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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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January CEO Message

Posted By Administration, Tuesday, January 28, 2020
Updated: Thursday, January 23, 2020
Earlier this month, we hosted our fourth annual Public Health Success Showcase, “Elevating Public Health to Social Health – Establishing Multisectoral Partnerships to Impact the Root Causes of Chronic Disease.” 
The event included a poster session featuring more than 60 projects from NACDD’s program portfolio and a live-streamed Fireside Chat with Dr. Karen Hacker, Director of CDC’s National Center for Chronic Disease Prevention and Health Promotion; Gov. Mike Leavitt, Founder of Leavitt Partners, former Secretary of Health and Human Services and former Governor of Utah; NACDD Board President Monica Morales, the Deputy Director for the Center for Healthy Communities at the California Department of Public Health; and Susan Winckler, President of Leavitt Partners Solutions, who served as moderator. 
This Showcase’s topic is especially important, because as this country continues to struggle with improving population health—from sedentary behavior, to less nutritious foods, to vaping—we also face challenges and inequalities in housing, transportation, education, and wages. 
The panel shared insights on how local and federal government can work together in the new era of value-based care to respond to the needs of our communities, and our poster session demonstrated the continuing, critical work being accomplished at the state and territorial level to create healthier communities.
Through our growing body of hundreds of projects, we are intensifying our reach and our impact, with military communities, an Obesity Prevention summit, and multiple thought-leader roundtables around forward-thinking topics. 
We also are using data like never before. We have new projects and new partners that have catapulted our ability to collect and leverage data to speed, track, and evaluate change. [Read Gov. Leavitt’s article “Examining Data and Value-Based Care” in our Insights magazine].
This expanded work is powered by deep partnerships at the state and federal level, across government agencies, and within industries, to implement effective strategies that improve the health of the public.
As Gov. Leavitt is fond of saying, “This is public health’s moment”— and at NACDD, we couldn’t agree more. 

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Trump Administration Vaping Ban

Posted By Administration, Tuesday, January 28, 2020
Updated: Sunday, January 26, 2020

On January 2, 2020, the Trump Administration announced a partial ban on flavored e-cigarettes. The ban applies to flavored e-cigarettes that use cartridges but does not include “open tank e-cigarettes” that are often sold in vape shops. The ban also exempts menthol and tobacco flavored products.

The ban falls short of earlier signals from the administration that indicated the Department of Health and Human Services would ban all flavors, except tobacco. The Trump Administration has said that the ban was scaled back due to concerns about job losses and other negative effects that a total ban might have on the vaping industry. In addition, administration officials have justified continuing to allow menthol products because research has shown that while mint flavored products are very popular with youth users, menthol products are not. Public health experts have expressed concerns that if menthol products continue to stay on the market youth e-cigarette users will substitute menthol products once the popular mint-flavored pods are no longer available.

After the announcement, NACDD put out a statement calling for stronger action by the Food and Drug Administration and a full ban on flavored e-cigarettes.

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FY 20 Appropriations Update

Posted By Administration, Tuesday, January 28, 2020
Updated: Sunday, January 26, 2020

The fiscal year 2020 (FY20) federal funding agreement was signed into law on December 20, 2019 and provides funding for the government through September 30, 2020. The agreement comes after months of negotiations and two continuing resolutions that pushed the appropriations process well passed the October 1, 2019 deadline.

The funding agreement includes an overall 8.7% increase for the Centers for Disease Control and Prevention (CDC). To address chronic disease, the bill includes increases for:

·      Alzheimer’s

·      Breast and cervical cancer

·      Heart disease and stroke prevention

·      National Diabetes Prevention Program

·      Oral health

·      Tobacco control


The deal also includes a provision that increases the legal age to purchase tobacco products, including e-cigarettes, to 21.

The FY21 process will kick-off when President Trump submits his budget to Congress. The Trump Administration has announced the budget will be submitted by February 10, 2020. After Congress receives the President’s budget, work will begin on crafting a congressional budget and eventually appropriations legislation that will provide funding for FY21.

