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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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New Leadership Opportunity: ECHO Clinics

Posted By Administration, Wednesday, May 29, 2019

NACDD unveiled a new leadership opportunity, ECHO Clinics, for state Chronic Disease Directors to engage in peer conversations on emerging topics: Adverse Childhood Effects (ACEs) and Public Health Linkages and Housing. NACDD collaborates with the University of New Mexico ECHO Project on these virtual peer-learning sessions using the ECHO Platform and Zoom technology. These clinics provide a “case management” focus to these topics and allow for in-depth discussion by the participants. The clinics leverage ECHO hub-and-spoke connectivity technology and are founded on principles that support communities of practice and peer mentoring. The clinics are meant to create a facilitated discussion and to engage creative thinking about emerging issues impacting public health practitioners working in chronic disease.  

Linda Scarpetta, MPH, Director, Division of Chronic Disease and Injury Control, Michigan Department of Health and Human Services and Jodi Spicer, MA, Consultant, Division of Chronic Disease and Injury Control, Michigan Department of Health and Human Services, kicked off the first ECHO Clinic, providing information on the impact of ACES on chronic diseases and sharing their Michigan state case story—particularly how they leveraged funding to create a position that supports and collaborates with other partners on ACES. Additionally, they shared their success at the 2019 NACDD Chronic Disease Academy in Atlanta. 

Gabriel Kaplan, PHD, MPA, Colorado Chronic Disease Director and NACDD Board President, along with Cassandra Dove, MPH, Chief Program Officer, Office of Preventive Health and Director, Delta Health Collaborative, Mississippi Department of State, and Tameka Ivory Walls, PhD, MS, Community Clinical Linkage Director, Mississippi State Department of Health –Delta Health Collaborative, shared the importance that housing can play in improving health of the community, particularly on hypertension screening during the second ECHO Clinic.

Two additional ECHO Clinics are planned for this summer. More information will be forthcoming once dates are finalized for the remaining two clinics.  

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Tribal/Territorial Cancer Screening Capacity Building Workshop

Posted By Adeline Yerkes, Wednesday, May 29, 2019

The Tribal/Territorial Cancer Screening Capacity Building Workshop was held April 29 through May 3, 2019. The workshop brought together 12 tribal and 6 territorial organizations to improve skills for staffs of breast and cervical cancer and colorectal cancer screening and prevention programs. The workshop was a series of skill building workshops focusing on evidence-based screening interventions, leadership, communication, and collecting and reporting data relevant to screening programs. During each workshop, participants were involved in reviewing or revising their work plans to capture ideas presented during the workshop. Participant evaluations reported the workshops were useful, applicable, and would very likely use the information gained to improve their programs.

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CDC’s 6|18 Initiative: Medicaid Coverage for the National DPP Lifestyle Change Program

Posted By Wendy Childers, Wednesday, May 29, 2019

CDC’s 6|18 Initiative brings together state Medicaid, public health, and partners to target six high-burden health conditions with effective, evidence-based interventions to improve health and control health care costs. The 6|18 priorities include: reduce tobacco use, improve antibiotic use, prevent unintended pregnancies, control high blood pressure, control asthma, and prevent type 2 diabetes.

NACDD is working with the Division of Diabetes Translation at CDC to provide technical assistance to eight states that chose Medicaid coverage for the National Diabetes Prevention Program (National DPP) as a focus for their 6|18 work. The 2018 – 2019 6|18 diabetes prevention cohort includes Medicaid and public health representatives from the following states: California, Indiana, Kentucky, New Hampshire, New Jersey, Pennsylvania, Rhode Island, and Wyoming.

