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Public health emergencies occur every day across the United States. Tornadoes, hurricanes, wildfires, floods, infectious disease outbreaks, terrorist attacks, and other emergencies have all occurred within the past few years and likely will happen again. Communities must be ready in the event of a public health emergency – both those they expect and those that come without warning.

Since 2002, CDC’s Public Health Emergency Preparedness (PHEP) program has provided funding and guidance to 50 states, four cities, and eight territorial health departments across the nation to protect communities. Planning and exercising plans help ensure that health departments are ready to respond and save lives when emergencies occur.

While we all hope that emergencies never happen, they are inevitable and the true test of any preparedness system. The following stories are examples of how CDC’s PHEP program works with states and local communities to ensure they are ready to respond to any emergency. Some of CDC’s partners include health departments, community organizations, national public health organizations, and private companies.

Restoring California Communities after Devastating Wildfires

In 2017, nearly 9,000 fires, almost double the average annual number, burned 1.2 million acres in California. The fires destroyed more than 10,800 structures and killed at least 46 people. However, thanks to years of planning for such events and building a public health infrastructure through the PHEP program, state and local health departments were ready to respond immediately and help their communities recover over the following months.

Through partnerships and support provided by the PHEP program in and around Sonoma County, local officials evacuated more than 1,160 patients from area hospitals and many other healthcare facilities. Additionally, because of the relationship the state built with the California National Guard through the PHEP program, more than 100 volunteer troops cleaned the Sonoma Developmental Center in one day. More than 200 patients with disabilities were then able to return safely to the facility.

Ensuring Access to Medication during an Influenza Outbreak in Maine

In March 2017, an influenza outbreak on Vinylhaven, a remote island off the coast of Maine with a population of about 1,165, sickened half of the island’s residents. The outbreak depleted the medical center’s Tamiflu® supply. Tamiflu® can greatly lessen the severity of influenza but it must be taken early in treatment.

Because of a partnership agreement established under PHEP with the Northern New England Poison Center, local pharmacies, and other organizations, and the Maine Department of Health staff quickly delivered 100 treatment courses of Tamiflu®. As a result, the state successfully reduced the impact of the influenza outbreak on the island.

Responding to a Water Contamination Incident in Illinois

On May 2017, a water main break under a river contaminated water in Cumberland County, Illinois, and left some residents without water entirely. Health department staff funded through PHEP established water distribution sites with bottled water donated by private partners such as Walmart, Coca-Cola, and Anheuser-Busch. Staff also went door-to-door to check on residents and distribute materials about safe water.

The PHEP program ensures public health emergency management systems and experts are ready to respond when emergencies occur. Preparedness efforts throughout the years have saved lives and helped communities return to normal operations as quickly as possible.

From natural disasters to infectious diseases, the PHEP program protects America’s health, safety, and security to save lives. Check out the PHEP Stories from the Field to find out more about how the PHEP program has helped communities prepare for, respond to, and recover from public health emergencies.

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Most of us are familiar with the parental-like voice in the back of our minds that helps guide our decision-making—asking us questions like, “Have you called your grandmother lately?” For many that voice serves as a gentle, yet constant reminder to wash our hands.

Handwashing with soap and water is one of the most important steps you can take to avoid getting sick and spreading germs to loved ones. Many diseases are spread by not cleaning your hands properly after touching contaminated objects or surfaces. And although not all germs are bad, illness can occur when harmful germs enter our bodies through the eyes, nose, and mouth. That’s why it is critical to wash hands at key times, such as after a flood or during a flu pandemic, when germs can be passed from person to person and make others sick.

Washing hands with soap and water is the best way to reduce the number of germs on them, however during a disaster clean, running water may not be available. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol. Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs.

Here are three key reasons why you should always care about handwashing:

  1. Handwashing can keep children healthy and in school. Handwashing education can reduce the number of young children who get sick and help prevent school absenteeism.
  2. Handwashing can help prevent illness. Getting a yearly flu vaccine is the most important action you can take to protect yourself from flu. Besides getting a flu vaccine, CDC recommends everyday preventive actions including frequent handwashing with soap and water.
  3. Handwashing is easy! Effective handwashing is a practical skill that you can easily learn, teach to others, and practice every day to prepare for an emergency. It takes around 20 seconds, and can be done in five simple steps:
    1. Wet your hands with clean, running water, turn off the tap, and apply soap
    2. Lather your hands by rubbing them together with the soap
    3. Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice
    4. Rinse your hands well under clean, running water
    5. Dry your hands using a clean towel or air-dry them

Promote Handwashing in Your Community

Global Handwashing Day is celebrated annually on October 15 to promote handwashing with soap as an easy and affordable way to prevent disease in communities around the world. This year’s theme, “Clean Hands—A Recipe for Health,” calls attention to the importance of handwashing at key times, such as before eating or feeding others, and before, during, and after preparing food.

