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The Impact Brief is the official newsletter for the National Association of Chronic Disease Directors. It is distributed monthly to approximately 4,800 NACDD members, partners, and stakeholders. You can view NACDD's Impact Brief archive here:


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State Health Departments Learn to Use GIS to Improve Blood Pressure Medication Adherence

Posted By MaryCatherine Jones, Thursday, April 19, 2018
In February 2018, Idaho, New York, South Dakota, and Wisconsin participated in the 2018 Advanced Thematic GIS Training for State Health Departments: Using Geographic Information Systems (GIS) to Address Blood Pressure Medication Adherence. Two representatives of each health department took part in a 10-day intensive GIS training, which included two days of in-person training at Rice University in Houston, Texas. Georgia, Maine, Michigan, and Vermont will participate in the second cohort in 2018. The training curriculum is tailored to meet the needs of state health departments working on blood pressure medication adherence as part of Domain 3: Healthcare system interventions. As a result of the project, participating states will use GIS to address the unique aspects of blood pressure medication adherence in their communities and follow an Identify-Assess-Act approach to using their maps to inform policies and programs, and to enhance partnerships. Products and lessons learned from the participating state health departments will be shared widely and posted to NACDD’s GIS webpage.

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Building an Evidence-Based Health Department

Posted By Margaret G. Ritchie, Thursday, April 19, 2018
Updated: Thursday, April 19, 2018

Experience has shown that evidence-based public health (EBPH) training gives chronic disease practitioners the tools they need to make decisions based on the best available evidence. Public health practitioners working within health systems studied and developed administrative evidence-based practices (A-EBPs) that can help facilitate the health departments’ roles in supporting the application of evidence-based decision making (i.e. how to become an evidence-based health department). A-EBPs consist of five major domains: workforce development, leadership, organizational culture and climate, relationships and partnerships, and financial processes.

In 2016, the National Association of Chronic Disease Directors (NACDD), and the Centers for Disease Control and Prevention (CDC), in collaboration with the Prevention Research Center at Washington University in St. Louis issued a national survey including a subset of questions on A-EBPs. There were four workforce development questions assessing perceptions of the respondent’s work unit as a whole; 11 leadership questions related to quality of leaders, evidence-based decision making, management, and unit capacity; 10 statements that assessed perceptions of organizational culture and climate; and four questions to assess perceptions of financial transparency, type and structure of funding sources, and economic evaluation.

571 chronic disease practitioners responded to a national survey.

What did we learn?

 • In the leadership category, the highest percentage of respondents agreed with the presence of quality leadership (63%). The items with the lowest percentage of agreement were related to the future workforce in public health. Only 12.4% agreed that their department had a replacement plan for those who retire or move to another job.

• Within the culture and climate construct, 68% of respondents reported working in a department that encourages communication and collaboration. Respondents used a likert scale (from strongly disagree to strongly agree) as to whether their department "adequately represents the cultural needs of the communities in my state." 34% agreed or strongly agreed with the statement. Of all the questions in the climate and culture category, this had the fewest number/ lowest percent who agreed or strongly agreed.

• Within relationships and partners, only two items had agreement percentages less than 50%. Only 30% agreed that their health department collaborates with health plans, and 42% agreed that they collaborate with sectors outside of public health. The vast majority (87%) agreed that partnership development with both health and other sectors is needed to address health issues within their state.

• In the financial practices group of questions, less than one-third agreed that economic evaluation is included in decision making about programs and policies, and only 28% reported that their organization had a variety of stable and flexible funding sources. In addition to the use of evidence-based interventions, administrative best practices can help ensure the quality and sustainability of initiatives within state health departments.

The data from this study can be used to target training and to inform practice in a number of ways. They suggest a need for: 1) succession planning, particularly in light of the aging workforce; 2) continued development of leadership capacity; and 3) stronger collaborations, i,e. more integration of primary care and public health, and more partnering with other sectors outside of health. Enhancing awareness of A-EBPs within public health leadership and highlighting their importance to practice may lead to increased use of these practices.

For more on the findings, read the full article: Eyler, A. A., Valko, C., Ramadas, R., Macchi, M., Fershteyn, Z., & Brownson, R. C. (2017). Administrative Evidence-Based Practices in State Chronic Disease Practitioners. American Journal of Preventive Medicine, 54(2), 275–283. 

