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WC CWF Health District Board Minutes - 06/26/2015WICHITA FALLS - WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES June 26, 2015 Wichita Falls- Wichita County Public Health District 1700 Third Street - Parker Conference Room Wichita Falls, Texas BOARD MEMBERS PRESENT: Scott Plowman, Chair Julie Gibson, D.V.M, Vice -Chair Larry Rains, D.D.S Keith Williamson, M.D. BOARD MEMBERS EXCUSED ABSENCE: David Carlston, Ph.D. Robin Moreno, MHA -HAS, ACHE Diane Stewart, R.N., Secretary BOARD MEMBERS UNEXCUSED ABSENCE: None OTHERS PRESENT: Lou Kreidler, R.N., B.S.N. Amy Fagan, M.P.A. Woodrow "Woody" Gossom Director of Health Assistant Director of Health County Judge 1. CALL TO ORDER Scott Plowman called the Health Board meeting to order at 12:00 pm after a quorum of members was attained. II. APPROVAL OF MINUTES AND ABSENCES Scott Plowman called for the review and approval of minutes from the meeting held on Friday April 24, 2015. Dr. Keith Williamson introduced a motion to approve the minutes as presented and Dr. Julie Gibson seconded the motion. The motion passed unanimously. At this time it was noted the excused absence of Dr. David Carlston, Robin Moreno, and Diane Stewart with none unexcused. III. BURKBURNETT SMOKING ORDINANCE UPDATE Lou Kreidler, Director of Health expressed that the Burkburnett smoking ordinance process was amazing. Robin Moreno being on the Health Coalition contacted the Burkburnett officials with the ordinance but officials requested to delay until after the elections. Their elections had been held on a Saturday they called that Monday to announce they wanted to do a smoking ordinance and get it done by their next Council meeting we sent them the ordinance that day. It was back with revisions to us on Wednesday after some last minute revisions Thursday it was published Monday. The Commissioners Court meeting was that Monday night we attended and presented also in attendance was Dr. Williamson and Robin Moreno. They asked questions made revisions for a more stringent ordinance than the Wichita Falls ordinance and voted it in to place immediately. The process went so much more smoothly than Wichita Falls it did not pass unanimously with only one opposed. The Burkburnett ordinance includes no smoking in all parks and sport complexes also in addition no smoking on a sidewalk adjacent to a business these restrictions make their ordinance more stringent. Burkburnett is the 39th City in the State of Texas to have a comprehensive smoke free ordinance and probably the most comprehensive ordinance in the State. Amy Fagan, Assistant Director of Health stated the Tobacco Prevention & Control Coalition (TPCC) staff would distribute No Smoking signage and ordinance information next week in Burkburnett. IV. NUTRITION/CHRONIC DISEASE PROGRAMS Lou Kreidler, Director of Health explained that Nursing services is divided into two categories; Clinical Services being Infectious Diseases (TB, STI, Epidemiology), Immunizations and Preventative Chronic Disease being HIV Prevention, Tobacco Prevention and Control Coalition, Texas Healthy Communities, Community Partnerships Program that includes a Diabetes Education Empowerment Program (DEEP) those last four are grant funded. HIV Prevention provides education and testing in jails, bars, the streets much anywhere for Wichita Falls and the ten surrounding counties. Currently under the program is a syphilis outbreak in Wichita Falls. A couple weeks ago our Disease Intervention Services contacted us to locate the individuals so the region can arrive interview them to find out how many contacts. We had a transsexual whom had 36 total contacts within the last 90 days of those 31 in Wichita Falls. The program worked to find those contacts with 17 tested one tested positive that had an additional 4 contacts and those have been tested. Last week was another positive a young male with 4 female contacts college age that is not related to the first syphilis. On Monday this week was a third syphilis in a pregnant mom in her first trimester that went to her OB for care and tested positive. According to her and the baby's father both are monogamous and do not have any other contacts he was tested but the results are not yet received. The outcome is concerning that we have so many that are not related to each other. Every time tested for HIV a syphilis test is done the program was active in finding contacts and test for the syphilis it is a significant program. Dr. Williamson asked at last count was that 3 or 4 positives. Lou Kreidler answered 4 positives. Three clusters 1 of the additional positives belong to that first cluster Scott Plowman asked how the cases are found out about, do they come to the Health Department. Lou Kreidler responded that it is reportable the same day identified. The majority of positive syphilis are identified through our STI Clinic or the HIV Prevention program. The only one identified at another location was the third case the pregnant woman. It is an important program we have developed a relationship with Midwestern State University, the sororities and fraternities worked with them for several years. The Tobacco Prevention and Control Coalition grant was established in January 2014 there is a match associated with the grant. The County Tobacco Fund supports a large portion of that match which is greatly