Learn how you can get involved and promote handwashing at home, your child’s school or daycare, and your local community:

  • Tune in to CDC’s Facebook Live on October 15 at 11 a.m. EDT. During this presentation, a CDC expert will talk about the importance of handwashing and give a live handwashing demonstration on how to properly wash hands with soap and water.
  • Join CDC’s handwashing social media campaign. Post a photo of yourself or others showing your clean hands. Use the hashtags #HandwashingHeroes and #PrepYourHealth.
  • Promote on social media. Create your own messages or share some our sample social media messages. Use the #GlobalHandwashingDay hashtag.
  • Share health promotion resources. CDC has developed a variety of shareable promotion materials, including web-ready buttons, animated images, and fact sheets on handwashing.
  • Order free posters. Display handwashing posters in highly visible areas, such as schools, work areas, and restrooms.
  • Use web content syndication. Add the latest content from CDC’s Handwashing website to your organization’s website. The content is automatically updated when CDC updates it, so your content will always be accurate and current.
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Among the many lessons learned during the 2017 Hurricane season, we recognized that addressing children’s mental and behavioral health needs is a major concern in hurricane-affected areas.

CDC’s At Risk Task Force (ARTF) was established in 2017 to ensure identification and prioritization of the mental and physical health needs of at-risk populations, including children. ARTF’s first Emergency Operations Center (EOC) activation was on Aug. 31, 2017, in response to Hurricane Harvey, the first of three consecutive hurricanes to hit the United States and its territories in a five-week period. ARTF’s mission was to address the needs of at-risk populations in affected areas throughout the response and recovery phases.

Early in the response, it became clear that the emotional impact of the storms and the mental health needs of people, particularly children, affected were a critical area of focus. ARTF worked closely with federal and non-government agencies to address these needs so that children and families had the best chance for recovery.

October 10 is World Mental Health Day. The theme this year is Young People and Mental Health in a Changing World. In light of this, we want to share our experiences to inform mental health interventions and improve outcomes for children after public health emergencies and natural disasters. First, let’s talk about what makes children more vulnerable in emergencies.

Why are children more vulnerable in emergencies?

Mental stress from a disaster can be harder on children. Children are more vulnerable in emergencies because of their physical, developmental, behavioral, and emotional differences from adults. Children may have difficulty or may not be able to communicate symptoms or feelings. They may understand less about the situation and feel less able to control the events around them.

The aftermath of an emergency or disaster is also difficult for children because they have less experience coping with difficult situations.

The emotional impact of an emergency depends on a child’s characteristics and experiences, the social and economic circumstances of the family and their community, and the availability of local resources. Other factors may influence the emotional impact on children, causing them to be more vulnerable in emergencies. These include children with mental, behavioral, or developmental disorders. Children who have experienced trauma in the past may also have more difficulty coping with a disaster.  

What does the At Risk Task Force do for children’s mental health during a hurricane response?

During the 2017 hurricane season, the ARTF collaborated with federal and non-government partners to monitor behavioral health in affected areas and disseminate key messages and coping resources for children in schools and vulnerable populations in other contexts. ARTF coordinated a webinar for primary care physicians that focused on identification of common adjustment difficulties in children, provided strategies to promote effective coping skills in children and their parents, and explained the importance of self-care for professionals. The webinar was attended by more than 300 clinicians and other health care providers on Oct 26, 2017.

Public health professionals also play an important role in addressing short-term and enduring mental health needs of the population. Timely and accurate mental and behavioral health surveillance data, that includes specific information on children, could inform intervention efforts to improve developmental outcomes for children in the longer-term aftermath of disasters. It is important that mental health surveillance be incorporated into preparedness planning so that surveillance systems can be established or leveraged immediately when emergency response begins.

What are next steps for CDC?

Children’s mental health needs are a prominent concern in hurricane-affected areas. There is still a gap in real-time information on mental health needs to inform intervention efforts and improve child outcomes. CDC is working internally to enhance efforts to monitor health impacts during and after natural disasters, including integrating mental health into standard data collection.

CDC is also working with partners to integrate children’s mental health in preparedness planning. Following the 2017 hurricane season, CDC collaborated with the American Academy of Pediatrics to develop an activity book for children and families, Coping after a Disaster, that focuses on feelings children might have after a disaster and coping strategies that may help. This book is part of a series that follows Ready Wrigley, a dog who helps her family prepare for emergencies and their impacts.

CDC is now partnering with the National Hazard Center to develop mental and behavioral health training modules for researchers conducting field research immediately following an extreme event, such as a hurricane. These free, online trainings will provide background information on mental health in the context of disasters, as well as a list of mental health assessment tools used following a disaster for various vulnerable populations (e.g., children, older adults). The trainings and associated resources will address current research gaps in mental health, help to organize research in this area, and share best practices with researchers.

