Submitted by Adelaide Murray, Project Associate, Community Health Institute/JSI

My name is Sabryna Therrien, and I am a senior at Rivier University in Nashua, New Hampshire studying public health, and minoring in biology. I have always been passionate about investing my time in the needs of others, and how I could help them better, which is what prompted me to major in public health my sophomore year. Studying public health at Rivier has taught me how vast the public health field is, and what people like me can do to make our communities healthier.
Since taking a collection of classes at Rivier that ranged from Food Safety and Hygiene to Epidemiology, I soon found myself interested in Public Health Research and Health Promotion, Marketing, and Communication. During those classes I invested my studies in researching maternal health care initiatives in refugee camps due to recent international multimedia events in 2016. Karyn Madore, Operations and Communications Director at
JSI Research & Training Institute, heard that I was interested in Maternal and Child Health, through her class at Rivier, and invited me to intern with her at JSI and CHI in Bow, New Hampshire. This opportunity has landed me a yearlong internship until I graduate in the spring, working on Multimedia Services for a Maternal and Child Health Program called Healthy Families America. So far I have researched and worked on a literature review for our team to analyze and determine better ways of retaining and configuring the Healthy Families America Program. Overall this internship has taught me the importance of group work and diligent research, and I am elated to see what my next steps will be through this internship.
After many years of service, NHPHA Bookkeeper Ginger Fraser has moved on. Ginger graciously worked with her replacement to make the transition as smooth as possible. We are grateful to Ginger for her many contributions to the success of our organization and wish her the very best in her new endeavors.

Now, we would like to introduce you to our new bookkeeper - Liz Durant.

"My name is Liz Durant and I am excited to be working with NHPHA. As an entrepreneur with excellent mission-driven business and leadership skills in both non-profit and for-profit organizations, I split my time between several Liz Durantventures.

My background is in finance and accounting and for the last 5 years, I was the Business Manager at Red River Theatres. As a strong leader with “outside the box” creativity to identify challenges and offer solutions, I loved the opportunity to connect with members, donors and other community members regularly. I am looking forward to meeting many of you in the coming months!

My alter ego is as the owner of Well Balanced, a fitness and nutrition coaching business. I am passionate about working with clients in an individual and group setting - by providing guidance and expertise, I can work with them to create an action plan to successfully achieve their goals. I teach classes in several places in the Concord area and do personal training in person and online.

In addition, I am currently serving in my 10th year on the Hopkinton School Board, this year as the Chair.

This month we became members of the empty nest club - our children, Maddie (Franklin & Marshall - 2012) is currently living and working in Austin, TX; Hannah (St. Lawrence University-2016) works at Boston Children's Hospital; and Justin (RIT) was just dropped off for his freshman year. My husband, Jud, works for DHL Logistics and currently commutes to Ohio, leaving me with three cats, five chickens and fish...."
The Coalition is proud to announce that we were selected to host a John G. Winant Fellow for the 2017 summer session. https://carsey.unh.edu/winant-fellowship. The Fellowship honors former NH Governor and U.S. Ambassador to Great Britain John G. Winant. Please see Mr. Panesar’s introduction below.

Sameer Panesar resizedHi! My name is Sameer Panesar and I am very excited to be an intern for the New Hampshire Oral Health Coalition. My work is being supported by the University of New Hampshire’s Carsey School of Public Policy through the John G. Winant Fellowship. The Fellowship aims to “encourage the professional development of undergraduates with a strong commitment to public service.” As such, I am appreciative of the work that the OHC has done and inspired to improve oral health care access and delivery for citizens of our state. I am honored to contribute to this work and mission as a 2017 Winant Fellow.