appreciated. It is a great program for our community with an Adult Coalition and Youth Coalition involved. The Youth Coalition has been active in the development of a Flash Mob gone out to the mall, our Health Fair, and participated in "Relay for World No Tobacco Day" Burkburnett event in Freedom Park. After the ordinance passed the youth came up with "Glow With Your Body Not Your Butt" the activities are around not smoking and to work with peers to get youth involved to not use tobacco. A TATU (Teens Against Tobacco Use) program is taught to 12 -18 year olds in schools and the Boys and Girls Club then those teens go back teach it to the younger children. What is known are kids will listen to kids more than adults and the program has been a success. The FRESH START smoking cessation program that actually is the American Cancer Society program has had great feedback from participants. City employees that self- declare they are tobacco users have to complete the FRESH START program 2 for the tobacco user fee to be waived on their insurance. Not everyone in the class is a smoker many of them use spit tobacco so more information geared toward smokeless tobacco is being gathered to teach in the cessation classes. Several have quit after going through the program and those tobacco free for 30, 60, 90 days out have been much higher with this program than other programs at other levels. The combination of the program and instructors both being x smokers has made an impact. Dr. Rains asked how individuals that smoke affect insurance. Lou Kreidler replied insurance increases for any employer anytime there are smokers or anyone with a chronic illness. Statistics show increases of mi:,sed work and seeks more health care due to health issues a work associated cost. Amy had stated in her newspaper article the more people we can get healthy or get to quit smoking the healthcare insurance cost whomever the employer the health cost goes down. Judge Gossom questioned if the City insurance has different rates for smokers and nonsmokers. Lou Kreidler answered no it is the same rate but what they have is a tobacco use surcharge $25 or $30 per pay period. The surcharge can be waived annually through participation in the cessation program but if you continue to use tobacco you continue to attend the program each year for the surcharge to be waived. Dr. Larry Rains asked if you can ask a potential employee if they smoke Lou Kreidler answered no not unless seeking employment in the TPCC program because the program is geared toward tobacco prevention and control we can ask them and they would not be eligible otherwise it is illegal for us to ask if they smoke. In addition Amy Fagan stated one of the big components established by the State of the program is advertisement combined with the education. Part of the grant staff responsibility and goal with the smoke free ordinance is to go out and provide education to business owners and the public. Lou Kreidler said the program developed a commercial since there was not one for e- cigarettes or any type of vapor device that runs on both radio and television. What has been ironic with the billboards is some of the vapor shops bought the billboards next to us so it has hit a nerve with those in the vapor industry. When a youth tobacco survey was done what was found that more youth recorded to use the electronic vapor devices than to use normal tobacco cigarettes so it has become an increased problem with the youth. The devices are not regulated with no regulations on what a company can put in the devices just now began to do studies and what was found many of the same carcinogenic in a regular cigarette or in the vapor devices. Dr. Rains questioned if the vapor device is exhaled the same as a cigarette. Lou Kreidler answered they do not know exactly that is part of the studies being done. The vapor industry says it is just water but it is not studies found small particles of tin along with other chemicals and compounds that are in second hand smoke there has not been enough research done. The Community Partnerships for Healthy Mothers and Children is the newest grant program awarded by the National WIC Association (NWA) to only 15 in the nation. The grant adopted an approach to increase healthy food access in sub - recipient communities along with improving community and clinical linkages for chronic disease prevention and management. The program staff is working on a Community Action plan to increase access to mother friendly work sites for mothers that breastfeed upon the return to work and a healthy restaurant initiative. A local Mexican restaurant was the first to start the Por Vida (For Life) program in San Antonio to provide healthier options for healthier patrons. The restaurant worked with the local Health Department did surveys with the patrons that had good results. The 3 restaurant would put in an application to become a part of the program to have a Nutritionist identify items on the menu believed to fit nutritional guidelines as designated with the Por Vida item. A Nutritionist works with the restaurant to ensure those items identified meet the guidelines than the restaurant can in- cooperate a sticker or flyer to designate and recognize the Por Vida items. Hopefully in time Por Vida will be in all restaurants in the community for known choices of nutritional value. Locally 5 