson County mothers are paid for by Medicaid. Adults living in households with children might have difficulty affording preventive health services. Among households with children: • One in four adults were current smokers • One in three adults were heavy drinkers • One in three adults reported some sort of abuse in childhood. In spite of relatively high levels of poverty among unmarried and single women with children, infants born in Jefferson County are healthy. The risks facing these infants during childhood may not be based in biology, but in economic, and psychosocial conditions. In addition to the consequences of poverty, many county children live in households with adults who smoke and drink heavily. One third of adults in households that include children under the age of 18 reported that they have experienced abuse during childhood. National research indicates that adults with such histories are at greater risk of being abusers. 18-34 Year Olds One in five 18-34 year old county residents had an income below 100%of poverty. Approximately half of the 18-34 year olds in the county has a high school education or less. Two out of five county adults 18-34 years old had incomes of less than $25,000. Among county 18-34 year olds, about 2 out of 5 live at less than 100%of poverty. Among county 18-34 year olds, about I out of 3 live at less than 185%of poverty. Jefferson County residents age 18-34 are more likely to have lower educational attainment(high school or less) than either their peers statewide, or older county residents. They also have lower incomes and higher rates of poverty. This age group is less likely to be overweight and more likely to be physically active than their contemporaries across the state, or older county residents. On the other hand, they are more likely to smoke or drink alcohol (Table 38). Access to primary healthcare and dental services appears to be lower than in older populations. • Table 38: Summary of Risk and Protective Variables, County 18-34 Year Olds Risk and Protective Variables All Adults 18-34 Year Olds Excellent, Very Good, Good Health 84% 93% Health Care Insurance 91% 74% Usual Health Care Provider 85% 67% Usual Place of Care 88% 74% Routine Physical in past 12 months 74% 64% Seen dentist in past 12 months 63% 74% Overweight 29% 16% Physically Inactive 13% 7% Current Smoker 16% 28% Alcohol consumption within past 30 days 68% 73% Source: Jefferson County 2001 BRFSS People 65 and Older One out of six county residents are 65 or older. Three out of ten county residents 65 and older have 4 or more years of college. Among residents age 65-74 years old, about I in 10 on Marrowstone Island lives below 100% of poverty. Among residents 75 and older, nearly I in 5 are living below 100%of poverty in Port Townsend and Port Hadlock/Irondale. Health care access indicators are better among respondents age 65+ than county averages. • Residents age 65+ represent one fifth of the countyulation. Residen + PoP is age 65 account for greater than 25%of the population in Port Ludlow, Marrowstone, and Brinnon. As a group, residents age 65+ are better educated than their peers statewide. Poverty rates among county residents age 65-74 are less than half the state rate, but among residents age 75+ poverty rates are higher than the state average. Older residents in Marrowstone have markedly higher poverty rates. As a group, county residents age 65+ have good access to health care and appear to make appropriate use of preventive services. Most are physically active, and fewer are overweight compared to the state rates. r HEALTHY JEFFERSON • Jefferson County residents ranked Public Health # 2 in 2003 "State of the County" Newsletter Survey. VISION Mobilize Jefferson County residents to develop priorities, initiate actions, and strengthen/build assets that create a Healthier Jefferson. PRIORITY GOAL OPTIONS The following goal statements are based on: • Summary of key findings: 2003 Health of-Jefferson County. • Notes from May 13, 2003 community response meeting. POPULATION FOCUSED I. Strengthen and support safety net for families with children. Key Findings: Risk Factors a. In Jefferson County, I-out-of-6 children younger than 18 lives below 100% of poverty; 1-out-of-3 children lives below 185% of poverty. b. In Port Townsend, Port Hadlock/ Irondale, Brinnon, and Quilcene, about 1-out-of-every-5 children live below 100% of poverty. c. Three-out-of-five children in female-headed households live below 185% of poverty. d. 3-out-of-I 0 births occur to single mothers in Jefferson County. e. I-out-of-2 births to Jefferson County mothers are paid for by Medicaid. f. Adults living in households with children might have difficulty affording preventive health services. g. In addition to the consequences of poverty, many county children live in households with adults who smoke and drink heavily. Among households with children: i. I-in-4 adults were current smokers. ii. I-in-3 adults were heavy drinkers. iii. I-in-3 adults reported some sort of abuse in childhood. Key Findings: Assets a. Infants born in Jefferson County are physically healthy. b. Nurse-Home Visit Partnership (Best Practice). c. Big Brother— Big Sister (Best Practice). d. e. 4 2. Improve the health of the 20% of County residents who are 65 and • older. Key Findings: Risk Factors a. Nearly half of the county females 75 and older have some type of disability. b. Among residents 65 — 74 years old, about I-in-10 on Marrowstone Island lives below 100% of poverty. c. Among residents 75 and older, nearly I-in-5 are living below 100% of poverty in Port Townsend and Port Hadlock/Irondale. d. Older residents in Marrowstone have markedly higher poverty rates. Key Findings: Assets a. Health care access indicators are better among respondents 65+ than county averages. b. As a group, residents age 65+ are better educated than their peers statewide. c. Poverty rates among county residents age 65 — 74 are less than half the state rate, but among residents age 75+ poverty rates are higher than the state average. d. As a group, county residents age 65+ have good access to health care and appear to make appropriate use of preventive services. Most are physically active, and fewer are overweight compared to the state rates. e. • f. 3. Decrease the number of families living below 185% of poverty level. Key Findings: Risk Factors a. In Jefferson County, I-out-of-6 children younger than 18 lives below 100% of poverty; I-out-of-3 children lives below 185% of poverty. b. In Port Townsend, Port Hadlock/Irondale, Brinnon, and Quilcene, about -out-of-5 children live below 100% of poverty. c. 3 out of 5 children in female-headed households live below 185% of poverty. d. I-out-of-2 births to Jefferson County mothers are paid for by Medicaid. e. Adults living in households with children might have difficulty affording preventive health services. Key Findings: Assets a. Seasonal, resource jobs and special events provide income. b. Numerous small businesses in community are employers c. Mentoring of small businesses by EDC. d. e. • 2 4. Increase educational/vocational opportunities that develop job skills and employment opportunities for 18 — 34 year olds. Key Findings: Risk Factors a. Jefferson County residents age 18— 34 are more likely to have lower educational attainment (high school or less) than either their peers statewide, or older county residents. b. 47% of county 18 —34 year olds reported some post-secondary education. c. Among county residents age 18— 34: i. In Port Townsend and Port Ludlow, more than half have some post-secondary education. ii. In Port Hadlock/Irondale, about I-in-5 have some post-secondary education. iii. In Marrowstone, Quilcene and Brinnon, about 3-out-of-10 have some post-secondary education. d. I-in-5 18— 34 year old county residents had an income below 100% of poverty. e. About half of the 18— 34 year olds in the county has a high school education or less. Key Findings: Assets • a. The education profile of the County is better than the State. i. 92% of all County adults had a high school education or more in 2000. ii. 30% of all County adults have 4 or more years of college. iii. County residents age 65+ are better educated than residents 65+ statewide. b. There is a committed educational community