 View the assessment tool online.

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NACDD Health Equity Council Continues to Develop Strategies to Address Health Disparities

Posted By Robyn Taylor, Thursday, April 19, 2018

Through the active participation of representatives from state chronic disease programs, NACDD’s Health Equity Council (HEC) has developed tools, resources, and technical assistance for members. The Council continues to host opportunities for public health leaders to discuss, explore, and develop additional resources for state chronic disease directors to effectively address chronic disease disparities and the multi-dimensional issues contributing to disparities experienced by ethnic and racial minorities, people with disabilities, the LGBTQ, rural communities and the poor. Nine statesLouisiana, MassachusettsGeorgiaArkansas, Virginia, MississippiNew HampshireMinnesotaFloridaare working with the NACDD HEC to pilot the recently released, “Moving to Institutional Equity” tool. The objective of the tool is to help users recognize institutional racism by moving through a process to identify potentially racist policies and/or procedures, and then to explore opportunities to facilitate new outcomes. The nine states are analyzing hiring practices and developing health equity policies that will sustain health equity efforts in state chronic disease programs. Additionally, HEC recently was awarded a grant to implement the 2018 Health Equity Virtual conference, which is scheduled for fall 2018. Members are invited to join the Council as it works on these and other projects to develop tools, resources, and training for state chronic disease programs. The HEC meets the second Tuesday of each month at 2:00 p.m. ET. For call details, contact Robyn Taylor at

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CDC DNPAO and NACDD Announce Final Two Webinars on Childhood Obesity

Posted By Leslie Best, Friday, April 13, 2018

The Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity and Obesity and the National Association of Chronic Disease Directors announces the last two webinars in a series on effective strategies to increase utilization of evidence-based healthy weight management programs for children with obesity.


The webinar, “Four Stages of Obesity Care: Translating Expert Committee Guidelines on Childhood Obesity into Practice,” presented by staff from Nationwide Children’s Hospital Center for Healthy Weight and Nutrition, is scheduled for Tuesday, May 1, 2018, at 11 a.m. ET. Registration instructions will be issued in April.


In addition, Denise Wilfley, PhD, the Scott Rudolph University Professor of Psychiatry, Medicine, Pediatrics and Psychology at the Washington University School of Medicine in St. Louis and Samar Muzaffar, MD, MPH, Medical Director for the Missouri HealthNet Program, will present on “Family Based Behavioral Treatment for Obesity: Lessons Learned from Translating 30 Years of Research to Practice,” at 2 p.m. ET on May 16, 2018. Registration instructions will be issued in April.


This webinar series has created peer-to-peer learning opportunities to facilitate information sharing among state health departments, public health practitioners, healthcare providers, clinician researchers, community organizations, and others seeking to develop sustainability plans, monitor success, share lessons learned, and explore the role of nontraditional partners in this emerging issue in pediatric public health.  View the rest of the series’ archived webinars online.

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Medicaid Coverage for the National DPP Demonstration Project to Conclude in 2018

Posted By Wendy Childers, Friday, April 13, 2018

The Medicaid Coverage for the National Diabetes Prevention Program (National DPP) demonstration project has been ongoing for approximately the last three years and will conclude in late 2018. The National Association of Chronic Disease Directors (NACDD), with funding from the Centers for Disease Control and Prevention (CDC), has been working with two demonstration states (Maryland and Oregon) to develop and test models for implementing and delivering a sustainable coverage model for the DPP in Medicaid. The two states are working with managed care organizations (Maryland), coordinated care Organizations (Oregon), and CDC-recognized organizations to build contracting mechanisms, billing and coding guidance, and reimbursement models. The states also are developing and testing strategies to enroll, engage, and retain Medicaid beneficiaries in the National DPP lifestyle change program. Nearly 1,000 Medicaid beneficiaries have been enrolled in the program between the two states.

In addition, in collaboration with Leavitt Partners, NACDD launched the National DPP Coverage Toolkit in June 2017 to provide information about the mechanics of covering the National DPP lifestyle change program. The audience for this toolkit includes state public health officials, Medicaid, Medicaid MCOs, commercial plans, and Medicare. The toolkit’s URL recently was updated to; if you have visited the site previously, please clear your cache and bookmark the new site. NACDD also is working with RTI International to conduct a robust evaluation of the project, collecting data on participant satisfaction and outcomes, program structure, implementation, and cost. Data collection will continue through June 2018, and full evaluation results will be available in October 2018.