A little bit about me - I grew up in northern Maine but currently live in the seacoast region of New Hampshire. I went to high school here and graduated from UNH this past May with a BA in Political Science. While in college, I had the opportunity to work for the Institute for Health Policy and Practice on a variety of research projects spanning multiple focal areas. The one that has the greatest relation to oral health care was a project entitled “Identifying Priorities for and Strategies to Optimize Oral Preventive Service Delivery in Pediatric Primary Care Settings in New Hampshire.” The focus of the project was to assess the current status and barriers and facilitators to the delivery of oral preventive services (including fluoride varnish) in pediatric primary care practices in New Hampshire, with a particular focus on children under six years. Additionally, the project aimed to identify strategies to optimize the delivery of oral preventive services in pediatric primary care settings.

I am interested in oral health care as well as its place in the broader American health care delivery system. The broad and systemic challenges and opportunities facing our health care system fascinate me and I hope to contribute to solving these problems as a future health care professional. Of great interest to me is the aging of the U.S. population and how that will affect the prioritization and distribution of future resources. At OHC, I am focusing my work on the status of oral health care delivery to the senior/elderly population in New Hampshire. I think that oral health is an often overlooked area of care delivery for seniors and I hope to leave the OHC (and all stakeholders) with a white paper and various briefs on what the current status is like and challenges and opportunities moving forward to improve such care delivery - and also review models that are currently being implemented throughout the state. This work should leave the OHC and stakeholders with a current overview of the state of oral health care delivery and recommendations, challenges, and opportunities moving forward.
I, like you I am certain, watched in horror as the violence and hate erupted during the white nationalist rally in Charlottesville this month. I had a visceral reaction to the images as they unfolded on the screen; first because it was so terrifying and repulsive to witness the level of hate expressed by the white nationalists and secondly because I attended the University of Virginian and it hit too close to home. Charlottesville is a bucolic, architecturally beautiful city situated in the foothills of the Blue Ridge Mountains. It is steeped in tradition, academic excellence and the influences of Thomas Jefferson – who admittedly is not beyond controversy. But seeing this happen in Charlottesville made it clear, this type of expression of racism could happen anywhere. It leaves us with so many questions about how we find ourselves in this place, right now in this country and what we can do to confront the overwhelming issue of racism.

In a recent article in CNN (August 15, 2017) several health organizations (the American Academy of Family Physicians, the American Psychological Association and the American Public Health Association) were noted to acknowledge racism as a public health issue. It was reported that multiple studies suggest that the risk for health issues such as depression, hypertension, heart disease and death can be increased for individuals experiencing racism or discrimination.

But what can we do about racism? The American Public Health Association campaign against racism suggests three approaches to address racism.

  1. Put racism on the agenda. Name racism as a force determining the social determinants of health.
  2. Ask “How is racism operating here?” Identify how racism drives past and current policies, practices, norms and values that create the inequitable conditions in which we are born, grow, live, learn and age.
  3. Organize and strategize to act. Promote and facilitate conversation, research and intervention to address racism and its negative impact on the health of our nation.

Having recently revisited its values, NHPHA pledges to become a part of the solution in New Hampshire. Our pertinent revised values are:

Equity- We believe in fair and just opportunities that will allow people to achieve their full health potential
Community – We believe that everyone has a right to live, work and play in healthy and safe communities that foster well-being and prosperity
Collaboration – We mobilize partners for collective action to advance the public’s health

We have the opportunity to participate in this conversation with two upcoming events in New Hampshire. First is the Inaugural Symposium on Race and Equity: Building Foundations for the Future sponsored by the Endowment for Health. The symposium is currently at capacity due to the tremendous interest but is seeking to increase that capacity to accommodate interested participants. Secondly, NHPHA is holding its annual fall forum on November 15, 2017 and will focus on strategies to advance health equity in the state. A save the date can be found in our August newsletter.