in Jefferson County: Jefferson Education Association, AAUW, WSU (e.g., Clemente Program), and Peninsula College. c. Public schools offer alternative educational programs for K— 12 students. d. Distance learning alternatives are utilized by students. e. f. ISSUES — FOCUSED 5. Maintain and increase access to health care for all age groups Key Findings: Risk Factors a. About I-out-of-every-4 County residents age 18-34 does not have health care insurance. b. I-in-5 18-34 year old County residents had an income below 100% of poverty. i 3 c. County respondents age 18-34 were significantly less likely to have a usual place of care than county respondents 35-64 or 65+. d. Over half of the County births are paid for by Medicaid. e. Adults living in households with children reported difficulty affording preventive health services. f. Access to primary healthcare and dental services appears to be lower for 18-34 year olds than in older populations. Key Findings: Assets a. 90% of all county respondents reported having some form of health care insurance. b. 85% of all county respondents reported one doctor or health care provider. c. Family Planning Clinic,Jefferson County Health Department serves about 33% of I5-19 year olds and 33% of 20-24 year olds. d. 88% of all county respondents reported having a usual place of care. e. 75% of all county adult respondents had a routine check-up within the past year. f. Colorectal screening rates among County respondents age 65+ were significantly higher than in the state. g. Hospital employs physicians and runs 3 large medical practices —open on sliding scale for those unable to pay. h. • 6. Increase substance abuse continuum of care capacity (prevention, intervention, treatment) for all age groups Key Findings: Risk Factors a. 7-out-of-10 County adult residents reported at least I drink of alcohol on the 30 days prior to being surveyed. b. I-in-4 County adult residents drank on 20 or more of the 30 days prior to being surveyed. c. I-out-of-5 County adults are heavy drinkers (5+ drinks at one setting) within the past 30 days. d. 3-out-of-10 County e graders reported at least I drink of alcohol in the past 30 days. e. 1-out-of-5 County 8th graders are heavy drinkers (5+ drinks at one setting) within the past 2 weeks. Key Findings: Assets a. Healthy Youth Coalition. b. Substance Abuse Advisory Board. c. Birth-to-Five Coalition. d. Active law and justice community, e.g., Drug Court. e. Programs and services based on enhancing youth assets: Peer-In, Boiler Room, Big Brother—Big Sister (Best Practice). • 4 f. O3A home visits for older adults. 0 g. Bi-County (Clallam-Jefferson) Youth Treatment Planning Grant. 7. Increase affordable, safe housing Key Findings: Risk Factors a. Nearly I-in-5 County homeowners spend 35% or more of their household income on housing. b. About 2-out-of-every-5 County home renters spend 35% or more of their household income on housing. c. I-in 5 18-34 year old County residents had an income below 100% of poverty. d. 2-out-of-5 County adults 18-34 years old had incomes of less than $25,000. e. Among County 18-34 year olds, about 2-out-of-5 live at less than 100% of poverty. f. Among County 18-34 year olds, about I-out-of-3 live at less than 185% of poverty. Key Findings: Assets a. Habitat for Humanity b. Jefferson Housing Authority— Family Self-Sufficiency/ other c. OlyCap d. Zoning permits ADU's • e. Live-aboard boats f. Trailer parks g. h. 8. Increase mental health continuum of care (prevention, intervention, treatment) for all age groups Key Findings: Risk Factors a. About I-out-of-4 County adults reported some type of abuse in childhood. b. One third of adults in households that include children under the age of 18 reported that they have experienced abuse during childhood. c. I-out-of-4 County 8t'graders med the clinical screening criteria for depression. d. One third of adults in households that include children under the age of 18 reported they have experienced abuse during childhood. e. About I-out-of-4 County adults reported some type of abuse in childhood. Key Findings: Assets a. Domestic Violence/Sexual Assault b. Nurse-Home Visit Partnership • c. National research validating impact of sexual abuse 5 d. Many private therapists in community, often with sliding fee scale e. • f. 9. Increase support for residents with disabilities Key Findings: Risk Factors a. Nearly I-out-of-5 County residents had some kind of disability.* b. About I-in-10 County males age 5-15 has some type of disability.* c. Nearly half of the County females 75 and older have some type of disability.* d. Of those with a disability, nearly 1-in-every-5 is living at below 100% of poverty. Key Findings: Assets a. Over half of the County residents are physically active b. The 18-34 age group is less likely to be overweight and more likely to be physically active than their contemporaries across the state, or older County residents c. d. * Disability refers to impairments an individual experiences in trying to manage the activities of daily living, such as dressing oneself, eating without • assistance, walking, or seeing. 4 6 Health of Je f ferson County, 2003: The Community Responds Notes from May 13, 2003 Community Meeting As you read through this list, please note what's missing that the data in Health of Jefferson County, 2003 told us. If you want a copy of Health o f Je f ferson County, 2003, please contact Kellie Ragan. Access to Healthcare I. Improve access to health care and dental care 2. Maintain and improve prevention services within local health care. (primary care and prevention services). 3. Improve health care access for low-income problems, esp. young families 4. Improve health care choices to keep people in the community for health care. Quality of Life I. Increase the number of family-wage jobs. 2. Increase local health care jobs as source of family-wage jobs in a growing industry. 3. Increase jobs that will support families and keep kids here. 4. Remove barriers to education and training, e.g. transportation, mental health & • social services, for 18-34 year olds. 5. Increase opportunities for single moms to pursue education (single mom with several children). 6. Improve post-high school education and support, including vocational education. 7. Address all risk factors of poverty—all connected. 8. Increase cross-generational involvement. Encourage and inspire older adults to pass on stories. 9. Use the resources of talented people in community to help meet community needs. 10. Find ways to build community. II. Educate entire community about community norms. 12. Educate and encourage the community to bond and come together. 13. Educate people about the value of prevention services & long-term costs. 14. Educate older population about community needs--poverty, support for schools. 15. Encourage & inspire more affluent communities to help the less fortunate ones. 16. Increase multi-cultural acceptance. 17. Invigorate people's sense of community. 18. Enhance churches as resources—food, housing. 9. Increase commitment to community by "in-migrators." 20. Reduce housing affordability gap, especially for young families, by making bold initiatives to purchase land now to allow for homes in the future. 21. Increase ways for the community to embrace and support diversity 22. Strengthen Families a. Education 110 b. Livable wages c. Housing d. Community norms e. Connect the 2 Jeffersons f. Cross-pollinate generations 23. Reduce pattern of poverty being passed from generation-to-generation. 24. Increase parenting resources. 24. Reduce adult tolerance to kids using alcohol and drugs. 25. Address and reduce the stigma and fear of utilizing services. 26. Increase the connection and integration of Jefferson County service agencies with state policy makers/legislator Tobacco, Alcohol & Other Drugs I. Address the use of alcohol, marijuana, methamphetamine, and other drugs by young people. 2. Increase public awareness of the problem of alcohol use/abuse by young people. 3. Reduce adult/ community acceptance of juvenile drinking. 4. Find ways to break the cycle of substance abuse in young families. 5. Educate about correlation of adults drinking in households and kids use of alcohol and drugs • 6. Educate seniors about medication & alcohol interactions. 