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Moving the Dial on Pediatric Obesity Services Payments: A Minnesota Statewide Partnership Example

Posted By Leslie Best, Wednesday, March 14, 2018

This third webinar, out of five, will illustrate how Minnesota collaborated with diverse partners to develop the Minnesota Partnership for Pediatric Obesity Care and Coverage (MPPOCC), which works to promote the delivery of payment for best practices in pediatric obesity care. MPPOCC is led by the Minnesota Council of Health Plans and the Minnesota Chapter of the American Academy of Pediatrics. The council’s members include clinicians, health plans, state-level health and human services departments, local public health and community-based service providers. The partnership formed in 2012 and has successfully promoted best practices messaging, clarified coverage for clinic-based services, and developed and tested models with Community Health Workers (CHWs) delivering intensive community-based behavioral interventions for kids and families. The state of Minnesota has Medicaid coverage for CHW services--MPPOCC promotes the CHW model as a sustainable service delivery method to reach children and families most at-risk. The partnership is financially support by the MN Statewide Health Improvement Partnership, and regularly convenes its Steering Committee, Learning Collaborative, and full membership.

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First-Ever Summit Highlights Diabetes Prevention Progress in 30 States

Posted By Trina Thompson, Wednesday, March 14, 2018

The National Association of Chronic Disease Directors (NACDD) designed and facilitated a two-day summit to share and celebrate the success of states working to prevent type 2 diabetes by expanding the uptake of the evidence-based National Diabetes Prevention Program. The summit, held in Atlanta from Feb. 21-22, focused on the collective impact of state health departments working with their partners to achieve priorities developed by each state. Since 2012, NACDD assisted 30 state health departments to build strategic partnerships and host a statewide meeting to engage their stakeholders to develop and implement a diabetes prevention action plan. Dr. Ann Albright, Director of the CDC’s Division of Diabetes Translation, spoke at the summit and stressed the unprecedented accomplishments of the National DPP and CDC’s continued support. NACDD extends special thanks to states and their partners for submitting 41 outcome briefs which summarized their successes to date and helped shape the summit agenda. The summit included a peer-to-peer session to collect successful strategies, new tools and ideas, details on troubleshooting problems, and technical assistance needs. A summary report is being developed to highlight state actions and outcomes, reveal insights, and demonstrate the collective impact of this work.

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NACDD is Gearing Up for its 4th Annual Walkability Action Institute

Posted By Karma Harris, Wednesday, March 14, 2018

For the last three years, the National Association of Chronic Disease Directors (NACDD) has been doing its part to support the US Surgeon General’s “Call to Action to Promote Walking and Walkable Communities” through the implementation of a multi-day action Walkability Action Institute (WAI) for interdisciplinary state and regional teams. To create healthy and active states, regions, and communities, and multiple disciplines must work together toward active community design by combining individual resources and expertise.

Through a competitive funding process previously, NACDD provided travel assistance to 32 interdisciplinary teams representing public health, transportation, planning, and elected officials as required team members. In recent months, NACDD has selected nine additional interdisciplinary regional teams—totaling 41 teams—to participate in this year’s action institute project. These teams will participate in far more than just a course; they also have committed to participating in pre- and post-course webinars, development and implementation of team action plans, and progress reporting and community of practice activities following course participation.

With funding support provided by the CDC Division of Nutrition, Physical Activity, and Obesity (DNPAO), NACDD will host this year’s course in the city of Decatur from April 9 – 12, 2018. The city of Decatur is a small town in the Atlanta area that has implemented some of the biggest built environment improvements during the last two decades to make active transportation through walking and biking a priority. Decatur’s real-life examples, coupled with visible infrastructure improvement projects in progress, make this location ideal for teaching others around the country about how important it is to make improvements to active transportation.

Participant teams will be guided through the four-day action institute by Lead Course Director Mark Fenton. Mr. Fenton is a national community and transportation design expert who assists NACDD and its Course Steering Committee with all content development for the course. Past participants view Mr. Fenton as “fun, enthusiastic, and inspiring!” NACDD is grateful for Mr. Fenton’s participation and leadership.