In a recent interview on NPR, Brittany Packnett, educator and activist provides some guidance and encouragement for taking on something as massive as racism. “Get in community with other people. It might be a book group. It might be you and your neighbors. It might be members of your family. But get together and figure out how you're going to work on this together.” Packnett goes on to talk about the importance of awareness first. “Educate yourself as to the fact that racism is not only real but that it's more than extremes like the KKK or even the individual, everyday slights. There are tools like Peggy McIntosh's "Unpacking The Invisible Knapsack" that gives you 50 ways in which white privilege can manifest in your life.” Packnett notes that we can confront racism when it pops up in many ways, “It's about making sure that when you see a colleague of color being spoken over, that you acknowledge that in the moment…. It means …. checking yourself when you see a black man walking down the street and you decide to cross it. Having the dialogue within yourself to say, why did I have that reaction, and how can I hold myself accountable to my own biases and disrupting those? …We need to make covert forms of racism as socially unacceptable as what we saw in Charlottesville.”

We at NHPHA look forward to working with our partners to have these difficult conversations and taking action to confront racism in New Hampshire.

Written by Joan Ascheim, Interim Executive Director NHPHA
Dear Governor Sununu: 

We are writing on behalf of the board and membership of the New Hampshire Public Health Association, a trusted voice that has worked to promote and protect the health of the people of New Hampshire for the last 25 years. 

We are asking that you join with your fellow governors, both Democratic and Republican, who are calling for a bipartisan Senate approach on healthcare reform to preserve critical health benefits for millions of Americans. All of the governors who have signed a letter urging this collaboration are from states like, New Hampshire, that have expanded Medicaid under the Affordable Care Act. The Republican bill in both chambers will phase out federal funding for that expansion.
 
As you well know, nearly 190,000 individuals have enrolled in Medicaid and the Children's Health Insurance Program as of March 2107 and thus have had access to essential preventive and acute care health services. 

We are most concerned about the following in the Senate version of the American Health Care Act:
 
  • With the phasing out of Medicaid Expansion, the loss of health care coverage for NH adults and children and their inability to access essential health benefits such as maternity care, mental health and substance abuse disorder services and prescription drug coverage.
  • The loss of these services would hamper New Hampshire's ability to assist individuals to receive behavioral health services and address some of the root causes leading to the state's growing opioid epidemic.
  • The blocking of Medicaid reimbursement to Planned Parenthood, which provides quality reproductive health services for both men and women. This will result in less access to care and potentially more unintended births and increased spending for the Medicaid program. 
  • The maintenance of the Prevention and Public Health Fund for state and local prevention activities that has brought over $23.3 million to New Hampshire since 2010 for programs to: reduce tobacco use; address childhood lead poisoning; prevent falls among the elderly; reduce health disparities; prevent diabetes, heart disease and obesity; respond to disease outbreaks and improve access to vaccines. These are critical prevention funds for New Hampshire that allow the state flexibility to address its most pressing public health needs. The loss of these prevention funds would be devastating and potentially lead to higher health care costs.

New Hampshire is projected to see Medicaid costs that are $111,316,000 over their projected federal funding cap as proposed in the House passed AHCA. We urge you to consider joining your colleagues to assure a bi-partisan approach to assure that all Americans continue to receive critical health benefits and can lead healthy, productive lives.

Sincerely,Katie Robert, President NH Public Health Association
Joan Ascheim, Executive Director NH Public Health Association
June2017Oral1On June 1, NHOHC held its annual Legislative Breakfast at the NH State House cafeteria. With over 100 in attendance including NH Senators, Representatives, policy-makers, legislative staff, and an advisor from the Governor’s office, twelve state-wide Coalition member programs provided displays, information, and policy highlights on the non-traditional, community-based oral health programs that provide care to low resource, Medicaid-covered, and dentally underinsured residents of NH.

Highlighting the programs that exist outside of the traditional dental office, member displays focused on programs providing care within local schools, senior centers, child-care and nutrition programs, nursing homes, public housing sites, and more.

While each program is unique, the need and service exists across the lifespan from pregnant women to children to adults and seniors. Services may be held in “brick and mortar” and mobile settings including vans and portable equipment transported in automobiles.

