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Impact Briefs
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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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Top tags: Arthritis  Health Promotion  Walk with Ease 

NACDD Supports the Health of our Military

Posted By Catherine McCann, Friday, November 30, 2018

A recent report to Congress by the Community Preventive Services Task Force (CPSTF) on military readiness and resilience estimated that seven in 10 young people would not qualify for military service due to unhealthy weight and other factors. Additionally, obesity, tobacco use, and alcohol abuse pose a significant challenge to the health of current service members. While there is considerable investment in healthcare, programs, and services for active duty service members residing on military bases, the Department of Defense (DoD) recognizes the need for increased support for service members who do not reside on military installations and for those in the Reserve forces and National Guard. Many of these service members rely on community supports and programs to help meet their health and economic needs.

Earlier this year, DoD launched a pilot project to help them better understand the resource challenges affecting the health, readiness, and resiliency of its population. The pilot, Building Healthy Military Communities (BHMC) is taking place in seven states: Florida, Indiana, Oklahoma, Maryland, Minnesota, Mississippi, and New Mexico. DoD has conducted rapid needs assessments in these states and are in the process of finalizing action plans to meet the top needs identified by the assessments.

The Centers for Disease Control and Prevention (CDC) and the National Association of Chronic Disease Directors (NACDD) understand the importance of this work and have partnered together with DoD to help them connect their work to chronic disease programs in the pilot states. Through this partnership, CDC and the Association have been able educate high-level military personnel on upstream, evidence-based interventions for physical activity, nutrition, and tobacco cessation and prevention. This pilot represents the first time that DoD has invested in a coordinated public health approach across the uniformed branches. If successful, it could pave the way to increased funding for more upstream policy, systems, and environmental approaches to health and wellbeing in military communities across the nation.

For more information, contact Catherine McCann.

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Cancer Prevention Across the Lifespan

Posted By Leslie Best, Friday, November 30, 2018

The Cancer Prevention Across the Lifespan project will develop innovative resources to empower public health practitioners and community leaders to implement evidence-based strategies to reduce cancer risk in their communities by making it easier for people to reduce exposure to carcinogens and adopt healthy behaviors where they live, work, learn, and play.

This project builds upon past work of the CDC Cancer Prevention and Control’s Cancer Prevention Across the Lifespan Workgroup (CPAL), which included collaboration with NACDD to conduct literature reviews and convene meetings of experts to identify factors that influence cancer risk and promising strategies to address these risks throughout the lifespan.

The first year of this project is focused on four key focus areas: calculating and communicating cancer risk; avoiding unnecessary exposure to radiation in cases of pediatric mild traumatic brain injury; physical inactivity; and caregiver stress. NACDD is collaborating with CPAL to identify experts in each of these fields and convene small, in-person meetings on each of the four focus areas to discuss the risk factor, identify gaps in existing resources, and develop innovative yet practical resources to fill the identified gaps. Plans to disseminate and evaluate these new resources are also key deliverables this first year. The evaluation plan will be continuously modified throughout the five-year grant period.

NACDD members should expect a series of webinars in 2019 that will share promising practices to address the risks in each focus area, which will be archived on the NACDD website, along with resources and information related to lifetime cancer risk reduction.

For more information, contact Leslie Best.

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NACDD Supports Efforts to Increase Awareness and Participation in the Arthritis Foundation’s Walk With Ease Self-Directed and Group Interventions

Posted By Paige Rohe, Tuesday, October 16, 2018

As one of the national awardees for the CDC Arthritis Program’s “National Advancing Arthritis Public Health Approaches through National Organizations” cooperative agreement, NACDD continues to work with partners and subcontractors to increase awareness and participation in arthritis-appropriate, evidence-based interventions. Main components include working to increase access to arthritis self-management interventions in worksites and physical activity interventions through the Walk With Ease Self-Directed Funding Support Opportunity. As of September 29, 2018, NACDD has provided mini grants to the following recipients: 

 American Physical Therapy Association Affiliate Chapters

 Hospitals (Wellness Center)