applications have been received for the program one being McDonald's and Luby's said they would be on board both are on the program in San Antonio. Scott Plowman said he was looking into it for his restaurants. We were awarded the Texas Health Communities grant in October 2014 upon completion of a county wide community assessment we received the Silver Award along with Houston and Harris County the only two communities in the State to receive the Gold Award. They looked at several indicators with one of those Ambulance Response times because of the nature we do not meet those response times not anything we as a Health Department can change. One thing to be done through this is to get some AED (Automated External Defibrillators) equipment for the fire stations they are going to an EMT first responder model as locally Fire responds to all first responder calls. Fire are to become EMT's to give them the ability to start IVs and push meds in coordination with the ER be able to do more for the benefit of the patient before the ambulance reaches the site so it should increase the response time. Another part is the Active Living Plan it looks at the eight sectors of our community to get people from those sectors to work together and say are community would be more active if set things were in place the plan should be finalized soon. The Mother Friendly Work Places is one of the objectives another is the 5- 2 -1 -0 =8 it is 5 servings of fruits or vegetables -2 hours or less of screen time -at least 1 hour of exercise -0 sugar drinks =8 hours sleep. The 5 -2 -1 -0 is the National campaign we added the 8 recognizing that at least 8 hours of sleep is important not only for children but adults to your overall health when added it equals 8. The 5- 2 -1 -0 =8 commercial being broadcast was viewed and the printed posters that are to be posted around the city for the introduction and promotion of the program to the community. The vision is to create a culture change within our community with an awareness the 5 -2 -1- 0=8 are the choices that need to be made for a healthy life. Last year Kaye Knauff a nursing instructor at Midwestern State along with her nursing students taught the program in the Burk schools and the Wichita Falls Independent School District (WFISD) committed for the program to be taught in the fall. The staff is to teach the program at the Boys & Girls Club and the Y agreed to promote the program. Amy Fagan elaborated in the fall with the 5- 2 -1 -0 =8 program in the WFISD half are to get the curriculum and half are not there are 758 in each sub group. They will be tracked for an outcome on whether or not the program makes an impact there would be no need to do something that sounds great but makes no difference. The Healthy Vending Work Site Wellness started with United Way and a Health Coalition pushed initiative that the grant brought an opportunity for involvement for a Healthier Community. Work has been done with some local business to convert to healthy vending machines it does make people upset. We heard it would be a lot easier if the machines offered some healthy and some moderate options so the staff came up with the idea of vending machine clings. The cling needed to be simple identifiable for people to pay attention so the other day the "GO SLOW WHOA" idea rolled out. Lou Kreidler stated the Diabetes Empowerment Education Program (DEEP) is the first time in our community we have been able to offer a complete free diabetes program. We are not trying to compete with United Regional who does the bulk share of the Diabetes training it is expensive even if covered by insurance but many times people cannot afford it. The program is not just about education it is about empowerment it is working with those individuals already diagnosed with diabetes to help them understand with modules on nutrition, medication, and physiology. People know they have diabetes but do not know how it affects their body in all the different ways they do not understand why it is so important for eye exams and keep their sugars under control. A class is offered during the day and at 10 night because people told us they could come in the day but not the night. Also a Spanish class is offered with hopes the class does well and grows since there are a large number of diabetics in the Spanish population. An application for a Diabetes grant that goes along with DEEP was submitted now just waiting to hear the outcome. Amy Fagan offered the DEEP statistics they had 50 complete the program and currently have 2 classes a week with 38 enrolled. Out of a list of people that want to be trainers 15 people are about to be trained so more classes can be taught and to have one local master trainer to train other people to be trainers. V. THE PHOTO VOICE PROJECT Amy Fagan, Assistant Director of Health said one of the things we heard doing the smoking ordinance was as people heard about the Health Coalition's work was that we did not incorporate them in any of the work did not invite them to meetings, talk to them and ask their opinions. That was not true because we had Stake Holder meetings and heard the responses. In a move forward we looked at community engagement in the elicitation of behaviorallenvironmental change which takes the people to do the work and make conscious decisions. One way would be the PhotoVoice Project basically people can use