NACDD and Leavitt Partners are providing group-based technical assistance through a Peer Learning Collaborative to share information and facilitate state-to-state engagement related to Medicaid coverage for the National DPP lifestyle change program. Three sessions have been held since this project kicked off in October 2018: Introduction and Overview: The Basics of Medicaid Coverage and the National DPP Coverage Toolkit (optional introductory session); Making the Case for Coverage: Cost Analysis, Communication, and Partnerships; and Medicaid Policy: State Options and Strategies for Coverage of the National DPP. A fourth session is planned for the end of May, which will focus on working with Medicaid managed care organizations (MCOs) and CDC-recognized organizations, and will include information on contracting, establishing referral systems, and building network capacity for delivering the program statewide. Two final sessions will be held in July and September of this year.

NACDD and Leavitt Partners are also supporting these states through direct technical assistance on an as-needed basis (including participating in webinars or other meetings, providing information and resources, and facilitating state-to-state communications) and continuing to engage states as they complete their 6|18 work plans.

For more information on Medicaid coverage for the National DPP, visit the Coverage Toolkit

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Cancer Prevention Across the Lifespan

Posted By Leslie Best, Wednesday, May 29, 2019

The Cancer Prevention Across the Lifespan 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 new project is focused on the development of innovative resources for public health practitioners in 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.

The focus on physical inactivity will be highlighted by a webinar on July 22 on innovative ways to implement the Complete Streets program in Indiana and Louisiana, which will be accompanied by case studies on the experiences in each state. A meeting of the Calculating and Communicating Cancer Risk Workgroup is scheduled for June 25, with subject matter experts presenting innovative ways for public health practitioners to communicate data and cancer trend to the general public and policymakers.

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Lupus Awareness Month

Posted By Leslie Best, Wednesday, April 24, 2019

May is Lupus Awareness Month in the United States. Lupus is most common in women between the ages of 18-45, but it can affect men also. Lupus can affect almost any organ in the body. The symptoms of lupus also differ from person to person. For example, one woman with lupus may have swollen knees and fever. Another woman may be tired all the time or have kidney trouble. Someone else may have rashes. Over time, new symptoms can develop, or some symptoms may happen less often. Lupus symptoms also usually come and go, meaning that you don’t have them all of the time.

Systemic lupus erythematosus (SLE) is the most common type of lupus. SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. It can affect the joints, skin, brain, lungs, kidneys, and blood vessels. There is no cure for lupus, but medical interventions and lifestyle changes can help control it. The causes of SLE are unknown, but are believed to be linked to environmental, genetic, and hormonal factors.

Recent studies indicate that lupus incidence rates are almost three times higher in black women than white women and affect 1 in 537 young African-American women. Minority women tend to develop lupus at a younger age, experience more serious complications, and have higher mortality rates—up to three times the mortality rate of white women. In 2015, NACDD led a cooperative effort with the CDC, the Lupus Foundation of American and other stakeholders that included public health professionals, lupus experts, clinicians and individuals living with the disease to develop the first-ever National Public Health Agenda for Lupus (Agenda) to help prioritize public health efforts to improve the care and quality of life for people living with lupus. The Agenda outlines a broad public health approach to lupus diagnosis, disease management, treatment, and research.

Since then, NACDD has collaborated with the American College of Rheumatology, the Georgia Council on Lupus Education and Awareness and the Big Bend Rural Health Network to develop state-based plans to address lupus that reflect the strategies identified in the Agenda. These partnerships have resulted in improved data collection, as questions about lupus were added to the 2019 BRFSS in both states, and every school district in Florida and two in Georgia now collect data on students with a diagnosis of lupus. The school health results should be available later this year. Lupus Care Plans and Transition to Adult Care Plans were developed for use by school nurses, and recent Georgia-based trainings received very enthusiastic evaluations from the 55 nurse participants. For more information about lupus, visit, or

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Partnerships Are Essential

Posted By Robyn Taylor, Friday, April 19, 2019
Updated: Tuesday, April 16, 2019

Nationwide as Chronic Disease programs strive for equitable and sustainable health outcomes across all groups, leaders must work to partner with various organizations and community leaders. To do this requires head and heart knowledge as well as a perspective transformation as to what is believed to be possible in public health and a removal of the perceived limitations on who public health partners should be.