7. Education/PR campaign on negative impact of community norm of"anything goes." Mental Health I. Find/create interventions to address people's fear of mental health system that result in not seeking help. 2. Educate about how depression affects self-esteem. Vulnerable Populations Youth/Young Adults I. Increase cross-generational involvement, including ways for older adults to pass on stories. 2. Early prevention for youth. 3. Provide support and options for kids who didn't leave for something better, (military, school, job) Don't give up on them. 4. Create training and education programs to prepare young people for gainful employment 5. Reduce barriers to education and training (transportation, mental health, social services). 6. Address health issues related to workforce development. 7. Find, create ways to create hope, give direction, create self-esteem and vision for 18— 34 year olds. • 8. Reduce teenage pregnancy rate and 55% births paid for by Medicaid. • Seniors I. Explore availability of affordable housing. 2. Create support systems to enable elderly to stay in homes. 3. Explore services that will be needed in the future for growing senior population. 4. Inspire the elderly. Encourage older adults to mentor and pass on to the younger generations. Have them teach younger people about what community really is. Increase cross-generational activities / involvement. 5. Address problem of Marrowstone Island water and its impact on low- income seniors. What is a Healthy Community? I. Support neighborhoods that integrate income and age. 2. Enhance sense of community, e.g., responsive, mentoring adults who pay attention to neighborhood kids. 3. Increase availability of sufficient low-income housing that is not substandard. 4. Create community support and watchdog groups, e.g., Medicare funding—watch and support legislative changes to increase service. 5. Increase availability of well-paying jobs, livable wage jobs that can support housing and health needs of families. 6. Drug court . 7. Educate so that the community is aware and informed of what life is like for its • poorer, less-educated members. 8. Establish community-wide support systems and encouragement to complete high school and workforce education. 9. Build an economy with jobs to keep people in the community. 10. Create programs and initiatives for affordable housing that would keep people here and invite people here. I I. Habitat for Humanity—they can only do it for so many years. They need another/next generation of volunteers to come up. 12. We need to get to a point where the two sectors can see one another— break down the denial. 13. Somehow the wealthy (or the "haves") recognize that there really are people out there that are living in poverty, children living with abuse and sub-standard living conditions. 14. Create economic development including vocational education at high school and college level for the 18—35 year olds who don't leave the county. • �- cn D) - = v, u, mo 7mm p �' o c c a �- ."� •; 3 3 50. 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A ti R: ° °b c .ala l. , 0 CD .o • ri,r* p,aro °c 1-tz. b p ,I, 4.._ IQ CD m is h rci p C '.. 241 CDC Cs O '•ara UQ• N .+, �n ; F C Jr: e, C g v0, O C' .1 5 '7ms ra' Board of Health New Business Agenda Item # V., 3 • Bioterrorism Draft Plan November 20, 2003 • Board of Health New Business Agenda Item # V., 4 • Influenza Season A / SARS Preparedness November 20, 2003 2003-2004 influenza activity in King County Page 1 of 2 Ong county Home News. Services Comments Sedrch Communicable Diseases • 2003-2004 influenza activity in King County 1 P• This info updated: Friday, November 07, 2003 at 05:53 PM ti ,,, ? � First Confirmed Influenza in King County and Public #' th Washington State Seattle&King County • """" Public Health Public Health-Seattle& King County laboratory's sentinel provider surveillance system has identified Hcrneaae one case of influenza A in a 17 year-old person who lives in south King County. Additionally, two = a a Click image to enlarge other King County cases and one Pierce County case were reported positive by DFA(Direct Fluorescent Antibody)testing last week at local laboratories and have been I rirs Pro Water to the Washington State Department of Health's (WA DOH) laboratory Program for confirmation by culture. There have been three AH3N2 isolates confirmed a by culture at the WA DOH public health laboratory, two from Whitman County (Washington State University) and one from Franklin County. Sexuallyitted^ Health care workers should be vaccinated to help protect the high-risk Trattsrrss patients for whom they provide care. People at risk of complications if they Drseaes get influenza, along with adults and children that live, work, or may come in contact with people at high risk should receive a flu shot.III -_ Remember that a flu shot is encouraged for healthy children 6- Birth and Death age and for children age six months through 18 years who have high risk of Records medical conditions. The Vaccines for Children program subsidizes the cost of . ," , e' . children's vaccines at most health care clinics. > Key links Contact Us • Public Health's Influenza Surveillance System • Information About the New Influenza H1N2 Strain • Respiratoryvirus detections by the Univers ity of Washington's Clinical Virology Laboratory • National_and global influenza activity from the CDC • Influenza ona statewide level by the Washington State _ Department of Health A back_totop All information is general in nature and is not intended to be used as a substitute for appropriate professional advice. For more information please call (206)296-4600 (voice/TDD). Public Health Homepage I Safe Food I Safe Water http://www.metrokc.gov/health/immunization/fluactivity.htm 11/14/2003 Page 1 of 1 Public Health - Seattle & Ding County Sentinel Provider Influenza Surveillance Laboratory-confirmed Influenza Isolates, 2003-04 Season • 28 24 '� 20 —•-Specimens submitted 16 - s-Inlluern a A pia a3 12 —a—Iriluern a B 8 4 41 42 43 44 45 Calendar Week http://www.metrokc.gov/health/immunization/images/fluresults.gif 11/14/2003 CDC-Influenza Page 1 of 3 I CDC Home Search :Health Topics A-2 CDC. r_ National Center for Infecfa uprse Yom. Influenza Site Contents Influenza A(H1N2) Viruses Related Information ♦ Factsheet on Influenza A ► Overview Questions and Answers (H1N2)___Viruses ► Vaccine ► Antiviral Drugs 1. What is influenza A(H1N2) virus? 2. Where did the A(H1N2) virus come from ► Reports& and_._where has.._it been identified? Surveillance 3. How is this virus different from other ► Healthcare Providers currently circulating influenza A viruses? ► Other Resources 4. Isthis the_...start.__of a pandemic? 5. Does the A(H1N2) virus cause more severe illness than other influenza viruses? 6. Will the influenza vaccine I received for the 2003-04 influenza season protect me from A(H1N2) viruses? 1) What is influenza A(H1N2) virus? The new A(H1N2) strain appears to have resulted from the reassortment of the genes of the currently circulating influenza A(H1N1) and A(H3N2) subtypes. Influenza viruses can be divided into two types, influenza type A viruses and influenza type B viruses. Influenza A viruses can be further divided into subtypes on the basis of two proteins, hemagglutinin (H) and neuraminidase (N), found on the surface of the virus. Since 1977, two influenza A subtypes, A(H1N1) and A(H3N2), have circulated widely among people. The hemagglutinin protein of the A(H1N2) virus is similar to that of the currently circulating A (H1N1) viruses and the neuraminidase protein is similar to that of the current A(H3N2) viruses. 2) Where did the A(H1N2) virus come from and where has it been identified? It is unknown where the A(H1N2) virus originated, but on February 6, 2002, the World Health Organization (WHO) in Geneva and the Public Health Laboratory Service (PHLS) in the United Kingdom reported the identification influenza A(H1N2) virus from humans in http://www.cdc.govincidod/diseases/flu/Q&AH1N2.htm 11/14/2003 CDC-Influenza Page 2 of 3 England, Israel, and Egypt. In addition to the virus isolates reported by WHO and PHLS, the Centers for Disease Control and Prevention has identified influenza A(H1N2) virus from patient • specimens collected during the 2001-02and 2002-03 seasons. Influenza A(H1N2) viruses have circulated transiently in the past. Between December 1988 and March 1989, 19 influenza A (H1N2) virus isolates were identified in 6 cities in China, but the virus did not spread further. 