 Physical Therapy Clinics

 During NACDD’s last five-year cooperative agreement with the CDC Arthritis Program and working in partnership with Westat, Inc., the CDC Arthritis Program and NACDD surveyed 841 physical therapists and learned physical therapists are willing to recommend arthritis-appropriate, evidence-based programs in the community either during therapy and at discharge. CDC, NACDD and the American Physical Therapy Association, American Chronic Pain Association and Westat, Inc. used responses to creation of a toolkit of informational flyers and decision aids now available online at and

The Toolkit includes an overview fact sheet presenting the value for arthritis-appropriate, evidence-based programs, six program fact sheets designed to provide information of importance to physical therapists, six program fact sheets PTs can distribute to patients, and a decision aid PTs can use to find an appropriate intervention to refer to patients. The toolkit is free for use by anyone interested in increasing awareness and participation in the identified interventions.

 According to CDC, arthritis remains as one of the nation’s most common causes of disability. As a significant public health issue, NACDD continues efforts to provide technical support, funding and connections enabling parties interested in working to connect adults to arthritis-appropriate interventions and help improve the quality of life for people living with arthritis or limited mobility.    

 For more information about the NACDD Arthritis programs, contact Heather Murphy NACDD Arthritis Lead. 





Tags:  Arthritis  Health Promotion  Walk with Ease 

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Pilot States Use the Institutional Equity Tool to Examine Organizational Policies

Posted By Robyn Taylor, Friday, September 21, 2018

The Moving to Institutional Equity: A Tool to Address Racial Equity for Public Health Practitioners was developed by NACDD’s Health Equity Council to identify policies that have resulted in unintended or negative socio-economic and health outcomes for women and minorities. The tool takes users through four worksheets designed to guide user in:

·      assessing if the policy or procedure is written and implemented in a way that is inclusive and allows for diversity;

 ·      determining if and where there are opportunities/decision points to ensure the policy or procedure is inclusive and promotes diversity, thereby avoiding structural inequalities;

·      identifying action steps to modify the policy or procedure and to implement new steps to ensure diversity and inclusion; and

·      vetting the plan/policy with an Equity Crosscheck.


A recent pilot of the institutional equity tool among participating states resulted in states analyzing organizational health equity policies, developing organizational health equity training modules, revising hiring and promotion policies, and applying the tool to program planning and assessment procedures. For more information about the Moving to Institutional Equity tool, please contact Louise Square or Robyn Taylor.

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USAPI Continues to Build Capacity to Prevent Type 2 Diabetes

Posted By Gwendolyn Hosey, Friday, September 21, 2018

The U.S. Affiliated Pacific Islands (USAPI) continue to build capacity for an integrated primary care-level response to address the region’s increased non-communicable disease (NCD) rates, particularly complications of type 2 diabetes. In 2018, 11 multidisciplinary teams, representing healthcare systems across the region, now participate in the culturally relevant Pacific NCD Collaborative. The Pacific NCD Collaborative, established in 2011, is built on a participatory process that promotes co-learning and facilitates collaborative and equitable partnerships, building the skills and strengths of local leadership responsible for health.

Using the Pacific Care Model (PCM), patterned after the HRSA Health Disparities Collaborative Model, teams work to improve healthcare quality and outcomes by incorporating information technology, evidence-based disease management, organizational change best practices, and self-management support - strengthened by community resources. NCD Collaborative teams at the June 2018 Collaborative Learning Sessions reported the expansion of registries of patients with diabetes (including individuals lost to follow-up and previously undiagnosed) and progress in improving evidence-based preventive practices. Extension of partnerships also continue to shore up outreach and expansion of the PCM. For example, in partnership with HRSA's National Hansen’s Disease Program, a train-the-trainer model honed skills for 12 USAPI healthcare professionals working to prevent lower extremity amputations in their communities.