Health begins where we live, learn, work and play. According to the American Public Health Association, public health agencies are responsible for protecting, assessing, and assuring individual, community, and environmental health. Often, public health professionals are familiar with health outcomes for groups and communities by census tract and census block groups, but how familiar are Chronic Disease Directors with the organizations and individual community leaders that serve specific communities? Building those relationships must be intentional and sustained long term.

According to the CDC, comprehensive studies of health-related community partnerships confirm that partnerships play a significant role in improving public health. Although every partnership is unique, research reveals that high-performance health-related community partnerships appear to have specific strategies and practices in common, while low-performance partnerships are deficient in one or more of these same strategies and practices. There are nine practices that are common in high performing partnerships:

1.     Use a mutual selection process when recruiting partners

2.     Encourage size and value diversity

3.     Recruit partners who are leaders within stakeholder communities

4.     Understand and address partner motivations

5.     Establish ground rules (codes of conduct)

6.     Embrace a common vision

7.     Develop commitment through leadership

8.     Create decision-making protocols

9.     Anticipate and manage conflict

More information about the above practices can be found at

Chronic Disease Directors in state public health agencies cannot reduce health disparities alone. There is a role that non-traditional stakeholders play in developing effective strategies to promote health in communities. These stakeholders include the faith-based community, community development organizations, transportation, education, housing, community and neighborhood champions, and many more. The time is now to remove barriers in engaging partners so that positive sustainable health outcomes can be realized for everyone through policy, education, individual and collective action.

Please join the Health Equity Council at 2 p.m. EST every second Tuesday of each month. Contact Robyn Taylor at for more information. 

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Diabetes Council Going Strong!

Posted By Trina Thompson on behalf of 233, Friday, April 19, 2019
Updated: Tuesday, April 16, 2019

For nearly 30 years the Diabetes Council has provided leadership opportunities, fellowship, and a voice for State Health Department staff working in diabetes prevention and control. NACDD convened a Diabetes Council networking opportunity on March 26, 2019 at the 1815/1817 meeting in Atlanta. This meeting attracted over 60 attendees and generated 22 new offers of participation for the Professional Development Workgroup, Mentoring Workgroup, and/or the Peg Adams Peer to Peer Program. The Diabetes Council Leadership Group (pictured above) would like to remind State Health Department staff that if you work on diabetes prevention and control, then you’re automatically a member of the Diabetes Council. Want to become more actively involved? There are eight Leadership Group positions up for election this May. Get your nominations in by May 3, 2019. Are you receiving information via email about the Council? If not, then we haven’t connected with you yet. Please ensure you’ve been counted as a member by contacting Susan Lopez-Payan at

Diabetes Council Leadership, from left to right: Rebecca O’Reilly (VT) Liaison to the NACDD Professional Development Forum and Peer to Peer Guide; Blythe Nett (HI) Liaison to the Health Equity Council; Becky DiOrio (CO) Chair and Peer to Peer Guide; Chris Lucero (NM) Past Chair; Brittany Ly (UT) Professional Development Workgroup Co-Chair; Shana Scott (GA) Chair-Elect; Allison Smith (GA) Mentoring Workgroup Co-Chair; Pam Geis (WI) Liaison for Outreach and Member Engagement; LorieAnn Wilkerson-Leconte (NJ) Mentoring Workgroup Co-Chair.

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Increasing State Workplace Health Expertise by Implementing Work@Health®

Posted By Lisa Erck, Monday, March 25, 2019

NACDD is increasing state workplace health expertise by training chronic disease prevention staff to implement Work@Health®, an evidence-based employer training program developed by CDC. Worksite wellness programs have the potential to reduce risk factors for chronic disease and injury while improving overall productivity. By implementing a range of workplace health strategies, employers can create work environments that emphasize and support health and safety.