3) How is this virus different from other currently circulating influenza A viruses? The H1N2 virus is not very different from the currently circulating influenza viruses. The H1 protein of the H1N2 virus is like the H1 protein of the currently circulating H1N1 viruses and the N2 protein is similar to the N2 protein in the currently circulating H3N2 viruses. The difference is that we don't commonly see the H1 and N2 proteins on the same virus. There has been no unusual increase in disease associated with this virus, and persons infected with the virus are expected to have influenza illness typical of A(H1N1) viruses. 4) Is this the start of a pandemic? • No. A pandemic virus has to have a new hemagglutinin or a new hemagglutinin and neuraminidase protein on an influenza A virus that has not circulated among humans and to which most or all of the population has no protective antibodies. Because the H1N2 virus has the hemagglutinin of the currently circulating H1N1 virus and the neuraminidase of the currently circulating H3N2 virus, most people will have been exposed to and have antibodies against these viruses. 5) Does the A(H1N2) virus cause more severe illness than other influenza viruses? There is no information to suggest that the A (H1N2) virus is causing a more severe illness than other influenza viruses, and no unusual increases in influenza activity have been associated with the A(H1N2) virus. The pattern of illness seen with the A(H1N2) virus is expected to be similar to disease caused by A (H1N1) viruses. Influenza A(H1N1) viruses are seen more commonly among younger persons and can be associated with outbreaks among http://www.cdc.gov/ricidod/diseases/flu/Q&AH1N2.htm 11/14/2003 CDC-Influenza Page 3 of 3 children, but do not frequently affect the elderly. 6) Will the influenza vaccine I received for the 2003-04 influenza season protect me from A(H1N2) viruses? Yes. Because both the hemagglutinin and neuraminidase protein on the A(H1N2) virus closely matches the hemagglutinin and neuraminidase proteins of viruses included in the current influenza vaccine, the vaccine should provide good protection against influenza A(H1N2) virus as well as protection against the currently circulating A(H1N1), A (H3N2), and B viruses. Other Links AIL totop Information about Influenza A (H 1 N 2) Viruses Top of Page Home I NCID Home I Contact Us CDC Home I Search I Health Topics A-Z This page last reviewed Oct 22, 2003 Division of Viral and Rickettsial Diseases National Center for Infectious Diseases Centers for Disease Control and Prevention Privacy Policy I Accessibility http://www.cdc.govincidod/diseases/flu/Q&AH1N2.htm 11/14/2003 • WA State EHSPHL, Communicable Diseases - Influenza Update Page 1 of 5 -x. a f t Sar f ,,.: . #IIea1th ::. iIwifi r ,,,..,, . ,, You are here: DOH Home » Flu News » Flu Update EmplAyees I Search Site Directory Influenza Update 2003-2004 Terms • Communicable Disease Antigen • Influenza Update November 10, 2003 A foreign substance which stimulates an immune response. Information Comments about site: A reminder that influenza is not a reportable disease DFA t florescent antibody test. Catherine.QConnor in Washington (nor is it in most states). A total Office of Epidemiology count of all cases in Washington State is not Epidemic The outbreak and rapid spread Last Update: available. The number of positive influenza isolates of a disease in a community, 11/12/2003 12:39 PM reported in Washington State and from the Centers affecting many people at the for Disease Control and Prevention(CDC) are Same time. samples of specimens from persons with influenza- ILI like illness nationwide. They are not meant to be Influenza-like illness. taken as a report of all cases in Washington or the NREVSS nation. National Respiratory and Enteric Virus Surveillance System Washington: Most laboratory confirmed influenza Pandemic activity has been reported from eastern Washington gDenotting anp epidemic that mainly in Spokane and Whitman Counties. We have geographic i poeulation of a wide aphic area. • results on 20 isolates statewide and three of these have been subtyped and they are influenza A, Sentinel physician An influenza sentinel physician H3N2. These have forwarded to the Center for volunteers to conduct Disease Control and Prevention for further testing to surveillance in collabo at onk illness with help make a decision on next seasons influenza the state health department and the Centers for Disease Control vaccine content. Influenza-like illness reports in and Prevention.Data provided by sentinel physicians are western Washington are increasing. One combined with other influenza surveillance laboratory is reportin a number of surveillance data to provide a g national picture of influenza parainfluenza cases. Whatcom and Snohomish virus and ILI activity in the U.S. Approximatin Counties are looking into influenza-like absenteeism 46 states enrolled lin they 900 'cians netwo network in two schools each. Specimens are being collected during the 1999-2000 influenza for confirmation at the State Health Laboratory. Season. Only 3 or 4 schools have been reported with ILI and AStrain esome of those have other symptoms and/or reasons influenza ic sola es.Thecnfluf enza for school absenteeism besides illness. All isolates type,geographice location of the subtyped in Washington have been A, H3N2. aanndd ty ear of first isolation bet the he describe these characteristics. An example of this Oregon: Oregon is reporting 1 influenza A. characterization is as follows: A/New Caledonia/20/99. A being the influenza type. New eing Idaho: Idaho is reporting 1 influenza A that they are geographic onia location where this in the process of subtyping, strain was first recognized. 20 being the specimen number and 99 being the year(1999) 1 USA-CDC: During the week ending November 1, that strain was first recognized. 111 45 specimens tested positive nationwide through Viral Isolate WHO and NREVSS laboratories. The proportion of Viral specimen positive for patient visits to sentinel providers for influenza-like influenza. http://www.doh.wa.gov/EHSPHL/Epidemiology/CD/HTML/FluUpdate.htm 11/14/2003 WA State EHSPHL, Communicable Diseases - Influenza Update Page 2 of 5 • Viral Type illnesses (ILI) overall was 2.2%, which is less than Three types of influenza virusare recognized A,B and C.Viral the national baseline of 2.5%. The proportion of type is determined by antigenic properties. deaths attributed to pneumonia and influenza was 6.3%. One state Health Department reported Viral Subtype pe A ncl regional influenza activity (Texas), local in 3 states subtypesInfluenza(Htyi 1N1,H2N2udes,H3N2three ) (Colorado,Louisiana, and Montana), and sporadic associated s ocia es avid pandemics.th iprea Ty in 19 states (AZ, AR, FL, GA, HI,KS, MS, MO, pe B and C do not have subtypes. NE,NV,NM,NY,NC,ND, OK, SC, TN, UT, WA). Twenty-four states and the District of WHO World Health Organization Columbia reported no influenza activity. Since September 28, WHO and NREVSS laboratories have tested a total of 4,371 specimens for influenza and 193 (4.4%) were positive. Of 193 viruses identified, 190 (98%) were influenza A and 3 (2%)were influenza B (AK, HI and MN). A Minnesota resident was tested positive at a North Dakota Laboratory. Twenty-eight percent of the 190 influenza.A viruses were subtyped; all were influenza A, (H3N2). Seventy-seven percent of all positive isolates were reported from the West South Central Region(AK, LA, OK, TX) and 15%were from the Mountain Region(AZ, CO, ID,MT,NV, NM,UT, WY). British Columbia: Last Week(Week 44) BC Centre • for Disease Control, Epidemiology Services reported 5 influenza A cases (no influenza B). Also, a few ILI outbreaks across the province were reported. October 31, 2003 Washington State now has 8 laboratory confirmed cases of influenza A. Of those sub typed, all have been A, H3N2. All but one case was from eastern Washington. Three cases were four years of age or under, and five cases ranged in age from 14 to 27. Washington