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"Videos and Virtual Reality: NACDD Works with CDC and Partners to Develop Innovative Tools for Communicating Cancer Prevention and Control Information"

Posted By Frank Bright and Natasha McCoy, Friday, September 21, 2018

As reported by CDC, cancer is the second leading cause of death in the United States. One out of every in four deaths in the US is attributed to cancer. Breast cancer was the primary form of cancer diagnosed among all women in 2015 at a rate of 124.8 per 100,000 cases, and breast cancer was the second most common form among all cancer deaths at a rate of 20.3 per 100,000 (preceded by lung and bronchus cancer). In this same year, cancers of the colon and rectum were the fourth leading cancer diagnosis at a rate of 38 per 100,000 people and the fourth most common cancer death among males and females at a rate of 14 per 100,000 people. 

Colorectal cancer is the only preventable form of cancer, yet only 67% of adults ages 50 to 75 are up-to-date with colorectal cancer screening (CDC DCPC, 2018). reports approximately 10-20% of all diagnosed breast cancer cases are triple-negative. Triple Negative Breast Cancer (TNBC) is a condition in which the breast cancer cells test negative for estrogen receptors, progesterone receptors and HER2 in the pathology report. In such cases, the patient’s cancer does not respond to common hormonal therapy or medicines targeting the HER2 receptors as no such receptors exist. 

The NACDD Innovative Communication in Cancer Prevention and Control project, funded by the CDC Division for Cancer Prevention and Control (DCPC) and financed through the CDC Center for State, Tribal, Local and Territorial Support, served to create innovative ways to communicate complex cancer prevention and treatment information to individuals who need to make a decision about their healthcare. According to CDC DCPC, if individuals understood the advantages and disadvantages of treatment or screening options, they would be better informed when making key decisions about their healthcare leading to best possible health outcomes at the individual and population level.

The project served to accomplish two goals: develop innovative communication encouraging age-eligible men and women to complete screening for colorectal cancer and to identify an innovative way to communicate treatment information to women diagnosed with Triple Negative Breast Cancer. 

Working with Lisa C. Richardson, MD, MPH, Director of CDC's Division of Cancer Prevention and Control and representatives from the Northside Hospital Cancer Institute in Atlanta, Ga., the project team completed the following:

- Literature review of communication practices completed by Westat, Inc.

- Working with Kognito, a virtual reality (VR) simulation company, the team created a new VR simulation, “Talk to Someone: Triple Negative Breast Cancer.” The simulation features Linda, a virtual triple negative breast cancer survivor, who is programmed to navigate users through a series of questions and responses addressing TNBC diagnosis and treatment. The simulation is powered by Kognito’s proprietary simulation platform and methodology. The project team received valuable insight from NHCI and many volunteer contributors, including Dr. Jeff Giguere, Director and Senior Medical Oncologist, Greenville Hospital System Cancer Institute Research, in Greenville, SC.

- Working with CBS Health Solutions and Health Media Network, NACDD created four public service announcements featuring former Good Morning America host and triple negative breast cancer survivor Joan Lunden. Two PSAs urged age-eligible adults to complete appropriate screening for colorectal cancer and two PSAs urging women diagnosed with TNBC to remain engaged in their treatment process and follow appropriate treatment. 

The colorectal cancer screening and triple negative breast cancer public service announcement videos and TNBC breast cancer virtual reality simulation can be accessed
online on the CDC’s website. The “Talk to Someone” virtual reality simulation is also available in the form of a mobile application. The mobile “Talk to Someone” app can be downloaded using Android and Apple IOS devices. 



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NACDD Report Shows National DPP Collective Impact of 35 States and National Partners

Posted By Administration, Friday, September 21, 2018

To coordinate national efforts to prevent type 2 diabetes, NACDD and CDC worked together to develop an engagement model for State Health Departments to support their expansion of the National Diabetes Prevention Program. Since 2012, with support from CDC’s Division of Diabetes Translation, NACDD has provided customized guidance to 35 states to help them galvanize partners to support and implement a statewide type 2 diabetes prevention plan.