Legislative attendees expressed great interest in the oral health needs of NH’s children, uninsured adults and seniors, understanding that oral disease has a significant impact on the June2017Oral2overall health and function of both children and adults. Dental decay is cause by bacteria and is the #1 chronic disease for children both in NH and nationally. Yet, decay is preventable.

Key oral health policy priorities for NH include the alignment of oral health reimbursement with authorized services, especially for the NH certified public health dental hygienist (CPHDH) that can provide lower cost, community-based care; the consideration of a Medicaid adult dental benefit that provides a return on investment in health, productivity, and corrections costs; and increased opportunities for medical-dental integration – “putting the mouth back in the body.” More information on policy considerations can be found in the report from the NH Legislative Commission on Pathways to Oral Health. The full report can be found at: http://nhoralhealth.org/blog/wp-content/uploads/2015/11/FINAL_SB_193_Oral_Health_Pathways_Commission_Report.pdf.

For more information on community-based oral health care programs in NH, see the NH Baseline Survey and GIS map at: www.nhoralhealth.org. You can contact the Coalition at: info@nhoralhealth.org.

Section Convenes First Annual Meeting

Nurses Annual Meeting 2017

On June 5, 2017, the NH Public Health Nurses' Section of the NH Public Health Association held its inaugural annual meeting.

Dr. Rosemary Taylor PhD, RN, CNL was the key speaker and gave a presentation titled: "Any one of us on a bad day: Making sense of nurse bullying, tough-love, hoarding, and other unprofessional behaviors."

Twenty-six nurses attended the presentation, which was well received. An excellent discussion took place and several issues close to NH nurses were discussed.

Meeting organizers wish to send sincere thanks to Dr. Taylor for sharing her expertise with the group.

This has been an eventful year for the NHPHA Nurses' Section. It has been one of finalizing its bylaws and developing its vision and mission for the group.

We look forward to developing public health priorities for the coming year. Please join us.

Terry Johnson was recently honored by the Governor's Council on Physical Activity and Health with the 2017 Outstanding Achievement Award for making a difference in New Hampshire's health. Terry Johnson

The Outstanding Achievement Award for Physical Activity and Health is awarded annually to organizations and individuals who have made a significant impact on the health of NH residents by promoting healthy lifestyles through physical activity and fitness programs. Johnson has nearly 25 years of experience developing and directing health promotion and clinical programs in community, medical and work-site settings to lead the New Hampshire Healthy Eating Active Living (HEAL) Initiative. He works with many state and community partners to establish policies and programs that support healthy eating and active living where New Hampshire's residents live, learn, work and play.

Johnson served as the Director of Healthy Eating Active Living (HEAL) NH at the Foundation for Healthy Communities since 2008, and upon the program's conclusion, assumed the role of Director for the NH Comprehensive Cancer Collaboration on June 19th.

There is a new initiative in New Hampshire, Tick Free NH (TickFreeNH.org), with a goal of educating everyone about the risk of being bitten by a tick and how to prevent tick encounters and tick bites.

May is Lyme disease awareness month. Lyme disease is caused by a bacteria (Borrelia burgdorferi ) and is transmitted to humans through the bite of infected blacklegged ticks (aka the deer tick). Lyme disease can be debilitating if not identified very early and treated by antibiotics. Children ages two through 13 are at particular risk for tick encounters and contracting Lyme disease. In late Spring, nymph (baby tick) season starts - these nymphs are so tiny, they may appear to be a speck of dirt, like a poppy seed.