NACDD was funded to develop an online platform for Work@Health® training materials and build capacity to deliver Work@Health® training. NACDD’s worksite health team will train Work@Health® trainers in four State Health Departments: Montana, Oklahoma, Utah, and West Virginia.

The Work@Health® employer curriculum covers building buy-in for worksite health programs and developing and evaluating the program. Participating employers complete the CDC Worksite Health ScoreCard to assess implementation of evidence-based worksite health strategies. Work@Health® trainers master the employer training materials and learn how to deliver the blended training and be an effective instructor, coach, and technical assistance provider. All trainers and trainees take pre- and post-knowledge tests to assess learning.

To launch the courses, the NACDD worksite health team reviewed, inventoried, and refined the Work@Health® curriculum, including fourteen PowerPoint learning modules, dozens of resources and participant activities, and over ten data collection tools. The team built distinct Work@Health® courses within the online platform for trainers and employers and populated each course with content.

As of March 2019, the NACDD worksite health team has launched training for new Work@Health® trainers. By participating in Work@Health®, State Health Departments are building partnerships between public health professionals and the business community. Employer trainings across the four states are set to occur between April and July of 2019.

To learn more, please contact Lisa Erck at

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Medicaid Coverage for the National DPP Demonstration Project

Posted By Kelly McCracken, Monday, March 25, 2019

Establishing coverage for the National Diabetes Prevention Program (National DPP) lifestyle change program for vulnerable populations, including Medicaid beneficiaries, is a key factor in promoting health equity within chronic disease prevention. NACDD, with funding from the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC), led the three-year Medicaid Coverage for the National DPP Demonstration Project with Maryland and Oregon to show how state Medicaid agencies and State Health Departments can collaborate to implement, deliver, and sustain coverage of the National DPP. The Demonstration Project wrapped up in early 2019 with a Capstone Meeting in Atlanta, GA, which celebrated the partners’ successes and marked the release of the final evaluation executive summary. This information was also shared in a webinar hosted by NACDD on Jan. 17, 2019 [watch the webinar or view slides]. 

Importantly, the evaluation found that the National DPP lifestyle change program can be effectively implemented through Medicaid managed care. Among the Medicaid beneficiaries involved in the Demonstration, retention in the National DPP lifestyle change program was comparable to national data, and the weight loss average of 4.5% of body weight came close to the 6% national average.
The evaluation also generated specific recommendations in the areas of planning, organizational capacity, strategies for engaging and retaining Medicaid beneficiaries (including addressing social determinants of health), and developing effective community-based and online delivery networks. Key recommendations and lessons learned from the evaluation include:

Provide at least 6-month period for project planning
Assess CDC-recognized organizations’ needs for technical assistance to engage with managed care organizations (MCOs) and Medicaid
Incorporate program supports and services to facilitate attendance (e.g., flexible program locations and timing [including make-up sessions], transportation assistance, child care)
Use tailored, frequent contact by trained lifestyle coaches to encourage retention
Engage health care providers to establish a referral process

With continued support from CDC and NACDD, agencies in both of the Demonstration states are maintaining their focus on sustainable coverage for the National DPP lifestyle change program within Medicaid. Maryland is seeking a Section 1115 demonstration waiver that would authorize continued provision of the National DPP lifestyle change program on a limited basis. Oregon’s Health Evidence Review Commission has approved covering the National DPP lifestyle change program as a Medicaid benefit, and the benefit took effect in January 2019. 

The project team from CDC, NACDD, and Leavitt Partners has continued to build on the learnings from the Demonstration and disseminate this information through their “Coverage 2.0” work, which started in October 2018. The focus of this CDC-funded work continues to support State Health Departments and Medicaid agencies in establishing coverage for the National DPP lifestyle change program within Medicaid and across payer types. Learnings from the Demonstration and the Coverage 2.0 work continue to inform updates and the creation of additional resources that are being added to the National DPP Coverage Toolkit on an ongoing basis. 