is reporting sporadic influenza activity to the Centers for Disease Control and Prevention (CDC) It is never to late to receive influenza vaccine. Plenty of vaccine is available this year. Contact your local health departments or your private health care provider for information about where and when you can receive your influenza vaccination. http://www.doh.wa.gov/flunews/default.htm http://www.doh.wa.gov/EHSPHL/Epidemiology/CD/HTML/FluUpdate.htm 11/14/2003 • WA State EHSPHL, Communicable Diseases - Influenza Update Page 3 of 5 Oregon has reported one influenza A. • Idaho has reported no cases to date. United States Weekly Influenza Report week ending October 25,2003 Week 43. During week 43 (October 19-25,2003), 48 specimens tested by U.S. World Health Organization(WHO) and National Respiratory and enteric Virus Surveillance System(NREVSS) collaborating laboratories were positive for influenza. The proportion of patient visits to sentinel provides for influenza-like (ILI) overall was 1.8%, which is less than the national baseline of 2.5%. The proportion of deaths attributed to pneumonia and influenza was 6.1%. Texas reported widespread influenza activity, 2 states reported local activity (Alabama and Louisiana) and 14 states reported sporadic influenza activity(Arkansas, Colorado, Florida, Hawaii (1 B), Massachusetts, Missouri, Nebraska,New Mexico,North Dakota (1B),North • •Carolina, Oklahoma, Oregon, Tennessee and Utah). Twenty-nine states and New York City reported no II influenza activity. Since September 28, WHO and NREVSS laboratories have tested a total of 3,115 specimens for influenza viruses and 121 (3.0%)were positive. Of the 121 viruses identified, 119 (98%) were influenza A viruses and 2 (2%) were influenza B viruses. Isolates subtyped were A (H3N2). For the complete report see:http://www.cdc.gov/ncidod/diseases/flu British Columbia, Canada has reported no influenza cases. However, Edmonton, Albert Canada has a large outbreak of influenza A going on with over 80 cases so far. October 27, 2003 There have been three A, H3N2 isolates confirmed at the State Public Health Laboratory. Two are from Washington State University in Whitman County; • one is from Franklin County. The WA State Department of Health has been informed of several positive quick influenza tests across the state; two http://www.doh.wa.gov/EHSPHL/Epidemiology/CD/HTML/F1uUpdate.htm 11/14/2003 q,�� V 1 J WA State EHSPHL, Communicable Diseases -Influenza Update j T King County and one Pierce County cases positive by DFA. It looks as if we may have an early influenza season. • Please get the word out that influenza vaccine is available and every one should consider getting their shots as early as possible. October 20, 2003 Washington: We have received a few calls from physicians with positive quick tests for influenza A. Two specimens are to be sent from UW/COH laboratory for confirmation and subtyping and will then be sent to CDC for further testing. It is important that all immune compromised ssible. While thisget their influenza shots a oon aspo is early for influenza activity, other areas of the country are seeing positive cases of influenza A, H3N2. CDC: According to the October 11th weekly report from the Centers for Disease Control and Prevention (CDC), of 502 specimens tested by the World Health Organization(WHO) for influenza viruses, none were positive for influenza. The proportion of patient visits to sentinel providers for influenza-like • illness (ILI) overall was 1.6%, which is less than the national baseline of 2.5%proportion no�asa6 .3%. aths attributed to pneumonia and One state health department(Texas)reported regional influenza activity, 3 states and New York City reported sporadic activity, reported no 43 states and the District of Columbia influenza activity. Laboratories other than those participating as U>S> WHO or NREVSS collaborating laboratories may submit influenza isolates to CDC for further From all sources, influenza A (H3N2) viruses were reported during August from Alaska, Connecticut, the District of Columbia,Hawaii,New Hampshire, New York, and Wisconsin, and an unsubtyped influenza A virus was reported from Louisiana. During September, influenza A(H3N2) viruses were identified in Alaska, Connecticut and Texas, and unsubtyped influenza A viruses were identified in Louisiana, Texas and Washington. Other influenza A(H3N2)viruses collected during October in Texas have been submitted to CDC for • http://www.doh.wa.gov/EHSPHL/Epidemiology/CD/HTML/FluUpdate.htm 11/14/2003 Appendix C3 Algorithm for evaluation and management of patients hospitalized with radiographic evidence of pneumonia, in the absence of known SARS activity worldwide Hospitalized with radiographic evidence of pneumonia? Yes If no,treat as clinically indicated Continue droplet precautions and treat as clinically indicated 1 The clinician should ask the following three questions A. Does the patient have a history of recent travel(within 10 days) to previously SARS-affected areas1 or close contact with ill persons with a history of travel to such areas? B. Is the patient employed as a healthcare worker with direct patient contact? C. Does the patient have close contacts recently found to have radiologic evidence of pneumonia without an alternative diagnosis? Nt.Yes to one of No to three questions three questions Treat as clinically indicated 1. Notify Health Department • 2. Work up and evaluation for alternative diagnosis,which may include the following: A. CBC with differential B. Pulse oximetry C. Blood cultures D. Sputum Gram's stain and culture E. Testing for viral respiratory pathogens such as influenza A and B, respiratory syncytial virus F. Specimens for legionella and pneumococcal urinary antigen 3. Health Department and clinicians should look for evidences of clustering of pneumonias (e.g.,While traveling, exposure to other cases of pneumonia, clusters of pneumonia among health care workers). 4. NOTE: If health department and clinician have a high suspicion for SARS, consider SARS isolation precautions (WEBSITE) and immediate initiation of Algorithm in Figure 2. 1 After 72 hours, alternative diagnosis? Yes No 1 1 Treat as clinically indicated If part of a cluster of pneumonia (or there are other reasons to consider at higher risk for SARS), consider SARS testing in consultation with health department Treat pneumonia as clinically indicated 1Previously SARS-affected areas are defined as XXXXX. iSUPPLEMENT C: PREPAREDNESS AND RESPONSE IN HEALTHCARE FACILITIES PAGE 32 OF 35 • N o U ° E o > � ' &) � c > o • 0 0- o_ 1. -0oo r) -2 IA .E o (1) O 1 0 CT n. o °. p o 60To mcu E c E o c o • C) 'N ° a o_�_ _ o,� C C6 al L ns ; a > T = a o Q w � 7 � 5 b ow �, o G. + -+ "'c' Ln L z m � � rr � -5" � ,(-1,,,) N a —�' r >. M Q. Z -' � ti � cn � iU o ° (� n m` m o c o c ° m o f M ' c ° RI CL 'S E c o c M a° o f z O ° aL > c o 0 o c m ° C N Q' -0 o o N L 8 O an Zc a C CL> a an $O a o 0, m V L U w 0 a ZZ 8 K ; fp c 0 o Yo` o 12 w C4 1- a- 'D T co o o • wl N C W Q RI C C C I , ,, ♦ '° @ • (/1 L �.Na �� 44 Q H N p con >. 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O Q o ._ o w / '� -, ° T U) O-' s o O as ac z 0 0 ► hi 1 o o E Oa` � O N 0 0 0@ o w � o� Twa � .N ° a -aN � ° cm a > a° Hi co � o o m c --lb. 03 ov) a 2 7 .