On Sept. 12, 2018, CDC activated the EOC to respond to Hurricane Florence, which made landfall off the coast of North Carolina on Sept. 13. The ARTF was quickly activated to address the needs of vulnerable populations. As the storm decreased in intensity, North Carolina began reporting increased emergency department visits related to stress and anxiety. Mental health concerns in children, similar to 2017, are expected to remain a prominent focus throughout the response and recovery phases. The ARTF continues to monitor the situation and support the mental and behavioral health needs of children and vulnerable populations in affected areas.

Additional Resources:

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Every fall and winter the United States experiences epidemics of seasonal influenza (flu). Sometimes a flu pandemic occurs due to a new flu virus that spreads and causes illnesses around the world. We cannot predict when a flu pandemic will occur, but over the past 100 years, we have documented four flu pandemics resulting in close to 1 million deaths in the United States alone. 1

When a flu pandemic happens, it can take up to 6 months before a vaccine against a new flu virus is available. Antiviral drugs can help manage the symptoms of the flu, shorten the time you are sick by 1 or 2 days, and prevent serious flu complications, like pneumonia. But, there may be a limited supply of these medications during a pandemic so nonpharmaceutical interventions (or NPIs) may be the only prevention tools available during the early stages of a pandemic.

There are things you can do, apart from getting vaccinated and taking medications, to help slow the spread of a flu pandemic. NPIs, also known as “community mitigation measures,” are important because they will be the first line of defense in the absence of a pandemic vaccine. NPIs may be more effective when used early and in a layered approach (i.e., using more than one measure at a time). During the 1918 pandemic, cities that put NPIs in place quickly reported fewer deaths.2,3 NPIs may be used in different settings, including homes, schools, workplaces, and places where people gather (e.g., parks, theaters, and sports arenas).

Personal protective measures to prevent flu at all times

CDC recommends using some NPIs to prevent seasonal flu and other respiratory infections. To help prevent the flu, you should always:

  • Stay home when sick and away from others as much as possible,
  • Stay away from people who are sick as much as possible,
  • Cover your coughs and sneezes with a tissue,
  • Wash your hands often with soap and water,
  • Avoid touching your eyes, nose, or mouth, and
  • Regularly clean surfaces and objects that you use a lot.
Personal protective measures to prevent flu during a pandemic

Many of these NPIs would still be recommended during a pandemic, but some would be reserved for use during a flu pandemic. Depending on the severity of a pandemic, CDC might recommend:

  • Stay home if exposed to a sick household member,
  • Use a face mask when sick and out in crowded community settings, and
  • Implement community measures to reduce exposure to pandemic flu (coordinating school closures, limiting face-to-face contact in workplaces, and postponing or canceling mass gatherings).
CDC is preparing for a flu pandemic

There is always a threat that a flu pandemic will arise, so CDC is taking steps to prepare. In 2017, CDC issued updated community mitigation guidelines to help state and local public health departments and their community partners make plans before the next pandemic happens. Visit www.cdc.gov/npi to access the updated guidelines; plain-language planning guides for the general public and community settings; and additional NPI communication, education, and training materials. You can find more information about seasonal and pandemic flu at www.cdc.gov/flu and at www.cdc.gov/flu/pandemic.

Footnotes:

1 Past Pandemics: https://www.cdc.gov/flu/pandemic-resources/basics/past-pandemics.html

2 Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci U S A. 2007; 104:7582-7.

3 Markel H, Lipman HB, Navarro JA, et al. Nonpharmaceutical interventions implemented by US cities during the 1918–1919 influenza pandemic. JAMA. 2007; 298:644-54.

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The devastating hurricanes of 2017 reminded us how important it is to prepare for disasters. These potentially life-threatening situations have real impacts on personal and public health. During Hurricane Irma, existing medical conditions and power outages increased the likelihood of death. Being prepared with supplies and an Emergency Action Plan can help you protect the health of your family until help arrives.

September is National Preparedness Month (#NatlPrep), and the perfect time of year to remind people of The Power of Preparedness. This year’s call-to-action of Prepare Your Health (#PrepYourHealth) and four weekly themes highlight the roles that individuals, state and local public health, and CDC play in creating community health resilience. It takes everyone “pulling in the same direction” to create families, communities, and a nation that can withstand, adapt to, and recover from personal and public health emergencies.

The first week focuses on personal preparedness, and the importance of nonperishable food, safe water, basic supplies, and the personal items you need to protect your health until help arrives.