For more information, contact Kelly McCracken at

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NACDD Cancer Projects Portfolio 2018-19

Posted By Frank Bright, Monday, February 25, 2019

NACDD was successful in competing for thirteen cancer prevention and control projects funded by the Centers for Disease Control and Prevention Division of Cancer Prevention and Control.  All thirteen projects submitted were approved for funding. Following is a brief description of each project in the cancer project portfolio.

Increasing Colorectal Cancer Screening Rates: State-Specific Health Intelligence and Partner Collaboration - Using the State Engagement Model, NACDD, in partnership with CDC and Leavitt Partners, works with six state health departments (3 with Medicaid expansion and 3 without Medicaid expansion) to create state-specific health intelligence tools and resources and to engage key health system and health plan stakeholders to develop and implement targeted strategies to increase colorectal cancer screening rates. 

Cancer Prevention Across the Lifespan: Putting Scientific Evidence for Primary Prevention in Public Health Practice - This project uses information gained from previous work and applies it to the development of innovative resources to empower public health practitioners, including CDC funded Comprehensive Cancer Control grantees, to put evidence-based cancer prevention strategies into action in their communities using a lifespan approach.  During the first year of this five-year project the core focus areas include calculating and communicating cancer risk, reduction of unnecessary exposure to medical radiation, physical inactivity and caregiver stress. 

Cancer Leadership and Collaborative Technical Assistance –This project supports the NACDD Cancer Council activities including quarterly meetings of the entire Council, interaction with the CCC National Partnership and NCI, quarterly meetings of the CDC screening programs (NBCCEDP and CRCCP), regularly scheduled professional development offerings, special interest area discussions such as palliative care, cancer services in rural areas, impact of health insurance reform on programs and health communications, and peer-to-peer support.

Data Analysis and Support for Evaluation of the NBCCEDP and the CRCCP - NACDD has an ongoing partnership with the University of Washington (UW) who has been conducting annual surveys of screening projects for a few years.  NACDD has contracted with an Evaluation Specialist to work with CDC on evaluation capacity-building at the project level. NACDD will work with UW and CDC on the development of useful formats for evaluation training and program enhancement. The purpose of this project is to increase evaluation related technical assistance to NBCCEDP/CRCCP grantees and to increase the dissemination and utilization of survey data.

Capacity Building Training for Tribal and Territorial Cancer Prevention Programs - NACDD is collaborating with CDC and tribal/territorial cancer screening grantees to plan and provide a capacity-building workshop focusing on evidence-based strategies to increase breast, cervical and colorectal cancer screening.  The showcasing evidence-based strategies include: patient reminders, provider reminders, provider assessment and feedback and reducing structural barriers.  The training workshop provides knowledge and skill building workshop experiences to assist the attendee in having an enhanced ability to effectively implement health systems intervention strategies and leave with identified actions steps to implement through their programs.

Enhancing Cancer Program Grantee Capacity through Peer to Peer Learning - This project supports collaboration and communication across programs by facilitating peer‐to‐peer learning opportunities for NBCCEDP and CRCCP grantees and their partners. The project  develops and implements a training forum for grantees and select partners to:  discuss implementation of health systems change (and potentially, other FOA strategies) including successes, challenges, and lessons learned;  share promising practices and success stories in implementation, evaluation, and sustainability;  provide peer‐to‐peer skill-building and technical assistance (TA) training in critical implementation and evaluation areas;  share practical implementation and evaluation tools and tips; and  discuss data use and management to support program monitoring and improvement, and outcomes evaluation

Impact of the Changing Health Policy Environment on State Cancer Program - NACDD monitors the health policy environment at the national and state levels to assess how state cancer prevention and control programs are transforming to take advantage of opportunities to increase appropriate cancer screening and early detection, especially for CDC-funded cancer programs.  Briefs, reports and presentations of the impact of health policies on cancer screening programs are developed for use by CDC, state chronic disease directors and directors of CDC funded cancer programs. 