What are the top six things you can do to prevent a tick bite?
  1. Protect with permethrin (for shoes and clothing only, use as directed) or insect repellent with DEET (20-30%).
  2. Tuck your pants into your socks - don't let ticks crawl up your pants!
  3. Inspect yourself, children and pets when you come in from the out of doors - every time.
  4. Shower, do a tick check (with a mirror) and put your dry clothes directly into the dryer on high for 6-10 minutes.
  5. Remove all ticks immediately and properly (use a tick spoon or tweezers - don't twist, pull straight up). Wash site with alcohol.
  6. ID your tick, save in tape or plastic bag, and if you've been bitten visit a doctor.
The blacklegged tick can transmit Lyme disease in 24 hours and the Powassan virus in 15 minutes. Doing a tick check (on you and children) and showering after coming indoors are two of the best prevention methods you can add to your habits.black legged tick

Tick Free NH is an initiative supported by a New Hampshire funder, local businesses, and a group of New Hampshire public health, environmental health, and childcare professionals who share the mission of providing the most up to date information to New Hampshire residents about how to prevent tick encounters and protect themselves from tick bites.

Tick Free NH offers no-cost and low-cost resources for order or download. We encourage you to visit their website www.TickFreeNH.org and review the prevention information. You can order hard copies of their materials through the web site and online order form.

Contact them at: tickfreenh@gmail.com

Check out what they've done so far at www.TickFreeNH.org or find them on Facebook and Instagram.
Submitted by Allison Power Bernal, Prevention Coordinator, New Hampshire Coalition Against Sexual &Domestic Violence (NHCADSV)

April is Sexual Assault Awareness Month, and this year’s theme is Engaging New Voices. At NHCADSV, we are working to engage youth-serving institutions, educators, the health care field, policymakers, and public health practitioners in recognizing how sexual violence impacts the health of individuals, families, and communities. NHCADSV is a statewide network of 13 independent member program crisis centers that provide services to vicNHPHA 195 of 225for webtims of sexual assault, domestic violence, and stalking. Member agency services are free, confidential, and available to all victims regardless of age, race, gender, religion, sexual orientation, physical ability or financial status. In 2015, the 13 member programs served 13,000 victims in NH. In addition to supporting services at local crisis centers, NHCADSV leads in statewide policy advocacy for victim’s rights, ssexual violence prevention programming, and runs the Sexual Assault Nurse Examiner Program, which has placed trained nurses in 23 out of 26 hospitals in the state; SANEs improve prosecutions of sexual assault by ensuring that exams are conducted competently, collecting appropriate evidence and providing testimony at trial.

Sexual violence is one of the most pressing, under-reported, and underfunded public health problems facing our state, and is a silent driver behind other public health epidemics, including the opioid cri
sis. According to the CDC’s National Intimate Partner and Sexual Violence Survey, the lifetime prevalence of sexual violence victimization other than rape for NH women is 51%, and the lifetime prevalence of rape is 23.5%. The lifetime prevalence of sexual violence victimization of NH men is 28%. Victims of sexual and intimate partner violence experience significantly higher rates of depression and anxiety, asthma, irritable bowel syndrome, frequent headaches, chronic pain, difficulty sleeping, and substance misuse disorders. Recently published the Journal of Preventative Medicine, “Lifetime Economic Burden of Rape Among U.S. Adults,” concludes that the lifetime cost per victim is $122,461. Nationwide, this accounts for an economic burden of nearly $3.1 trillion, which includes $1.2 trillion (39% of total) in medical costs and $1.6 trillion (52%) in lost work productivity. (Peterson, DeGue, Florence, & Lokey, 2017)

In particular it’s important to highlight the connection between the epidemic of sexual violence and the opioid epidemic in this state, and the key role the healthcare and public health infrastructure has in connecting
 victim to services. On April 17, U.S. Representative Annie Kuster held the Voices for Change panel, which follows the launch of her Bipartisan Congressional Task Force to End Sexual Violence. During the panel, Rep. Kuster recounted meeting with women in Sullivan County living with addiction to opioids, and each one said the trauma of sexual abuse was a major factor driving their addiction. This anecdote is a just a snapshot of how sexual violence underscores so many of our public health problems in New Hampshire.