Personal needs

A large-scale disaster or unexpected emergency can limit your access to food, safe water, and medical supplies for days or weeks. However, nearly half of adults in the U.S. do not have an emergency kit for their home; they don’t have the provisions, supplies, and equipment necessary to protect the health of their families in a disaster. This list will get you started:

  • Special foods—such as nutrition drinks—for people with dietary restrictions, food sensitivities and allergies, and medical conditions such as diabetes.
  • Prescription eyeglasses, contacts and lens solution
  • Medical alert identification bracelet or necklace
  • Change of clothes
  • Emergency tools (e.g., manual can opener; multi-use tool; plastic sheeting; etc.)
  • Durable medical equipment (e.g., walkers; nebulizers; glucose meters; etc.)
  • Medical supplies, including first aid kit
  • Pet supplies
  • Baby and childcare supplies
Prescriptions

Many people need daily medications and medical equipment. Nearly half of Americans take at least one prescription drug, and a quarter of Americans take three or more medications. A large-scale natural disaster, like a hurricane, could make it difficult to get prescription and over-the-counter medicines.  You and your family may need to rely on a prepared emergency supply. There are some basics to include:

  • A 7 to 10 day supply of prescription medications stored in a waterproof container.
  • An up-to-date list of all prescription medications, including dosage and the names of their generic equivalents, medical supply needs, and known allergies.
  • Over-the-counter medications, including pain and fever relievers, diuretics, antihistamines, and antidiarrheal medications stored in labeled, childproof containers.
  • A cooler and chemical ice packs for storing and keeping medicines cold in a power outage.
Paperwork

Over half of Americans do not have copies of important personal paperwork. Collect and protect documents such as insurance forms, and medical, vital, and immunization records. Here are some of the basics:

  • Health insurance and prescription cards
  • Shot records
  • Living wills and power of attorney forms
  • Vital records (e.g., birth and death certificates; adoption records)
  • User manuals, model and serial numbers, and contact information for the manufacturer of medical devices (e.g., blood glucose meters; nebulizers)
  • Hardcopies of your Emergency Action Plan
Power sources

A power outage can close pharmacies, disrupt medical services, and can be life threatening for over 2.5 million people who rely on electricity-dependent medical equipment. Be ready for a lengthy blackout with an emergency power plan and back up. You will need alternative power sources for your cellphone, refrigerator , and medical equipment. Here’s a checklist:

  • Extra batteries, including those for hearing aids, in standards sizes (e.g., AA and AAA)
  • Fully-charged rechargeable batteries for motorized scooters
  • Hand-crank radio with USB ports
  • Car chargers for electronic devices, including cell phones and breast pumps
  • A generator
Practical skills

Finally, it’s important to know some basic do-it-yourself skills to stay healthy and safe until help arrives. Here are the basics to get you started:

  • Call 911 in a life-threatening emergency
  • Get trained in cardiopulmonary resuscitation (CPR). If you do not know CPR, you can give hands-only CPR—uninterrupted chest compressions of 100 to 120 a minute—until help arrives.
  • Learn how to use an automated external defibrillator (AED).
  • Learn Handwashing is one of the best ways to protect yourself, your family, and others from getting sick.

The good news is that it is never too late to prepare for a public health emergency. You can take actions, make healthy choices, and download free resources to help you prepare for, adapt to, and cope with adversity.

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Emergency Response Interpreters Credentialing (ERIC) program interpreter, Beth Kovatch, works with the Operations Section of the Southwest Incident Management Team 1 on the Tinder Fire to record an accessible video updating the public on the the status of the wildfire.

Vicki Bond is not surprised at how hot, but at how cold the temperatures can get out on a wildfire. “I’ve worked on responses to more wildfires in freezing temperatures than in extreme heat,” she says.

Coincidentally, making sure people aren’t left out in the cold in an emergency is why she has so much experience with the weather.

Bond works for the Arizona Department of Emergency and Military Affairs (DEMA) as a licensed American Sign Language (ASL) interpreter and deployment coordinator for the Emergency Response Interpreters Credentialing (ERIC) program. She helps prepare licensed ASL interpreters and Communication Access Realtime Translation (CART) captioners to deploy for emergencies throughout the state.

ERIC interpreters and captioners work alongside communicators to interpret and transcribe information presented at community meetings and media briefings, on websites and social media, and in evacuation shelters for people who are deaf and hard of hearing.

“The goal of the ERIC program,” said Bond, “is to ensure deaf and hard of hearing community members have access to critical information during emergencies and disasters in the State of Arizona.”

People in Arizona are at risk from a variety of hazards, including extreme heat, floods, and wildfire. More than 1,500 wildfires occur in Arizona each year.

Trial by Fire The ERIC team is made up of American Sign Language Interpreters, Certified Deaf Interpreters, and Communication Access Real-time Translation captioners.