Providing Communication Technical Assistance to State Cancer Prevention Efforts - NACDD supports CDC cancer grantee communication efforts by offering on-going, proactive technical assistance.  NACDD supports and motivates grantees to act, ensuring implementation of communication plans and tools to the best of grantee capacity.  NACDD is committed to providing continued support and new messaging to grantees and CDC through an NACDD facilitated grantee to grantee mentoring program, new data-informed messages and talking points allowing for the enhancement of website, a national awareness push leveraging the state-of-the art resources, partnerships and talent of CBSHealthSolutions.

National Program of Cancer Registries: Identifying and Implementing Best Practices for Registry Operations - NACCD and the North American Association of Central Cancer Registries (NAACCR) work with the CDC Division of Cancer Prevention and Control to identify best practices among grantees funded by the National Program of Cancer Registries (NPCR) in an effort to improve compliance with the NPCR standards for 12-month and 24-month data quality and completeness.  Best practices are identified through a survey issued by the CDC Division of Cancer Prevention and Control, informal interviews, focus groups and in-person summit meetings.  To better understand differences in practice, project team will work with at least 8 registries that have difficulty meeting the NPCR standards and 8 registries that have demonstrated better compliance with the standard.  As a result of this project, cancer registries in the NPCR program will be better equipped to collect and process cancer incidence data in a timely manner and make data available for evidence-based/informed decision-making regarding public health priorities.

Strengthening National Program of Cancer Registries by Enhancing Educational and Training Capacity and Infrastructure - Working in partnership the CDC Division of Cancer Prevention and Control, NACDD, University of Miami School of Medicine's Fundamental Learning Collaborative for the Cancer Surveillance Community (FLccSC)  and the North American Association of Central Cancer Registries (NAACCR), will increase access and use of an existing online learning management system able to support the present, expected and forecasted educational needs of the National Program of Cancer Registries (NPCR) and CDC Division of Cancer Prevention and Control grantees.  The identified online educational portal will include functions to create sites specifically for cancer registries and cancer programs, a course management tool, a Help desk offering bi-directional communication and ability to offer pre- and post-tests to document changes in knowledge, attitude and practice.

Reducing Breast Cancer Disparities in States: Creating the Bridge from Data to Action The CDC Division of Cancer Prevention and Control, NACDD and the Association of State and Territorial Health Officials (ASTHO) work with five identified state health department cancer prevention and control programs to strengthen their capacity in implementing evidence-based interventions and actionable strategies for reducing breast cancer disparities.  NACDD and ASTHO will coordinate webinars, support calls, in-person technical assistance (TA) visits and a new community of practice

Increasing Healthy Behaviors Among Cancer Survivors in Rural Communities. - The purpose of this project is to expand the reach and sustainability of multiple-component survivorship wellness programs in rural communities by building capacity and fostering relationships with Community Based Organizations. NACDD is working with State Comprehensive Cancer programs and their partners to identify the needs of cancer survivors and address those need though local access to wellness and health education services.   Grant awards (4-6 awards) will support efforts to engage local community-based organizations in developing and implementing evidence informed wellness interventions for cancer survivors in rural communities.

Health and Wellness in Cancer Survivors: Developing new tools to talk about behavior change - NACDD partners with Kognito, a health simulation company to develop 4 simulation modules for cancer survivors.  Proposed modules will include nutrition, physical activity, tobacco and alcohol and anxiety. An additional fifth module will address health care providers. State, territorial and tribal health department professionals will be trained on the modular tools in order to deploy them throughout their survivor-communities. A strategic communication dissemination plan will be developed for state, territorial and tribal health departments as well as for traditional and social media, partner organizations and the larger clinical community.

For further information please contact Frank Bright – or the lead NACDD Consultant/Staff on each project (the first person listed).

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