This April is also a chance to highlight how sexual assault intersects heavily with other issues facing youth, including bullying and suicide. For example, the new Netflix series 13 Reasons Why is the story of a girl who documents the events, including sexual harassment and sexual assault that lead up to her suicide. The series is generating enormous response from suicide prevention and anti-bullying advocates and the public health community wanting to support youth who watch the series. The culture of sexual violence, impunity of the perpetrator, lack of support from school staff that drives the tragedy. Unfortunately, crisis center advocates and educators support victims with similar stories every day in New Hampshire, but continue to be committed to working with youth, schools, and parents to respond to and prevent sexual violence perpetrated against and by youth. 

Sexual violence prevention is about social norms change, and it works: the CDC Rape Prevention Education program is in 50 states and 4 U.S. territories, and here in New Hampshire crisis center educators focus on reducing risk factors like toxic masculinity and homophobia, exposure to sexually explicit media, family violence, lack of institutional support from community and judicial system, and societal norms that tolerate sexual violence while increasing protective factors like community connectedness, empathy, respectful peer relationships, and gender equity. NHCADSV staff are so appreciative of NHPHA for the Friend of Public Health Award, and we are excited to continue building partnerships with the public health community to prevent and respond to domestic and sexual violence in the Granite State Institute, and the American Public Health Association.
 
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Submitted by Keryn Bernard-Kriegl, New Hampshire CHildren's Trust 

As Child Abuse Prevention Month ends, we reflect on our shared responsibility to provide children with safe, stable, and nurturing environments.

"We all have a role in strengthening our families and communities to give children the great childhoods they deserve," said Keryn Bernard-Kriegl, Executive Director of NH Children's Trust. "The good news is it's not as hard as it sounds."

March 28 served as a kick-off for Child Abuse Prevention Month as almost 300 participants gathered at Grappone Conference Center in Concord for NH Children's Trust's widely-anticipated event, "Resilient Communities: The Prevention Connection," a summit aimed at inspiring action that strengthens policies, culture and behaviors that prevent child abuse and neglect and promote health and well-being. In April, many supporters raised awareness for prevention efforts. NH Children's Trust distributed 950 pinwheels, a symbol for great childhoods. Organizations across the state set up pinwheel gardens in their communities, and on April 7th, hundreds of people raised awareness by wearing blue and standing in solidarity for great childhoods.

The effects of child abuse and neglect impact individuals, families, and communities for decades. We can all have a hand in preventing child abuse by making sure parents and communities are equipped with the supports and skills needed to raise thriving children. From sharing educational social media posts, to offering help to a stressed parent, to advocating for family-friendly policies, there are many opportunities to be a part of the solution.

NH Children's Trust thanks all of our supporters and partners for doing their part this Child Abuse Prevention Month - because great childhoods begin with all of us.

GFWC Dover for webThe River CenterNH Public Health Association for web




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Figuring Our Work in the Upcoming Legislative Session
Submitted by JJ Smith, NHPHA Public Policy Co-Chair

A week has passed since the elections and now we need to adjust our policy work for the upcoming two years. Much has changed even though the partisan make-up of the NH legislature remains nearly the same as of this writing (some recounts are still in progress). With many new Representatives and Senators elected we will struggle to know what issues will come to the forefront for us and how the newly elected officials will decide on issues that are important to advancing public health. We need help from all of you, our members, to monitor and contact the legislators who represent your districts and in following introduced legislation once it is known what policies are in the bills that are being filed. Be alert for updates from us as this is a long process while the legislative services office slowly helps write up hundreds of bills that may exist just as concepts in the legislators’ minds.

One important change is in New Hampshire’s Governor. We agreed with many of the vetoes issued by Governor Hassan. Since the legislature was not able to override those vetoes, we expect similar pieces of legislation to be introduced again. Whether any of them will then become law will depend on the issue and the attitudes and beliefs of many people but most of all of Governor Sununu. Since he was not a part of the last legislature, we don’t know where he will come down on many things we care about. It is likely he will agree with legislation that is sent to him after passing the House and Senate since they majorities of both chambers come from his political party. But there is some uncertainty about that, especially since he has said he favors reproductive rights, including access to abortion.