The pilot of the ERIC program was a literal trial by fire. In 2017, ERIC interpreters and CART providers deployed in response to one flood and nine wildfires, where long hours, limited supplies, and sleeping in tents are the rule, not the exception.

The ERIC staff of five captioners, 15 interpreters, and three certified deaf interpreters deployed to two major fires this season–the Tinder Fire and the Rattlesnake Fire in April—and, most recently, supported Coconino County’s response to flooding east of the City of Flagstaff.

ERIC staff have not worked with a public health department on an exercise or real-life emergency, such as a Point of Distribution (or POD) drill or activation as of yet, but Bond anticipates “many more” deployments with the recent enactment of State of Arizona Senate Bill 1296, which is meant to improve the accessbility of emergency communication.

Bond hopes the early success of the ERIC progam will help highlight the need for ASL translators and CART captioners on all emergencies.

Know Your Community

It is not a matter of if you will need an interpreter and captioner, but when you will need them. In Arizona, an estimated 1.1 million people are hard of hearing, and over 20,000 people are culturally deaf and use ASL as their primary language.

Public health and emergency management agencies can use tools like Community Assessment for Public Health Emergency Response (CASPER) surveys to assess local health and communication needs, and collect data that can help emergency planners know when to request resources like interpreters and captioners. The earlier the better in most cases.

Think Accessibility

In today’s “digital first” world, where half of visitors to CDC.gov come on mobile devices first, it is important to think about accessibility throughout the process of creating content, from conceptualization to publication.

Small print, videos without captions, and the use of long and technical language in printed materials and on websites are barriers to communication and possible violations of federal and state laws. Section 508 of the Rehabilitation Act and other laws like it help protect people who have disabilities that affect their ability to hear, speak, read, write, and understand information.

Here are 5 ways to create web and social media content that is useful, usable, and accessible:

  1. Add alternate text (or AltText) to images.
  2. Caption social media video and web video.
  3. Provide transcripts for videos and podcasts, and interpreters for livestreams.
  4. Improve the readability of print materials with large text.
  5. Write in plain language to increase understanding of your message.
Related resources: Other Public Health Matters posts you might like:
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Like many states, New York is suffering from the consequences of the opioid overdose epidemic. There has been a dramatic increase in the number of overdoses due to both prescription and illicit drug use in recent years. Overdoses are killing people of all races and ages. The New York State Department of Health (NYSDOH) is coordinating statewide prevention interventions to save lives and prevent opioid overdoses.

Adapting the RxAwareness Campaign for New York State The Rx Awareness campaign videos tell the real stories of people whose lives have been negatively impacted by prescription opioid use and abuse.

The NYSDOH’s Prescription Drug Overdose Prevention Program is using the CDC RxAwareness Campaign. The campaign ran from February 2018 to June 2018. This is an evidence-driven prescription opioid overdose prevention campaign that tells the real stories of people whose lives have been torn apart by opioid use and abuse.  The campaign aims to:

  • Increase everyone’s awareness that opioids can be addictive and dangerous
  • Increase the number of individuals that choose options other than opioids for safe and effective pain management
  • Decrease the number of individuals who use opioids for non-medical or recreational reasons

NYSDOH is using six 30-second testimonial video ads and five 30-second radio ads featuring people and families affected by prescription opioid abuse and overdose. This campaign includes Facebook ads, popular website display banners, streaming audio, and Google Search ads. Web banner ads and online search ads designed and audience tested by CDC were also used.

Real-time Monitoring Makes a Difference

The beauty of digital marketing is that it allows for real-time monitoring and optimization. The NYSDOH monitored two key metrics from the campaign every week:

  1. Click-through rates (CTR): the ratio of people who clicked on an ad compared to the total number of people who viewed the ad.
  2. Cost-per-click (CPC): the price that is paid for each click on the ad.

Continuously assessing the performance of individual ads allowed NYSDOH to swap out lower performing ads for higher performing ads. For example, mobile placements were showing strong performance, so more of the budget was allocated towards these placements and the budget for lower performing ads was reduced. High performance ads have greater reach, which leads to greater impact and increases the likelihood that the campaign will achieve its goals.

Evaluation Findings Help NY Maximize their Ad Budget

NYSDOH learned several things through real-time monitoring and evaluation:

  • Overall, women are spending nearly twice as long as men on the DOH campaign website, www.health.ny.gov/rxawareness
  • Adults 35 to 54 years old have a stronger click-through rate than the adults who are 35 to 54 years old and parents of teenagers
  • Banners on one weather site currently have the highest click-through rates and have resulted in the longest average time spent on the landing page
  • The click-through rates of online search ads increased consistently from May – June 2018
  • Public commenting on ads help NYSDOH understand how the campaign is being accepted

The NYSDOH continues to evaluate activity in this campaign. NYSDOH will utilize these findings in future campaigns.