§ o)o U I v) -0 ca 2 Co p o a > z • LL N ° °fn = ° a w W ° J Z 19 ° 9° U a co Z i C N w O J f \ J a 04 Board of Health New Business Agenda Item # V., 6 • 2003/2005 Youth Yellow Pages Project Summary November 20, 2003 • 2003/2005 Youth Yellow Pages (YYP) Project Summary III Cost: $11,000 (Included 10,000 YYP, 10,000 Help Card, Evaluation card, inserts & postage) Funding Sources: DOH Tobacco, Family Planning & Childcare, Timeline March 2003—Updated YYP information solicited from Healthy Youth Coalition and community via press release in Leader May 2003—YYP updated by JCHHS staff June 2003-2003/2005 YYP to printer, 10,000 copies ordered July, 2003—Mass distribution of the YYP begins; Bulk mailing I—Port Townsend & Chimacum School Districts households with youth in graders 6-12; 1553 total pieces; (Districts provided labels). Bulk Mailing II—All providers listed in 2003/2005 YYP and school, substance abuse, developmental disabilities boards; 521 total pieces. YYP Community Distribution Blue Heron staff, Counseling Center Insatiables Prosecuting Attorney* Boiler Room* Java Port Café* Port Townsend Library* Brinnon Visitor Center* Jefferson County Library* Port Townsend Visitors Center* CHS staff, Counseling Center Jefferson Mental Health* PTHS * CMS staff, counseling Center Jefferson Co. Sheriff PTHS Martina H Community Corrections Juvenile Services* Quilcene Community Center • Food Coop* Nordland Store Quimper Sound DCFS* O3A Rec Center DSHS* OlyCap-Linda* S. Co. Medical DV/SA* On common Ground* Safe harbor JGH Emergency Dept., Lab* Peninsula College* Sheriff Fresh Press Java &Juice Peninsula Midwives Sisiutl* Healthy Youth Coalition PennySaver SOS* Hwy 104 Visitor Center Port Townsend Police* Tyler Street Coffee *Complimentary acrylic displays September, 2003—Gaye Martin, CHS & Martina Haskins, PTHS integrate YYP into Health class curriculum. October, 2003—Help card w/Alcohol & Drug Overdose information to printer November, 2003—Help Card distribution —6,5000 2003/2005 Youth Yellow Pages distributed to date • Ci1iinkicU' /)/(7,91 £oo� 9003 YOUTH YELLOW PAGES TREASURE HUNT NAMES WRITE THE PAGE THAT YOU WOULD FIND INFORMATION ON THE FOLLOWING TOPICS: ---_1. Alcohol poisoning 2. library services w4. a 3. religious organizations �Y•+'tLj+�. �� ;:tea am Ten J T --_4. tattoos and body piercings (_E't, " 5. eating disorders S' 6. rape, sexual assault and sexual . Real Men On 't Rape Washington Coalition of Sexual Assault Programs www.wcsap.org 7. What company published this pamphlet? 8. There is an emergency number for Trevor Help line. What is it line for? a crisis 9. What is the purpose of the Youth Yellow Pages? 10. What does the MESSAGE TO PRETEENS TEENS YOUNG ADULTS about? talk 11. What are 3 toll free gefgragi listed on page 5. 12. What are the 4 CAGE Questions-Warning Signs Abuse? of Alcohol and Drug 13. List 5 recreational, leisure and sports programs that are Jefferson County. FREE in • 14. 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CmN =3 �= 0m =. cpE O000 2 m mN= N,‹ ' O ''FF ? — c' o Cm * Fw=o . mN21mgN Nm 'N mN C 0 =0 m D pr ym _> m 70.10 < m=' m --mg m c a c 0 0 01 m = 4 r = g b' o Z o 3 < n = oQ r' m m x0 ,=0 a S m N S 6 D '~4' Ng W f Z c • Z �C N 3 m G7 m m O m= I W ° : `22m~ m o n T � p u, -a N : O Z • _ _ \\\ 0 \ m\\\.. \\\\\\ o Om 0 9 oc)s0 vcvrnvT s zgmNDOD csmeor p —0 03 0 mo q CD* .., ," P30_, = < N000m xWojgo VN moC _ W0mo ' qoc . : =goovoNg —aN` mN �_"31 rU NN 23 = E / FdaNO3;m2O N': NNC . 0 Nr gp0 Nmmam 0W PG3NNgm � NmcN ' x N m � a 2 = sK(n oo. 0o.-, 00k vmx0 = - . mm y JMomma7 a 5 0 m Meat m < ooa n _ � 'p 3 = v$ -N ma � = 9 Nm mm S mZ riSm O�NN wN NNG N y D0Om03mmN ' TN vom � 173'el » g.Lk a M m —{ ap S_3 m §_. N = is m XI 0 Q ,Z1 N Om 0 X T "OP' 700-w ® po o> > :lit wZm mm g. s m m o08 * CD A a mg 0 0 CA o m (..g/ C -1 N, 0 w Board of Health Media Report • November 20, 2003 Jefferson County Health and Human Services OCTOBER — NOVEMBER 2003 NEWS ARTICLES 1. "Flu shots slated in Jefferson", Peninsula Daily News, October 14, 2003 2. "Top public health workers visit", Peninsula Daily News, October 22, 2003 3. "Teens Peer at themselves", (2 pages) Peninsula Daily News, October 26, 2003 4. "Opening communications with youth",Peninsula Daily News, October 26, 2003 5. "Washington youth say anti-tobacco ads give them good reasons not to smoke", (2 pages) WA State DOH News Release, November 5, 2003 • • • •_ . • lu shots slated � n Jefferson PENINSULA DAILY NEWS Thursdays,3 p.m.to 5 p.m:, p.m., Port Hadlock QFC mar- all others $15. Pneumonia Flu vaccination clinics are at the office of Dr. Richard ket, 1890 Irondale Road, Port shots also available for $25. Lynn, 1136 Water St., Port Hadlock. Medicare and Medic- II 15 and 16, 11 a.m. in full swing in Jefferson , Townsend. This walk-in clinic aid billed; all others $15. to 5 p.m., Safeway Pharmacy, County doctors' offices, phar- macies and at Jefferson Gen- is for established patients only. Pneumonia shots also avail- 442 Sims Way, Port Townsend. eral Hospital. ■ Tuesdays and Thurs- able for$25. Medicare will be billed;all oth- Vaccination is recom- days, 1:30 p.m. to 5 p.m., at II .Nov 7, j..0 a.m. to 4 ers $20. Pneumonia shots also mended for people at high the office of Dr. William p.m., Bay Club, 120 Spin- available. Coyne, 1136 Water St.; Port naker Place, Port Ludlow. IIMondays through risk, which includes those age Townsend. By appointment Medicare and Medicaid Thursdays, 8:45 a.m. to 50 and older, anyone with only; call 360-379-5121. billed; all others $15. Pneumo- 9:45 a.m. and 5 p.m. to 6 long-term health problems, those with weakened immune Medicare will be billed. nia shots also available for$25. p.m., South County Medical systems, residents of long- • Oct. 25 and Nov 8, 9 II Nov. 8, 10 a.m. to 4 Clinic, 294843 Highway 101, term care facilities, children a.m. to noon, at Jefferson p.m., Quilcene Community Quilcene. Medicare will be General Medical Group, 834 Center, 294952 Highway 101. billed, but no other insurance receiving long-term aspirin Sheridan St., and at Olympic Medicare and Medicaid billed; accepted. Fee is $10. therapy, and family members, caregivers or medical person- Primary Care, 1010 Sheridan nel who work with anyone at St., both in Port Townsend. high risk. Medicare will be billed,but no . For the first time this year, other insurance accepted. the vaccine is also being rec- Fee is.$10. ommended for healthy chil- ■ Oct. 18, Nov 1 and dren ages 6 months through 2 Nov 15, 9 a.m. to 11:30 years. a.m., at Port Townsend Fam- The shot is also recom- ily Physicians, 934 Sheridan ended for women who will St., Port Townsend. Medicare more than three months will be billed, but no other regnant during the flu sea- insurance will be accepted. son. Fee is$10. The scheduled clinics are: ■ Oct. 16, 23 and 30, 8 I Mondays through a.m.to noon and 5 p.m.to 7 s-Pb J 10 7 • • • • i • Pe ninsulallorthwest WEDNESDAY,OCTOBER 22,2003 A3 Top public health workers vi sit State, Clallam officials discuss local issues • BY JEFF CHEW PENINSULA DAILY NEWS ,,,, PORT ANGELES — The state's top health officials spent = �, the day with Clallam County �+ t r government and tribal officials, • t ' � Olympic Medical Center lead- i ✓ 4 ? ers and volunteers, broaching s t,7 issues from volunteer health 0 4:..„ , • s clinics to a more effective wayy `y to test for water pollution in ;- ¢, �, f riktgiDungeness Bay. r : , , : "This is clearly a communityif full of working departments him I' 414,44 ,40.„,.....v,.....ay .,a Fr ,` ti and collaborations,"said Secre- I ;r a, tx Yyu -, Lary of Health Mary Selecky, ', + •• r .1.' • %i- ` '�� Le ;.�, S, SFr _= who began her visit at 7:30 i _ : , S ti P.-- , a • a.m.Tuesday - "r_ Selecky, who attended the ------- .n..-. � Clallam County Board of ,,....,.. H h meeting Tuesday after- t the Clallam County iliiit ouse, was joined by Maxine Hayes, state health officer, and Marie Flake, area health liaison. Selecky, a member of Gov. KEITH ThORPE/PENINSULA DAILY NEWS State Heal h Officer Maxine Hayes, left, listens as state Secretary of Health Mary Selecky talks about health Gary Locke's cabinet since he care In local communities during a meeting of the Clallam County Board of Health on Tuesday in Port Angeles. appointed her in March 1999, praised Clallam/Jefferson state dollars to Clallam County Dungeness Bay to recreational Selecky said just because no Tharinger asked the state County Health Officer Tom through the Department of and commercial shellfish har- cases of West Nile virus were health officials about their Locke and Environmental Health Services. vestingbecause high counts of found this summer in the Health Director Andy Brastad g seto ro ect in public and his for seals- "What you have from me fecal coliform have been found. state, that does not mean it systems to protect the public lance tos the staff state in their for ...is a continued open door to "Locally, people are frus- can't happened next summer. from tooth decay. and atelia loo agents work with us," she said, trated because there's all the "What we in public health bacterial the investigationbioof a note "because without local public non-point pollution problems 'Get hit with It hard' know about fluoride is it is best threatening extortion and food health,we're in trouble." and people