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Integrating Alzheimer’s’ Messages into Chronic Disease Programs

Posted By Leslie Best, Thursday, January 23, 2020

The Alzheimer’s Disease and Healthy Aging Program at the Centers for Disease Control and Prevention (CDC) hosts the Healthy Brain Initiative (HBI). HBI provides data, information, and education to promote brain health, including information on Alzheimer’s disease and related dementias. Alzheimer’s disease is currently the fifth leading cause of death for persons over the age of 65. HBI applies principles, strategies, and expertise to promote public health actions related to brain health, Alzheimer’s disease, and caregiving. This work is guided by The Healthy Brain Initiative State and Local Public Health Partnerships to Address Dementia, The 2018-2023 Road Map.

NACDD is working in partnership with CDC to develop integrated messaging about brain health by adapting existing chronic disease risk reduction messages. This includes information about how behaviors related to these topics can also reduce the risk for cognitive decline. This purpose is consistent with the call to action in the most recent version of the Healthy Brain Initiative Roadmap, which is to integrate best available evidence about brain health and cognitive decline risk factors into existing health communications that promote health and chronic disease management for people across the lifespan.

This project focuses on integrating messages in five focus areas:

·      Heart health

·      Diabetes

·      Tobacco

·      Nutrition

·      Physical activity

NACDD and CDC have collaborated to identify subject matter experts in the field of Alzheimer’s disease and health communications to provide input and guidance on risk reduction messages that include information about brain health.

Alzheimer’s disease and related dementias have both social and economic impacts. According to the Alzheimer’s Association, 5.8 million Americans are living with Alzheimer’s Disease; by 2050 this number is expected to increase to 14 million. In 2019, Alzheimer’s and other dementias will cost the US $290 billion; these costs could reach $1.1 trillion by 2050.

NACDD and CDC together developed the State of Aging and Health in America Data Brief, Subjective Cognitive Decline: A Public Health Issue. This brief analyzed data from the Behavioral Risk Factor Surveillance System on the self-reported worsening or more frequent confusion or memory problems — known as subjective cognitive decline (SCD) — in adults 45 years of age and older from 2015–2017. These data showed that the prevalence of SCD is 11.1%, or 1 in 9 adults. The prevalence of SCD among adults aged 65 years and older is 11.7% compared to 10.8% among adults 45–64 years of age. The prevalence of SCD differs among racial/ethnic groups: 10.9% of non-Hispanic white adults reported SCD compared to 12.8% of black adults, and 11.0% of Hispanics, and 6.7% of Asians and Pacific Islanders.  Lower prevalence of SCD is reported in adults with more years of formal education.

For more information, visit the NACDD Healthy Aging website To learn more about the CDC Healthy Brain Initiative, visit

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NACDD Continues to Ramp Up its Work in Oral Health

Posted By Barbara Park, Thursday, January 23, 2020

On Dec. 16, 2019, NACDD held its first Community of Practice webinar with the five states (CO, CT, ND, SC and VA) that are being funded by CDC’s Division of Oral Health to implement medical-dental integration projects focusing on diabetes prevention and control, hypertension awareness and early detection, and tobacco use prevention. The webinar focused on evaluation successes, challenges, and anticipated technical assistance needs.

Future webinars will be held quarterly and will feature topics such as communication challenges between dental and medical electronic health records, practice management agreements, clinical workflow redesign examples, and examples of integrated medical and dental services in health systems/settings. In January 2020, NACDD presented a poster at its annual Showcase event on oral health and chronic disease.

NACDD has been invited by the South Carolina Department of Health & Environmental Control to present at their annual Chronic Disease Prevention Symposium in Myrtle Beach, SC, in March 2020. This concurrent session is titled “Could Your Patient’s Teeth be Affecting their Health? Let’s Talk About It!” In April 2020, NACDD will present a Roundtable at the National Oral Health Conference in San Diego, Calif., on medical-dental integration that will feature the work being conducted by the states that are being funded by CDC. Finally, NACDD received notice of a grant award from the North Dakota Department of Health to assist in planning and conducting an Oral Health State Engagement Meeting (StEM) that will take place this summer in Bismarck, ND. The oral health StEM will be modeled after the successful diabetes prevention StEMs that NACDD has helped states conduct since 2012.