Learn more:

This communication campaign was supported by the Cooperative Agreement Number, 5 NU17CE002742-03, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

We want to hear from you!

Leave a comment below and share how you are monitoring and evaluating your digital campaigns.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns. In the coming months we will look at other examples.

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We live in a complex world. Just as humans have left an impact on the environment, the environment also leaves an impact on us. Being exposed to certain physical and social environmental factors, like chemicals in the water, secondhand smoke, or poverty, can affect our health.

Understanding oral health data in Minnesota

The Minnesota Department of Health (MDH) Oral Health Program is committed to communicating data in a way that is understandable and easy to use. As part of the CDC’s Tracking Program, the MN Tracking Program allows us to do that by hosting our Minnesota Oral Health Statistics System (MNOHSS) data on the Minnesota Public Health Data Access portal.

The MN Data Access portal allows users to quickly find, interact, download, and visualize data through charts, infographics and maps. We also have been able to shed light on oral health disparities and use chronic disease data about diabetes, heart disease and cancer from the portal to look at shared risk factors with dental disease.

Oral health is key to overall health and the MN Public Health Data Access portal has brought greater visibility to this hidden chronic disease.

Taking health literacy into account

Nearly 90% of people struggle to understand health communication messages. This means that the data and reports we publish from our data tracking systems should take health literacy into account and provide health information that is easy to find, understand, evaluate, communicate, and use. Based on my experience, I have compiled 10 easy ways you can consider health literacy when you’re reporting data.

  1. Consider audience and outcome. Think about what actions or interventions you are hoping to achieve from your data and who needs to know about the data in order to make those changes. Your data should be presented in a way that is understandable, relevant and action-oriented for your target audience. This could include the media, policymakers, educators, researchers, students, clinicians and other health professionals, as well as the general public.
  1. Use storytelling to convey key messages. Think about your favorite novel, television show, or website. What keeps your attention and motivates you to tune in for more? I am learning a lot from communications and behavior change theories and from professionals such as Dr. Neil deGrasse Tyson, Alan Alda, and Dr. Randy Olson who are able to bring science to life through storytelling. Communicating data is a science, as well as an art. We can all take cues from Hollywood’s narrative structure to tell compelling stories that humanize our data and drive action.

 

  1. Reach people where they are. Research your target audience to find the best outreach strategies. You will need to use different strategies depending on their existing level of knowledge, motivating factors, and whether or not they are information seekers and early adopters. Does your audience prefer to receive information verbally (e.g. town hall meeting, webinar, television, radio or podcast), in writing (e.g. website, data brief, social media), or both? As an example, the Minnesota Department of Health’s MN Tracking Program developed a social media campaign that communicates data on the MN Public Health Data Access portal — Land of Healthy Kids — targeting public health professionals, schools, parents/guardians and caregivers of school age children.
  1. Make data digestible. When communicating your findings present data in bites, snacks, and meals. Not everyone who looks at your data is going to have the time or expertise to read your entire report so you need to make sure they can find information that is relevant and understandable.
    • Bite: Use anchors and headers to help users quickly find data and information. Brief headers that use a declarative statement to interpret a chart or map helps with data literacy.
    • Snack: Develop simple charts and maps with clear titles, legends, and axes. Charts and maps should be standalone features that do not require additional text to understand. They should communicate the who, what, where and when of the data you are presenting. Do not overwhelm viewers with p-values and confidence intervals. These can be added to accompanying tables and information pages.
    • Meal: Tables, data downloads, and information pages should be added for researchers, health professionals, and those who want to dig deeper into the data. You might include additional information about study design, sample and weighting methodologies, indicator definitions, sample or population size, confidence intervals, unreliable estimates or data suppression to help this audience to further analyze and interpret the data.
  1. Numbers count. Adults in the United States have lower numeracy skills than adults in other developed countries. Many do not understand percentages or ratios, have difficulty making comparisons (across years, geographies, or against a target goal), and do not know the difference between absolute versus relative risk. Dashboards, infographics or icon arrays, risk tables, ladders and scales help to visually display data, the magnitude of effect or risk, and can help individuals make comparisons if presented on the same scale.
  1. Think about accessibility. To ensure everyone has the same access to your data, familiarize yourself with 508 Standards for Electronic and Information Technology. People with visual, auditory, and motor skill impairments may not be able to access information on the web, even using assistive devices. Simple modifications can make a big difference, such as:
  1. Report data in meaningful, culturally, and linguistically appropriate way. Analyzing and presenting data by geography, sexual orientation and gender identity (SOGI), age, race/ethnicity, preferred language, disability, and chronic disease status helps to identify health disparities and prioritize resources. This should be done in concert with the affected community to ensure that data is collected, analyzed, interpreted, and reported accurately, meaningfully and in a culturally and linguistically appropriate way.