Additionally, a diverse course faculty team will help Mr. Fenton and NACDD throughout the four days in the form of expert presentations, large group facilitation, roundtable topic discussions, and team action planning assistance. The faculty team will serve as leaders in outdoor walk audit and scavenger hunt activities, which focus on aspects of the built environment that promote or hinder active transportation. Course participants will have full access to faculty members, and will be able to sign up for individual faculty consultations throughout the course. This year’s team includes the following experts:

1.     Phil Bors, Active Living By Design;

2.     Charles Brown, Edwards J. Bloustein School of Planning and Public Policy Rutgers University

3.     Ian Lockwood, Toole Design Group;

4.     Leslie Meehan, Tennessee Department of Health;

5.     Hugh Morris, National Realtors Association;

6.     Amy Rauworth, National Center for Health, Physical Activity, and Disability/Lakeshore Foundation; and

7.     Ian Thomas, America Walks.

 NACDD extends its greatest appreciation the CDC DNPAO, members of the Course Steering Committee (Active Living By Design, America Walks, Mark Fenton, and CDC DNPAO), and members of the course faculty team for their efforts at making this year’s WAI the best yet!

 For more information on NACDD’s Walkability efforts, please contact Karma Harris at

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NACDD Arthritis Program Connects with More than 17,000 Practicing and Future Physical Therapists at the 2018 APTA Combined Sections Meeting

Posted By Heather Murphy and Natasha McCoy, Wednesday, March 14, 2018

The National Association of Chronic Disease Directors’ (NACDD) Arthritis Initiative is in year two of a five-year collaborative project working with physical therapists (PTs) nationwide to increase awareness, enrollment, and completion rates for the Walk With Ease (WWE) Self-Directed intervention. As part of continued efforts to recruit PTs, Natasha McCoy, NACDD Senior Public Health Consultant, staffed a NACDD exhibit booth at the American Physical Therapy Association’s (APTA) Combined Sections Meeting, held Feb. 21-24, 2018, in New Orleans, Louisiana. McCoy showcased materials from the Arthritis Physical Therapist Marketing project, a former NACDD effort coordinated with CDC Arthritis and partners, in addition to promoting the $4,000 grant opportunity for APTA state chapters and PT clinics. The APTA Marketing project concluded with development of a toolkit of materials, specifically for physical therapists and their patients, addressing six arthritis appropriate evidence-based interventions showing proven ability to help reduce the burden of arthritis. This year’s APTA Combined Sections Meeting planners celebrated an attendance of more than 17,000 PTs, PT assistants, and PT students. As described by CDC, the WWE intervention was developed by the University of North Carolina for the Arthritis Foundation as a way to encourage people with arthritis to start walking and stay motivated to keep active. WWE helps people learn to walk safely and develop the habit of walking regularly. While walking is the central activity, WWE is a multi-component program that includes health education, strengthening and stretching exercises, and motivational strategies. The WWE group class is offered throughout the United States and is moderated by certified instructors. The WWE self-guided format offers similar instruction through guidebook available for purchase online on the Arthritis Foundation webpage. WWE is best suited for people with arthritis who want to increase their physical activity levels, and are able to stand on their feet for at least 10 minutes without increased pain. The program may also be appropriate for people with other chronic conditions—such as diabetes and heart disease—who want to be more active. Program participants can include current and past patients who would benefit from a walking program. More information about WWE and self-directed support tools are available online. For more information about the WWE Mini-Grant Opportunity for Physical Therapists, please contact Natasha McCoy at

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Practitioners Can Attend GEAR:UP to Learn More About Chronic Disease Prevention and Health Promotion

Posted By Jeanne Alongi, Wednesday, March 14, 2018

The National Association of Chronic Disease Directors’ Public Health Leadership & Practice is proud to sponsor GEAR:UP (Understanding Publications), a journal club for chronic disease prevention and health promotion. Practitioners interested in learning more about leadership and management best practices, and how the practices might be applied to our work in public health will benefit from the club. GEAR:UP is held every third Thursday of the month at 3 p.m. ET. Articles and podcasts for discussion are selected from the peer-reviewed literature such as Preventing Chronic Disease and the American Journal of Public Health, and mainstream media such as the Harvard Business Review. For information how to participate, contact Tamara Engel at

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