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Recognizing and Reducing Caregiver Stress: Opportunities for Cancer Prevention

Posted By Administration, Monday, November 25, 2019

Cancer Prevention Across the Lifespan 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. More information about the previous work of the CPAL workgroup is available on the CDC website

This year the core focus areas are Caregiver Stress and Environmental Health.

NACDD has analyzed caregiving data collected from community-dwelling adults 45 years of age and older in 2015- 2017 through the Behavioral Risk Factor Surveillance System, administered as part of the Caregiver Optional Module in 44 states, the District of
Columbia and Puerto Rico. According to Caregiving for Family and Friends, A Public Health Issue Brief compiled by NACDD, based upon the BRFSS data, caregiving can be emotionally and physically demanding.
• Over half (53%) of caregivers indicated that a decline in their health compromises their ability to provide care.
• 14.5% of caregivers reported experiencing 14 or more mentally unhealthy days in the past month.
• 17.6% of caregivers reported experiencing 14 or more physically unhealthy days in the past month.
• 40.7% of caregivers report having two or more chronic diseases.
• 53.4% of caregivers aged 65 years and older have two or more chronic diseases compared to 34.8%
The complete Issue Brief may be viewed here.

NACDD and CDC have collaborated to identify six subject matter experts in the field of caregiving to gather on November 21, 2019 at NACDD Headquarters to review data and findings from peer reviewed journals and their own policy and practice experience to discuss opportunities for cancer prevention for the caregiver. We anticipate convening a webinar on the environmental health topic in early 2020. 

Learn more at .

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NACDD Supports West Virginia and Virginia in efforts to advance Upstream Factors

Posted By Administration, Monday, November 25, 2019

West Virginia and Virginia both participated in a State Engagement Model (StEM) meeting in October to support and enhance efforts in their respective states to advance healthy living and continue to build on previously developed physical activity and nutrition program efforts. 

Through the State Engagement Model, participants from each state’s chronic disease programs—Jessica Wright, RN, MPH, CHES, the director for the Division of Health Promotion and Chronic Disease  in the West Virginia Bureau for Public Health and Melicent Miller, MSPH, Health Improvement Supervisor for the Virginia Department of Health—convened members of their departments and other state partners to plan and implement the StEM meetings. 

Working toward a collective impact process, the state teams were provided with support to assist them in implementing a strategic approach to connect state and local partners on the selected state priority.  In West Virginia, partners worked to develop a shared action plan to promote a state recognition program for healthy communities.  Virginia stakeholders worked to further advance and provide a technical assistance and a supportive environment for active transportation.  

The meetings opened with presentations by national leaders from the Centers for Disease Control and Prevention’s Division of Nutrition, Physical Activity, and Obesity as well as leaders in Active Transportation. The state leaders provided an overview of the local landscape before participants moved into smaller work groups to engage in a deeper conversation to develop the action plans. 

NACDD is  providing technical support to implement the action plan over the coming months.

Tags:  StEM 

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October CEO Message: Working Together to Conquer Cancer

Posted By Administration, Tuesday, October 29, 2019
As Breast Cancer Awareness Month winds down, I wanted to share with you all the many ways we are working actively with our partners to conquer breast, cervical, and colorectal cancer as well as promote state and territorial capacity to address cancer more broadly in our communities. Our extensive cancer portfolio includes projects that range from monitoring the impact of changes in the healthcare system to looking into more effective communications for cancer patients post diagnosis. 
NACDD is working with CDC across the spectrum of cancer prevention and control, from hosting a thought leaders roundtable on FIT test colon screening to helping patients understand treatment options by way of computer-simulated conversations, to helping survivors understand their need for healthy behaviors following treatment. NACDD has also partnered with six states to convene health systems, payers, and providers to find profitable paths to screening. (Listen to a podcast about our partnership with Kognito in creating a conversational platform with virtual humans).
We recently hosted the Comprehensive Cancer Control National Partnership’s semi-annual meeting at our headquarters, including Dr. Lisa Richardson, Director of the CDC Division of Cancer Prevention and Control, Dr. Karen Hacker, Director of  CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), and NACDD Member Leah Merchant, Section Supervisor of the Cancer Control Programs at the Montana Department of Health and Human Services to discuss emerging trends and issues.
This past summer, NACDD was honored to host a meeting for tribes and territories as well as a peer-to-peer meeting representing all of the grantees from both the National Breast and Cervical Cancer Early Detection Programs and the Colorectal Cancer Screening Program. 
Some other cancer projects that NACDD has engaged recently with are: 
  • Providing technical assistance to support state-based cancer prevention and control; 
  • Working with states to collaborate with Medicaid to increase breast, and cervical cancer screening as well as ongoing evaluation of these screening programs; 
  • Developing a team-based approach to increase colorectal cancer screening in community health centers; 
  • Improving messaging about skin cancer prevention;
  • Increasing healthy behaviors among cancer survivors in rural communities by increasing capacity and enhancing partnerships to improve quality of life; and
  • Studying information and communications related to colorectal cancer screening that is provided to specific populations post-diagnosis for breast cancer.