 

  1. Conduct audience testing. The best way to ensure your data can be found, accessed, and understood is to test your communication product with your target audience. Generally 5-8 people will suffice. The key is to make sure the group is representative.
    • Usability testing identifies whether or not your audience can find data and information, successfully complete specified tasks, and helps you to understand how your audience searches for information or completes tasks. You can also observe how long it takes them to complete tasks and determine ways to modify or enhance user experience.
    • Accessibility testing determines whether or not online content is 508 compliant. Using a screen reader or only a keyboard (not mouse), can you still navigate and access web content? Consider testing products with individuals who use assistive devices.
    • Health literacy testing identifies whether or not your data and information is understandable. Can your audience easily interpret the data in charts, tables, and maps? Is your narrative description of the data clear?
  1. Evaluate your work. To improve future communication about data, you should always evaluate your work.
    • Web and digital analytics applications allow you to monitor audience reach and user engagement. They can help you set goals, tell you what search engine terms are common, and whether or not users are accessing your page directly or are being directed from a different website. It can also tell you which pages are popular and which are not. Infrequent traffic or high bounce rates on a particular page may indicate lack of interest, lack of awareness, or perhaps a usability or health literacy issue.
    • Track different modes of communications. How many presentations, webinars, social media posts, etc. have you delivered in a specified amount of time? Who was the audience? Are there groups you have not yet reached?
    • Monitor how your data is being used. User surveys, in-person interviews, and external communications such as articles, reports, website links, and social media posts can tell you how your data is being used and if it is being used appropriately.
  1. Share best practices. Talking and listening to others is a great way to discuss new methods, share resources, and spark inspiration.
    • Join professional organizations and working groups on surveillance, epidemiology, and health literacy and discuss the importance of data literacy.
    • Engage with programs, like CDC’s Tracking Program, who use health literacy and numeracy principles to inform how they communicate about data.

Communicating data can be difficult and takes time and practice. But remember, we all appreciate clear communication. When you address health literacy, you improve data quality and consumer satisfaction and make data truly accessible to everybody.

The Minnesota Public Health Data Access portal is managed by the Minnesota Environmental Public Health Tracking Program (MN Tracking). MN Tracking is part of the CDC’s National Environmental Health Public Health Tracking Program, which collects, integrates, and analyzes environmental hazard and public health data from a nationwide network of partners.

Learn more

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

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Exposure to a traumatic event or set of circumstances can negatively affect a person’s mental, physical, social, emotional or spiritual well-being for a long time after the initial incident. We know that not all individuals respond to trauma in the same way and we know that individuals with a history of trauma, especially childhood trauma, are more likely to experience psychological distress and are at increased risk for the development of Post-traumatic Stress Disorder (PTSD) with future exposure to trauma.

The chemicals in our bodies change during stressful or traumatic situations

When the body is threatened, stress hormones are released to help you survive (fight or flight response). These hormones cause our bodies to minimize non-essential tasks, including growth, reproduction, and immune function and to maximize body functions that are necessary to prepare the body to fight or flee from a stressor.  Functions such as breathing, heart rate and alertness are useful for the body to survive the stress.   If someone is regularly exposed to trauma, stress hormones are repeatedly released and the brain can become exposed to these powerful stress hormones that would normally be present in the body for short periods of time. Over time repeated exposure to stress may cause your body’s natural stress response system to malfunction and can result in potentially unhealthy mental and physical responses to current or future stress.  These responses can include irritability, emotional reactivity, intrusive thoughts about the event, emotional numbing and avoidance, loss of one’s sense of safety, or diminished capacity to trust others.

Exposure to trauma can affect a person’s normal coping and stress management skills.  A person’s mental health during an emergency may be impacted by:

  • Direct exposure to the disaster, such as being evacuated or witnessing others (including family members) in life-threatening situations
  • Prior experience with and exposure to trauma
  • Pre-existing conditions, such as mental health conditions
  • Socioeconomic factors, such as family resources available
  • Family variables, for example, how parents react
Take trauma into account when responding to emergencies

When someone has experienced trauma, he or she can be re-traumatized if emergency medical service providers, healthcare professionals, and community service providers are not aware of and sensitive to the possibility of re-traumatization. Emergency responders should be aware that individuals and communities may have experienced a variety of traumas in their lives and need to consider a survivor’s physical, psychological, and emotional safety and well-being after a disaster.

Trauma-informed organizations and emergency responders need to be sensitive to the potential impact that widespread trauma can have on individuals. An essential underpinning of trauma informed care and approach is the awareness that procedures and interactions can be re-traumatizing.