asking if a test for for tooth decay," she said, tampering last month at a Hayes urged county health E. coli is the right one," Bra- "I think next year we're addingit was a decision to Safeway store east of Port officials to"think and act glob- stad said. going to get hit with it hard," Seleckymake locally. Angeles. ally"on issues such as paralytic Brastad said "genetic test- said. Hayes shellfish poisoning that can ing" of bacteria has been con- Health Officer Locke later y with her col- That gave us the response hurt people here and abroad. ducted, "and we have identi- agreed, saying, "This is not a league. oily to test(biotoxins response year when we dodged the did- The Port Angeles City fluo- system) Coun- in the event of an tied a number of possible let,this is where the bullet did- cil has approved adding ncy"Selecky told three Shellfish pollution sources" of pollution flowing n't get this far. It just fell at ride to the city's water, which Clallam County commission- Several volunteers were sec- down the Dungeness River our feet. local health-care providers gen- era, who act as the Board of into the bayerall support,ognized for their volunteer "I think we've been very Y but some resi- Health. "We feel the Department of fortunate this year to have a dents and business owners work testing county shellfish Health has been somewhat year for preparation." oppose. for the poisoning. Note on baby food resistant to(such testing)." Selecky "You have a tremendous said the county has Hayes lauded the county The and the economy Brastad said commercial four mosquito species that commissioners'recent decision a note investigation stemmed a jar isn't challengega," said. shellfish producers,such as the carry the virus that causes flu- to make the Environmental from food attached 18 jar 'What do you Hayes when. you Jamestown S'Klallam tribe, like symptoms in humans and Health Department part of the ay Safeway,Sept.ept in an have more needs than are concerned about testing for has been known to kill animals. Department of Health and aisleHighway offy theet. have reYou have to torm bacteria in shellfish. The state health leader said Human Services. A Clallam County Sheriff's coalitions,sourand you've done "The shellfish growers she expects the next state to be Previously, Environmental official confirmed that." really want to know what hard hit by the virus will be Health had been in the Com- Department note demanded mon Brastad informed the state sources there are," he told highly populated California munity Development Depart- the �e.Rnd '-, Selecky. Cou>fity Commissioner Steve ment. t nee to harm people. health leaders that @runty a to BI investigator said the entists were "knocking'head:;" • ca still pending. over the best way to find Selecky told the health sources of pollution in Dunge- board that many people do not ness Bay know that the agency funnels The state has closed much of • • PENINSULA DAILY NEWS 110- z 6-03 PENINSULA WOMAN Teens Peer at themselves BY LAuxA R.ossER Townsend High School stu- for frank discussions. Peer- FOR PENINSULA Woiwi dents came to her. In 1991, In was born. three students; Hillary Metzger is theHillary said the Jefferson of woman who cato face sought out Hillary after a . County Health Department ' kinda challenge and refuca to friend of theirs committed has always been innovative suicide. They were upset and progressive, so it was turn back. She encourages getting subjects out in the and needed someone to talk no surprise when her boss toopen and discussing them. '"I suggested that the program Thepublicshealth nurse guess they thought if I should be a part of Hillary's taught sex ed, I'd talk about for the JeffersonCo hat anything,"Hllary grinned. job and into her Health DepartmentThey were right. taught sex education in the Hillary wanted those Hillary's revelation since schools for years. teens to have a safe atmos- 199Studentsodiscuss who meet When teens ask ques- phere in which to talk weeklytopics, to yarious tions, she answers. about their problems, their mediator, rof Hillary asc a If she doesn't know the fears,their hopes. of sorts,become answer,she tells them she'll Hillary started meeting deat mentors for other stu- find out. with those three students Perhaps that's why Port every • PWednesday evening TURN TO AGE 5 EER/P • PENINSULA WOMAN PENINSULA DAn.Y NEWS SUNDAY, Peer: Group• � I T o.3 �� tl • �e., -,,,„-4:,ss x *ate N :.a� i ,,,,, ,- s..., -.:1;:.'ibi,',-- • -"'''" views choice _ ''` .,. aik.li. i ` : kSY r,y V`' is . r CONTINUED FROM PAGE 4 .' .-. e "�; ,z> i d" "It's you saying, `That looks a � i, lls �. •� P ` 4 That was when Peer-In got like the thin [0 CIO'SO I['S t ,--t.\,, "`' its name—"peer" meaning g - r '�� , g `. '� colleague as well as to look yOUr choice, not peer ,g.c�° r � closely at something—and pressure." , t became an official Health ' HILLARY METZGER '� t 1 _ a-„J Department program. -s y 1.c.7.‘..� I /, The students talk about public health nurse }.� issues concerning them— �.. anything from suicide,depres- �� sion and substance abuse to Judgmental. � ', 8 � � �, sexuality. "My goal is to promote ' No attendance is taken, healthy youth,"she said. "I ,f although students do sign in know not all the kids make «t�‘C....:;.'' ''..!'.x� when they come to a meeting. those healthy choices all the . sQ Students are welcome to time." • `ti 4. Students come to the weekly sessions, There is a good deal of held Wednesdays at 6:30 p.m. pressure to follow the norm, at the Jefferson County she said,which is not making Health Department,615 healthy choices. HillaryMe JeIIx�R J" Sheridan St.,Port Townsend, But Hill Metzger, standing center, collects notes from Peer-In par s re St. Hillary tells the teens Clement, Eva Weber. Mia Reade Baylor and Nolan Leh,from left. Y that they are the ones decid- ing what the norm is. Department familiarity They can change that by She said she loves that the changing their decisions.Self Port Townsend students come Pressure is more prevalent Peer: Exp an S 1 o n to the Health Department for than Peer pressure. their meetings because they "It's you saying, 'That become familiar with the ser- looks like the thing to do,'so • vices the department offers. it's your choice,not peer pres- sure CONTINUED FROM PAGE 5 en meeting at the Many of those services will ,"Hillary noted. Tri-AreaPer-Igroup Teen Center,81 Chi- be used by students in the She sees a number of stu- She said she got a postcard Chi- macum Road, Port Hadlock, coming years—such as food dents making healthy choices. from another former group on Thursdays at 6:30 p.m. handler licensing,immuniza- At a time when children are member who wanted to tell Hillary said she is hoping tion clinics and maternity claiming their independence, Hillary that her peers in col- that eventually the two lege had not experienced any- groups will get together once support. they are also looking for men- tors and positive role models. thing like Peer-In at their a month. They do not have to apply to be a part of the group. Hillary said she sees teens schools. But she has been discover- Attendance is not taken and connecting with adults other Hillary said the girl ing in these beginning weeks there are no qualifications to than their parents,so they are reported that she felt she was that the concerns of Port be met. claiming their independence lucky to have been able to Other peer education from that authority,but still participate. Townsend teens are different groups across the state, seeking adults to follow. from those among teens from Hillary said,require partici- Although she sometimes Expanding south southeastern Jefferson pants to maintain a certain feels she never left high County. grade-point average or meet school herself because she is The group remains open to Hillary may mediate,but other criteria. in such close contact with any high school student in the students themselves run "But I felt peer meant teenagers,she gets reminders Jefferson County,but few the discussions.Hillary said it equal—it didn't mean elite," that she is an adult who has from Chimacum have partici- pleases her to see them take a Hillary said. been a positive influence on gated because of the distance. true leadership role. And,she said,it is better to young adults'lifestyles. As a result,United Good "My goal,"she says, "is for let students participate when "The greatest thing for me Neighbors has provided a me to not have to say a word they need for as long as they is when I hear from kids after grant this year to form a and to let the kids lead." need,rather than put they leave high school,"she demands on them. said. "To me,it is important to She said a Port Townsend be an open door,a safe place," graduate who had gone on to she said. college called her from school. Non-Judgmental He said he was in the stu- dent union at college and savi About 15 students attend a poster with a"gross"pic- ture of sexually transmitted . on asemi-regular basis.The group is open to anyone diseases. "And I thought of you,"he attending high school. The format is open. said to Hillary. 