Governor Sununu’s attitude on reproductive rights issues may become the deciding factor because of the changes in the State Senate. Nine of the twenty-four Senators are new and did not participate in the Senate 12 to 12 deadlock on the attempt to repeal the NH law that puts protections in place for access to facilities that provide abortion. Those in favor of this repeal present this as a free speech issue for protesters. However, many believe that the law is helping keep those protesters from hostile behaviors that could discourage women from getting care even when pregnancy termination is not the reason for the visit to the facility. There was also a difficult battle over an attempt to add “fetus” to the definition of “another person” in our state homicide laws. By a narrow vote, the Senate replaced the House bill language to change it to “viable fetus” and excluded any pregnancy termination done by or at the request of the woman carrying the fetus. The House did not concur with that change so it ended there.

The nine new Senators include four that are replacing those who voted to maintain current law. It seems clear that three of those replacements will support reproductive rights but there is no information on this issue from the fourth in campaign literature or reporting. Another new Senator replacing a vote on the other side of these issues also does not have a position publicly articulated. Those two are Ruth Ward and Scott McGilvray.  We will need to reach out to them and perhaps to others whose minds can be changed by cogent reasoning on the negative consequences of such proposed changes in our laws. And the new Governor’s attitude to such changes is not a foregone conclusion either even though he has said he is in favor of maintaining reproductive rights.

The likely outcomes in the legislature on many other issues will be even more difficult to ascertain. Having more of our members making themselves available to contact their Representatives and Senators on issues is one important step. Another is to be available to come to the State House and testify on issues where you have expertise or passion for public health solutions. This can be difficult for some since times listed in the legislative calendars for testifying to committees are only accurate for the earliest possible start on a particular bill. But the State House does have open wireless connectivity so it is possible to bring a laptop or tablet and do work while waiting. If you have trouble knowing who represents the place you live, find the links to search by location at www.gencourt.state.nh.us
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An article from the November 2016 issue of the NHPHA e-Newsletter
Submitted by Keryn Bernard-Kriegl, MS, Executive Director, NH Children's Trust


More than 140 people attended NHPHA’s Team Up, Take Action conference last week to build on existing tools and evidence to bolster population health efforts in New Hampshire. I had the pleasure of co-presenting on Adverse Childhood Experiences and Resilience with Linda Douglas, M.S.Ed. from the NH Coalition Against Domestic and Sexual Violence and Dr. Janessa Deleault from Riverbend Community Mental Health, Inc. Although the original Adverse Childhood Experiences (ACE) Study occurred 20 years ago, we are just beginning to implement public health strategies to prevent the occurrence and treat the consequences of toxic stress.

“There are 10 types of childhood trauma measured in the ACE Study. Five are personal — physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Five are related to other family members: a parent who’s an alcoholic, a mother who’s a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment.” http://acestoohigh.com/got-your-ace-score/. There are many other adverse childhood experiences, and some of them are now being studied.

What the original study taught us was that when children experience toxic stress over a period of time, it changes their biology and puts them at risk for a variety of health consequences such as obesity, diabetes, depression, heart disease, stroke, cancer and broken bones. We know that more than half of the population has had at least one adverse childhood experience. We also know that the higher your ACE score, the greater your risk for health consequences.

Adverse Childhood Experiences is a public health issue that requires a public health response. In order to make significant progress in preventing the health consequences of toxic stress, New Hampshire needs strategies in the four social ecological domains. Public policies need to support services to parents battling addiction, mental illness, incarceration, domestic violence and parental abandonment. Communities need to have systems and norms that support health and wellbeing, such as parks and playgrounds, health centers and schools, employers and safety nets. Neighborhoods and families need to build trusting supportive relationships, and individuals need to increase their knowledge and skills to manage their histories and life’s challenges.