NACDD is pleased to share the National Diabetes Prevention Program, State Engagement Model Collective Impact Report, which focuses on the vision to maximize collective impact by coordinating actions of many multi-sector organizations. NACDD gathered information from State Health Departments, their stakeholders, and national partners to describe efforts to expand the National Diabetes Prevention Program through four areas: 1) Awareness; 2) Availability; 3) Screening, Testing, and Referrals; and 4) Coverage. This report highlights successes, including impressive increases in licensed provider awareness about the National DPP lifestyle change program, organizations obtaining CDC recognition, employers covering the program and more. NACDD continues to apply the NACDD/CDC State Engagement Model and provide technical assistance. For more information contact Trina Thompson.

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Standardization of Laboratory Tests for Chronic Disease

Posted By Leslie Best, Friday, September 21, 2018

The NACDD, CDC, The Endocrine Society, and the Partnership for the Accurate Testing of Hormones (PATH) are collaborating in an effort to promote the standardization of laboratory tests for chronic diseases. As part of this effort, a previous brochure explaining the impact of standardization on the diagnosis, treatment and prevention of cardiovascular disease has been revised to address all chronic diseases. Read the new brochure.

Download File (PDF)

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Final Report, Action Steps Available for "Advancing Team-Based Care through the Use of Collaborative Practice Agreements and Using the Pharmacists’ Patient Care Process to Manage High Blood Pressure."

Posted By Julia Schneider, Monday, August 20, 2018

NACDD and CDC’s Division for Heart Disease and Stroke Prevention worked with seven state teams on a learning program designed to accelerate team-based care using the pharmacists’ patient care process and collaborative practice agreements designed to manage high blood pressure. 

 To kick off the project, State Health Departments and their pharmacy partners attended a two-day workshop to develop a project plan and timeline for disseminating and supporting pharmacists with implementing the PPCP. State Health Departments partnered with their state pharmacy association, school of pharmacy and other healthcare partners to host and facilitate in-state trainings over the year. 

We have several new resources that have been developed as a result of this project. The final, in-depth summary report, including state-specific actions, is now available on the CVH website, in addition to a companion piece which focuses on the action steps and considerations for those looking to implement team-based care.

A presentation on this project will be held at the Annual Public Health Association Meeting, scheduled for session 3387.0, Collaborations, Linkages, and Teams in Pharmacy Practice on Monday, November 12, 2018 at 3 p.m. 

Success stories from each state can be found on the NACDD What’s Working Database at

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What Do We Know About Scaling Up Evidence-Based Public Health Training?

Posted By Carol Brownson, Monday, August 20, 2018

Evidence-based public health (EBPH) training has been shown to improve the knowledge and skills of public health practitioners. However, training opportunities are often limited. EBPH train-the-trainer courses were initiated in 2010 to build states’ capacity to train additional staff by replicating the course using local trainers. NACDD and the Prevention Research Center in St. Louis interviewed EBPH training coordinators in eight states to learn about course delivery formats and get their perspectives on barriers and success factors for course replication. 

Locally-offered courses were often tailored to include state-specific cases and data. In the sites interviewed, EBPH training was also delivered in a variety of formats – in person, distance, and blended versions that included some web-based and some live learning sessions. The training coordinators reported advantages and disadvantages to the different formats. For example, in-person formats provided opportunities for focused learning and interaction with colleagues and trainers, while fully distant courses afforded greater reach, lower travel costs and flexibility in timing for course completion. Blended courses shared some of the advantages and disadvantages of in-person and distance courses. 

Success factors for replication reported by these sites included having skilled coordinators and trainers; organizational incentives; leadership support; adequate funding; collaborators (e.g., schools of public health, public health training centers, area health education centers); the infrastructure to support training; and existing models and materials. Some of the challenges to continuing the course included staff/trainer turnover; lack of dedicated staff/trainer time for replication; lack of stable funding; and finding qualified and willing trainers.

Lessons learned from states that have been able to continue training their colleagues and partners can serve as a guide to other states committed to building and sustaining capacity for evidence-based public health practice. They may also apply more generally to other workforce development efforts. 

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