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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  capacity building  CNMI  CVH  Diabetes  Health Promotion  Healthy aging  heart disease  Louisiana  Medicaid  STAR  StEM  stroke  Walk with Ease 

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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Government Affairs: Federal Appropriations Update

Posted By Administration, Monday, October 28, 2019

On October 15, 2019, Congress returned from a two-week recess to face the daunting task of passing 12 appropriations bills with only weeks before government funding expires. The House of Representatives has passed 10 of 12 appropriations bills. The Senate Appropriations Committee has passed 10 of 12 bills (8 passed unanimously), but none of the bills have been considered by the full Senate. Controversial proposals around funding for a wall on the southern border and abortion have stalled progress on the remaining bills.

A short-term spending bill, called a continuing resolution, averted a government shutdown and moved the deadline for funding the government to November 21. Passing all 12 bills through both the House and Senate before this deadline will be challenging, and there is a strong possibility that Congress will pass another continuing resolution to push back the deadline and allow more time for consideration.

In other news out of the House Appropriations Committee, Chairwoman Nita Lowey (D-NY) announced she will retire at the end of her term. 

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Breast Cancer Disparities Online Toolkit Updated

Posted By Administration, Monday, October 28, 2019

The updated Breast Cancer Disparities Online Toolkit provides a coordinated guide of recommendations to operationalize best practice interventions by mobilizing data resources more effectively to address disparities in breast cancer mortality. Content in the toolkit outlines actionable methods informed by a multi-state learning collaborative across four phases: describing/understanding the burden of the problem, performing data collection, integrating a quality improvement model, and initiating and sustaining the effective implementation of evidence-based interventions. Since health systems across different communities are at different stages of readiness, phases are not in chronological order. Instead, this process is ongoing and often involves revisiting some previously adopted policies/protocols to further increase early detection and screening, reduce the follow-up time between screening and diagnosis, and improve the quality of breast cancer treatment for all regardless of socioeconomic differences. The toolkit also contains elements of health systems change, data-driven transformation and geospatial analysis.


The ASTHO Breast Cancer Online Toolkit is made possible by collaborative partnership and funding support from the Centers for Disease Control and Prevention (CDC) Division for Cancer Prevention and Control (DCPC) and the National Association of Chronic Disease Directors (NACDD). Visit the online toolkit at


The toolkit includes:

·       A set of phases to operationalize best practice interventions and mobilize data resources to address health disparities in breast cancer mortality and advance health equity in local health departments;

·       Recommendations to advance current practice toward addressing breast cancer mortality;

·       15+ case studies that describe how public health agencies advanced systems change, stakeholders that supported the work, and lessons learned to advise others; and,

·       80+ resources from allied organizations and others who support the breast cancer care continuum.

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What is Your Diabetes Story?

Posted By Administration, Monday, October 28, 2019

November is Diabetes Awareness Month and an annual opportunity to boost your state efforts to inform your partners and the general public about diabetes. The Centers for Disease Control and Prevention, American Diabetes Association, National Institutes of Health, and the International Diabetes Federation have excellent resources for you and your partners to use to raise diabetes awareness in your state during November and throughout the year. How can you make the diabetes story resonate in your state?


NACDD is thankful for the efforts of our Members and the Diabetes Council throughout the year. The Connector, a quarterly newsletter about diabetes work in State Health Departments is a great way to hear impactful stories from across the country. If you would like receive The Connector newsletter please contact Lanae Caulfield at

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What is MENDS (Multi-state EHR-based Network for Disease Surveillance)?

Posted By Administration, Monday, October 28, 2019

In 2018, CDC’s Division for Heart Disease and Stroke Prevention funded NACDD to conduct a demonstration of an electronic health record (EHR)-based chronic disease surveillance system. NACDD formed a team of experts including NACDD consultants, the University of Massachusetts Medical School, Commonwealth Informatics, Harvard Medical School’s Department of Population Medicine, the Public Health Informatics Institute, and the Council of State and Territorial Epidemiologists.

If successful, this demonstration project will lead to a real-time, chronic disease surveillance system in participating states using EHR data. EHR-based surveillance has the promise of being timely, accurate, reliable, as well as compatible with existing disease surveillance and data collection systems like the BRFSS and NHANES.

Specifically, MENDS is:

·      A multi-site demonstration testing an automated chronic disease surveillance system that provides accurate, near real-time, actionable chronic disease incidence and prevalence estimates using data from EHRs. The pilot is currently in Washington State and North Dakota and will expand to two additional sites in the coming months.

·      A collaboration between State Health Departments, healthcare organizations, and data aggregators such as Health Information Exchanges (HIEs). In Washington State and North Dakota, both the State Health Department and the HIEs are involved.

·      A specific technical approach using an open-source software system that:

o   Data partners create and securely manage a warehouse of EHR data using a common data structure.

o   Allows users to develop surveillance analyses without exposing personal health information.

o   Generates approved analytic results that are delivered to public health users, such as State Health Departments, as aggregate deidentified data.

Evaluating different methods for addressing the non-random nature of EHR data in order to develop and validate state, sub state, subpopulation, and national-level chronic disease estimates even in circumstances where EHR data is limited.

For more information on MENDS, go to

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