10 Hillary said the students She laughed with him. work very hard at being non- TURN TO PEER/PAGE 6 — — -- — • 04suidt WOMAN PENINSULA DAILY NEWS SUNDA OcroBER 26,2003 3 Opening •communications withY outh Public health nurse says • ,:; ___..... Cover Story society's norms can change '? BY LAURA ROSSER norm. sages,"she noted."Look at _ 0 't tt FOR PENINSULA WOMAN Part of her job as health • the fashions for 5-,6-, eyear- {� educator is to try to prevent olds,and then we wonder why r .7".1 ;' Hillary Metzger doesn't teenpregnancythey're chased when theyN r run from any subject. get ) And she doesn'tgloss over "We shouldn't be shocked older." -� _' answers. by it.Teens all over the world Hillary said she believes in , ".. �`-' The public health nurse for havegottenpregnant" Personal ustresponsibilitybut Axa Hillary said. society must look at the mes the Jefferson County Health sages it sends teens.In order 4,? r �'< ^_� � Department encourages But,she added,society stu- should be looking for what for a teen to become an adult ` / �.� dents to ask questions. she and the Health Depart- the youth needs to see the $ ` ;�p'� �� If they don't feel comfort- ment look for—the optimum adult role he or she wishes to `� a� r �� i i; i"O n able speaking ' up,she tells take on. .bsy p �' them to write down their healthy pregnancy Teen For many,that means what �€ mothers are not likely to have r 't questions and she'll read an optimum job they will want to pursue. *' d them as anonymousP pregnancy,let _ notes. alone the most stable of If they don't see a viable job, i j '''"� She teaches health educe- lifestyles for raising a child. one of the biggest adult roles . ! 1 � tion for all school districts in A new program at the is parenting,a Hillary said. !F con- Jefferson County,especially Health Department targets A weak economy is for students in grades 5 helping not just teen mothers, netted with the teen preg- through 9: nancy rate,she added. r Usually,she knows the but all at-risk mothers.The Hillary - Program provides weekly said she encourages y F4. answer—but not always. students to delve into their When she's stumped, health tests for babies born to she at-risk,first-time mothers creative stores.Many youth ^�` / expert who can talk until the child is a year old. will see a contribution as a way of -� '' the eta dents or looks up 'making a contribution to the �� Sometimes,she can't find Mixed messages' rld. Community service is �• the answer.Then she has to Society's attitude toward another way of encouraging come up with something that teen pregnancy Hillary said, contribution to society. JsNNssa JAczsoNhoq PENINSULAWOMAN Aronica,left,listens while Hillary Metzger mmakes will have an impact, is confusing. It means she has to think "We send very mined mes- TURN TO OPENING/PAGE 4 a point during a Peer-In discussion, quickly and have a sense of humor. On one such occasion, Hillary said,a fifth-grader asked bow much blood rushes to the penis during an erec- tion.Hillary didn't know the answer precisely. But,she said,she did know this: "Not so much that it cuts off circulation to the brain. You can think with an erec- tion." She got her point across. Changed attitudes When it comes to talking with youngsters about sex, Hillary she is astounded to hear how attitudes toward the subject have changed. For example,she said most teens now think that oral sex - is not sex. She said she has to explain • to teens the implications of such activity. "You can't get pregnant, but get sexually trinfections,"she She said teen pregnancy seems to be acceptable in today's society and that has created a different community Nzshingtort State Department of • Health News Release For immediate release: November 5, 2003 (03-178) Contacts: Tim Church, Communications Office 360-236-4077 Washington youth say anti-tobacco ads give them good reasons not to smoke Youth smoking rates dropping–new ad campaign aims to reduce rates further OLYMPIA—About 80 percent of Washington youth say they have seen the state Department of Health's anti-smoking advertisements, and about 94 percent of those say the ads gave them good reasons not to smoke according to new data released today by the agency. The new findings come as the department launches its newest anti-tobacco ads this week. The ads are a key element of the state's comprehensive campaign to reduce youth tobacco use. Since the start of the statewide Tobacco Prevention and Control Program in July 2000, the number of 111 Washington tenth graders who smoke has dropped by 40 percent. "We're creating real and lasting change in Washington," said Secretary of Health Mary Selecky. "Still, we have more work to do; about 55 kids start smoking every day in our state. Our new ad campaign will help us reach more youth so we can convince them to quit smoking or never start." The latest Department of Health youth survey results show that youth found the ads compelling and credible. For example, 90 percent of the youth who saw the ads said they were convincing; 92 percent said the ads grabbed their attention; and 82 percent said they believed the negative health impacts in the ads really could happen to them if they smoked. "The effectiveness of our advertising efforts lies in the extensive investigation we did with Washington state youth about what catches their attention most," said Terry Reid,manager of the state Department of Health Tobacco Prevention and Control Program. "Our ads speak directly to youth who are at risk for smoking, with messages specifically designed to get their attention and give them the hard facts." --More-- Anti-tobacco ads November 5, 2003 Page 2 IIIII The new anti-tobacco ads were created by Seattle advertising agency Sedgwick Rd. The firm tested different kinds of ads with youth to determine what messages would work in Washington. The ads aim to dramatize smoking's slippery slope of addiction. One TV ad features a group of kids who unwittingly jump on what appears to be a cool, rock-band tour bus, only to discover that the creepy, smoke-filled vehicle is full of hacking, disease-ridden smokers—and they can't get off. The second depicts a group of kids smoking in a dark alley just outside what looks like an exclusive nightclub. In a Hansel and Gretel-like turn of events, the kids are invited in only to find that the club is actually a kind of holding cell for smokers on the long, slow road to debilitating disease and death. "The information we gathered from kids through surveys, interviews, and journal exercises, made it clear that kids in Washington know that smoking is bad," Selecky said. "However, most kids who smoke still think they can quit any time. We want to show them that it's easier to become addicted than they might think. More than a third of all kids who try smoking become • habitual smokers before leaving high school." In addition to the television ads, the campaign includes radio,print and Web-based ads. The spots will run through August in a variety of outlets popular with youth ages 9-14. They are part of a comprehensive strategy designed to reduce youth smoking that also includes community outreach, support services and school-based education programs. ### Editor's note: Copies of the TV and radio ads are available by contacting Tim Church at(360) 236-4077. JPEG photos of the ads are also available upon request. Visit the Washington Department of Health Web site at http://www.doh.wa.gov for a healthy dose of information. •