It's an exciting time to be working in public health. The “root causes” of so many health problems can be traced back to early childhood experiences. I’d like to invite you to learn more about preventing adverse childhood experiences and building resilience. New Hampshire Children’s Trust is hosting a conference on March 28 entitled: Resilient Communities: The Prevention Connection. More information can be found at http://www.nhchildrenstrust.org/summit2017

In addition, there are several national leaders who have emerged to provide us with ongoing research and educational tools to help our public health system prevent and treat toxic stress. You can learn more about ACES at theses websites:

Robert Wood Johnson Foundation, http://www.rwjf.org/en/library/infographics/the-truth-about-aces.html,

Center for Disease Control and Prevention, http://vetoviolence.cdc.gov/apps/phl/resource_center_infographic.html,

Center for the Developing Child at Harvard, http://developingchild.harvard.edu/science/key-concepts/toxic-stress/,

ACEs too High, https://acestoohigh.com/ , and

ACEs Connection Network, http://www.acesconnection.com/  

Together we can make a difference in the lives of New Hampshire children and families and improve the population health of our state.
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An article from the November 2016 issue of the NHPHA e-Newsletter
Submitted by Christin D"Ovidio, Marketing & Communications Coordinator, Community Health Institute

In celebration of the 39th Great American Smoke Out (GASO), the New Hampshire Department of Health and Human Services (DHHS), Division of Public Health Services (DPHS) began offering nicotine replacement therapy patches, nicotine lozenges, and nicotine gum through (800) QUIT-NOW and www.QuitNowNH.org at no cost to residents who are trying to quit tobacco. Additionally, DPHS re-invigorated their current campaign to raise awareness around the health consequences of exposing children to secondhand smoke. DHHS is encouraging tobacco users to quit for at least one day in the hope that this might challenge them to stop permanently. The secondhand smoke ads carry messaging about protecting kids from secondhand smoke exposure where they live, travel and play, and encourages viewers to not smoke around children and to consider quitting.


“The Great American Smoke Out is a perfect time to consider making a plan to quit tobacco use,” said Marcella Bobinsky, acting Director of the Division of Public Health Services. “NH residents can call 1-800-QUIT-NOW for confidential coaching plus medications to increase their chances for success.”

In 2015, 17.5% of New Hampshire adults reported smoking but almost 65% reported wanting to quit. Ninety-nine percent of New Hampshire adults who smoke report having their first cigarette before the age of 26. Reducing the exposure of children to tobacco smoke is a priority of the Department’s, additionally the Department is concerned with youth and young adult tobacco use initiation, and this includes electronic nicotine delivery systems (ENDS), like e-cigarettes, e-hooka, and vape products. In New Hampshire, it is illegal for youth under the age of 18 to buy or possess any type of tobacco product (including ENDS). Nicotine is addictive and has been shown to affect a young person’s developing brain by preventing normal cell development. It is also illegal for tobacco products to be used on public educational properties. In spite of this, 25 percent of high-school-age youth reported using some type of ENDS, according to the 2015New Hampshire Youth Risk Behavior Surveillance survey.

The New Hampshire Public Health Association (NHPHA) recognizes that tobacco use is a major cause of chronic disease and premature death. Thousands of illnesses and deaths from tobacco use can be prevented and billions of dollars in medical expenses can be saved through longterm investments in a sustained campaign to prevent and control tobacco use. For this reason, NHPHA emphasizes the need to commit Tobacco Settlement Funds and/or dedicated funds to be used to promote programs and policies designed to:

·       Reduce youth access to tobacco products;

·       Decrease the population’s exposure to second hand smoke;

·       Promote quitting among tobacco users;

·       Counter pro-tobacco influences

·       Prioritize efforts to reach vulnerable populations affected by tobacco use

For more information about the New Hampshire Department of Health and Human Services visit www.dhhs.nh.gov. For information about the Great American Smoke Out visit www.cancer.org/healthy/stayawayfromtobacco/greatamericansmokeout/index. If you or someone you know would like free help quitting, visit www.QuitNowNH.org . The campaign runs through March 2017 and the nicotine replacement products are available while supplies last.
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