pictures to express how they think or feel about their health. It could be a barrier to their health a suggestion was to take a picture of a check because they could not afford their medications, gym membership or picture of a community that does not have sidewalks whatever barrier that keeps you from being healthy. As example I saw a picture from New Jersey with a man in a wheelchair on a road close to a hospital with no sidewalk and a car coming the opposite way that being a barrier to health if you cannot actually get there he may not make it to the hospital. The decision was to use the social media of Instagram, Twitter, and Facebook we came up with #picYourHealth for the general health campaign. We are 1 of 3 in the nation to get a grant from National Association of City and County Health Officials (NACCHO) to do a project on Community Resilience. It used to be Community Preparedness; do you have a kit, practiced your plan, talked to your kids. Community Resilience makes Community Preparedness sensitive it is how you feel about your preparedness, how your community is prepared, how you recover. People are going to be asked to take pictures of both at #picYourHealth and #picRUReady. Picture posts were shown as examples of what would be asked of people to engage with each other and us. The staff at dinner at Pascal's which promotes the restaurants farm to table salads, Amy's husband took a picture of their daughter for the reason he worked so hard the past year to get healthy, and a staff member took a picture of the clouds for how do I stay safe when the sky looks threating I do not have a weather radio. The whole idea is to engage the people it is the picture is worth a thousand words. The idea is for the posts not just to be seen by those who care about health but want others to see and interact so we thought about a contest for kids and adults. The YMCA is committed with some ideas and maybe the Boys and Girls Club for the kids and then an adult contest with two different components to win fabulous prizes. One would be a panel vote and the other a community vote on what picture resonates individually or associates with the program. The pictures chosen would be blown up then placed on easels with their information for a traveling gallery. The gallery would be put in the lobby of the YMCA then United Regional move around so as people walk in for services the pictures are seen which would resonate with them or not. In conversation with Deanna Watson of Times Record News (TRN) some ideas were discussed to integrate with the Imagine Wichita Falls Project which is every day an Imagine Wichita Falls quote is published in the paper. Downtown last weekend at the Art -N -Soul Festival the TRN rolled out their chalk board project for individuals to write on the board what they Imagine for Wichita Falls. We want to solicit feedback want people to engage what health means to them or the health barriers so it was decided to put a chalk board out with the traveling gallery as part of the project. After the Health Coalition meeting yesterday the YMCA came up with a great idea. He said one of the things they fight with they are not for profit with 12,000 people on the books and 400 kids in daycare everyday there is a huge opportunity for behavioral health change. They get 1,100 people participate in 5 the winter campaign competition but only 200 stay active members. He and I came up with the concept as people sign up then periodically throughout their membership in a week take a seifie in two weeks another to be continued that gives an opportunity for people to engage in their own behavior change. People love pictures especially this generation that has a phone in their hand every minute of every day to take pictures and periscope everything. We talked about doing health care settings that maybe Clinics of North Texas compete amongst themselves or show their own gallery. The idea is what we use not necessarily be data driven but that it really speaks the work that is happening whether it be positive or negative. It could be someone sitting at a restaurant that is smoke free or at the bar with no smoke or it could be someone sitting at a restaurant at the bar with smoke it could be interesting either way. Dr. Williamson asked if you can access the pictures as they are submitted. Array Fagan answered yes you will be too once the process is completed. Dr. Gibson first thought was the program is trying to make people aware of the choices they are making and doing but it is being done at healthy places. I think you would want to go to places that are not healthy. In my opinion if you want to get started with kids why not start with the schools. Amy Fagan replied because the grant is for the summer and schools are not in session that is the challenge but I could see this easily going into the schools. We are going into the Boys and Girls Club Eastside branch and the Y has a program that works with kids in low social economic status that we have a possibility of impact. Plans are to work with the Eastside and Lynnwood communities the most vulnerable population. VI. NEXT MEETING DATE August 28, 2015 VII. ADJOURN The meeting adjourned at 1:05 pm. f J Signature Print Name Scott Plowman, Chair, Julie Gibson, D.V.M., Vice - Chair. or Diane Stewart, R.N...Secretary Wichita Falls- Wichita County Public Health Board City - County Board 0