Training emergency responders in trauma-informed care

The CDC’s Office of Public Health Preparedness and Response (OPHPR) collaborated with SAMHSA to develop a trauma-informed care training for CDC. Working with Mary Blake (SAMHSA) and the Technical Assistance Center, SAMHSA’s National Center for Trauma-Informed Care (NCTIC) developed and led a new training for OPHPR employees about the role of trauma-informed care during public health emergencies. The training aimed to increase responder awareness of the impact that trauma can have in the communities where they work. Participants learned the six principles that guide a trauma-informed approach, including:

  1. Safety
  2. Trustworthiness and transparency
  3. Peer support
  4. Collaboration and mutuality
  5. Empowerment, voice and choice
  6. Cultural, historical, and gender issues

Adopting a trauma-informed approach is not accomplished through any single particular technique or checklist. It requires constant attention, caring awareness, sensitivity and it may require a cultural change at an organizational level. On-going internal organizational assessment and quality improvement, as well as engagement with community stakeholders, will help to imbed this approach which can be augmented with organizational development and practice improvement. The training provided by OPHPR and NCTIC was the first step for CDC to view emergency preparedness and response through a trauma-informed lens.

Resources:
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In 2016, 115 Americans died every day from an opioid overdose – that is more than 42,000 drug overdose deaths that involved an opioid including prescription opioids, heroin, and/or illicitly manufactured fentanyl. Prescription opioids (like hydrocodone, oxycodone, and morphine) are prescribed by doctors to treat moderate to severe pain, but have serious risks and side effects.

Anyone who takes prescription opioids can become addicted to them. Families across the county are dealing with the health, emotional, and economic effects of the opioid epidemic. The opioid overdose epidemic is a public health emergency and Americans of all races and ages are being killed by opioid overdoses.

Rx Awareness campaign tackles prescription opioids

Rx Awareness is CDC’s latest effort in the fight against the opioid overdose epidemic. Rx Awareness aims to:

  1. Increase Americans’ awareness and knowledge about the risks of prescription opioids, and
  2. Prevent inappropriate use of prescription opioids.

Rx Awareness uses the tagline, “It only takes a little to lose a lot” to educate the public about dangers of prescription opioids, including misuse, abuse, and overdose. The campaign features real-life accounts from people recovering from opioid use disorder and from people who have lost loved ones to prescription opioid overdose.

Public awareness campaigns, like Rx Awareness, are important in the fight against opioids. The more equipped people are with information and resources about the risks of opioids, the more we can support those affected by this epidemic. The cornerstone of Rx Awareness is a series of testimonial videos, and the campaign also includes radio advertisements, digital advertisements, billboards, posters, newspaper advertisements, and a website.

States are on the frontlines of the opioid overdose epidemic

CDC created the Rx Awareness campaign for states, coalitions, and communities to implement across the country. When the campaign was launched in 2017 it included an implementation guide to support CDC-funded states to use the campaign materials. State and local health departments and community organizations can take part in the Rx Awareness campaign and use the tested campaign materials and resources to launch local campaigns, support local prevention activities, and raise awareness about the risks of prescription opioids.

States are critical in preventing opioid overdoses. Through the Overdose Prevention in States (OPIS) effort, CDC is working with 45 states and Washington D.C. to provide scientific expertise, enhanced surveillance activities, and support resources to prevent risks of opioid use disorder, overdose, and death. The resources and information from this effort help combat prescription and illicit opioid abuse and overdose and is the heart of the CDC’s work on this epidemic.

Everyone can help stop opioid overdoses

The best ways to prevent opioid overdose are to: (1) improve opioid prescribing practices, (2) reduce exposure to opioids, (3) prevent misuse, and (4) treat opioid use disorder. Anyone can take action to help end the opioid overdose epidemic. You have a role in preventing opioid-related overdoses.

You can take steps to reduce your risk for prescription opioid misuse and help prevent opioid overdose deaths in your community:

  • Learn more about prescription opioids so you can help those at risk for opioid use disorder and overdose in your community.
  • Practice responsible use if you are prescribed opioids for pain and work with your doctor to ensure you are getting the safest, most effective pain management possible.
  • Help those struggling with addiction find the right care and treatment. Anyone who takes prescription opioids can become addicted and help is available if you or someone you know is battling opioid use disorder.
  • Spread the word and increase awareness in your community about the risk and dangers of prescription opioids. By sharing campaign materials you can broaden the reach of the message that, “It only takes a little to lose a lot.”
  • Know the signs and symptoms of an opioid overdose to help prevent opioid overdose death. If you suspect someone is overdosing, it is important that you don’t leave the person alone and that you call 911.
Learn more We want to hear from you!

Comment below if you have you noticed the Rx Awareness campaign in your community.

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