We’re also pleased to announce that on Oct. 1, Randy Schwartz became the Senior Public Health Consultant for Cancer Control. His vast experience and subject matter expertise will be invaluable in assisting us as we strategize how to build on the good work we have already accomplished.

We invite all state and territorial health staff who work on cancer issues to join NACDD’s Cancer Council, which is represented by more than 450 professionals working in CDC-funded cancer prevention and control projects in the states, D.C., territories, tribal nations, and Pacific island jurisdictions. 
The Council connects cancer program staff for knowledge sharing, brainstorming, problem solving, and best practice dissemination. The Council also offers professional development and leadership opportunities. If interested in joining, contact
We look forward to continuing this challenging and critical work with our partners and our Members. 

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Walk With Ease Project Highlights

Posted By Administration, Monday, October 28, 2019

NACDD is funded through a cooperative agreement from CDC (DP16-1606) to execute national strategies that enhance health, wellness, and quality of life for people with arthritis by working with employers to implement Walk With Ease, an evidence-based walking program developed by the Arthritis Foundation. Walk With Ease is aimed at reducing pain, improving balance and strength, and increasing physical activity levels for employees with Musculoskeletal Conditions. This can increase productivity, improve morale and job satisfaction, decrease absenteeism and health care costs.

To facilitate this work, NACDD is collaborating with partner organizations to provide technical assistance on the benefits of including Walk With Ease as a covered physical activity benefit, as well as to assist employers in the implementation process.

Current project highlights include partnering with:

  • MedWorks Consulting, the Greater Philadelphia Business Coalition on Health, and the Health Promotion Council to target employers in Philadelphia and Delaware.
  • The Montana Department of Health and Human Services to build on the success of the Work@Health® program and the Montana state employee workplace wellness program to implement Walk With Ease as a component of worksite wellness efforts in employers across Montana.
  • The Osteoarthritis Action Alliance (OAAA) to market their online portal to State Health Department members as an easy to implement and streamlined data collection tool for the Walk With Ease self-directed program.

To learn more, please contact Lisa Erck at

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Government Affairs: Continued Concerns about E-cigarette Safety Drive State Action

Posted By Administration, Monday, October 28, 2019

The Centers for Disease Control and Prevention (CDC) continues to investigate an outbreak of illness associated with e-cigarette use. As of Oct. 15, 2019, 1,479 lung injury cases have been reported from the District of Columbia, U.S. Virgin Islands, and every state except Alaska. There have been 33 confirmed deaths in 24 states. CDC continues to provide technical assistance to states as they work together on the investigation. The agency has also issued clinical guidance to help health care providers as they assess potential cases of e-cigarette, or vaping, product use associated lung injury (EVALI). 

The growing number of people falling ill and dying has spurred eight states to take executive action to limit or ban the sale of flavored e-cigarettes and tobacco products. Montana, Massachusetts, Rhode Island, and Washington instituted a 120-day ban on flavored e-cigarettes. Oregon’s ban will be in place for 180 days. In Utah, only tobacco specialty shops (which are regulated and inspected by local health departments) will be allowed to sell flavored e-cigarettes. These shops are required to post notices about the damages of vaping unregulated THC products. New York’s ban on flavored cigarettes and vaping products has been delayed by a legal challenge. A judge also blocked an executive order in Michigan to ban e-cigarette use as well as both retail and online sales.

Several state legislatures, including Illinois,  Massachusetts, and Ohio, have introduced measures that would limit or ban e-cigarette sales. 

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