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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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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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NACDD’s Healthy Community Updates and Reflections

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

It has been a very busy year the National Association of Chronic Disease Directors’ (NACDD) Healthy Communities and Physical Activity projects! During Fiscal Year 2017-2018, NACDD worked hard to increase access and opportunity for people to eat healthier and to be more physically active through several projects, including those highlighted below:

Reaching People with Disabilities through Healthy Communities

NACDD, with funding support from the Centers for Disease Control and Prevention’s (CDC) Disability and Health Branch and expertise from the National Center for Health, Physical Activity, and Disability (NCHPAD), is finishing a national pilot project involving 10 local communities from five states. For the first time, community changes for healthy eating, physical activity, and tobacco prevention or reduction are being made to be more inclusive to persons with disabilities. In 2015, NACDD began its work with two communities from five of CDC’s State Disability and Health programs–Iowa, Montana, New York, Ohio, and Oregon--to implement new policies, systems, or environments (PSE) that would yield more access or opportunity for people to eat healthier, engage in physical activity, andto  refrain from using tobacco products.

Each community was paired with a state expert advisor from CDC’s State Disability and Health program alongside NACDD’s project team to focus on the new healthy community PSE improvements to become more inclusive to persons with disabilities. The NACDD’s project team is in the process of finalizing project data and looks forward to sharing the final results in a future Impact Brief. It is estimated that the communities collectively implemented more than 100 inclusive PSE changes, and have formally integrated persons with disabilities and disability advocates officially into their ongoing Healthy Community efforts.

Through collaboration with NCHPAD, overall project and individual community videos were developed that help to tell the story of how this pilot project has influenced lives and healthy living. If you have any questions on how to promote inclusive healthy living in your community or state, please visit NACDD’s Reaching People with Disabilities in Healthy Communities program webpage.  

Walkability Action Institute


2018 Cohort:

Albuquerque, NM

Allegheny County, PA

Anchorage, AK
Eau Claire, WI

Hidalgo County, TX

Las Vegas, NV
 Lawrence/Douglas Counties, KS
 Richmond, VA
 Springfield, MO

NACDD, with funding support from CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO), implemented the fourth annual Action Institute to Increase Walking and Walkability in Decatur, Georgia, from April 9 –12, 2018. Referred to as the Walkability Action Institute (WAI), this multi-day course was implemented for nine new, interdisciplinary teams who received expert faculty instruction from some of the nation’s most renowned leaders in public health, planning, advocacy, development, transportation, and community design. The course included keynote presentations, and experiential learning activities–such as outdoor inclusive walk audits and scavenger hunts–all to assist attending teams with developing an action plan for their respective walkability strategies.

The 2018 cohort of teams now marks 41 total teams who have participated across the four-year project period to make lasting PSE changes promoting improved environmental design, municipal policy structure, and systems improvements to improve active transportation. To date, more than 325 related changes have reached nearly 19,000,000 people across the United States. For more information on NACDD’s WAI and the institute’s efforts, please visit the Healthy Communities webpage.

 Physical Activity Assessment Tool

 NACDD, with support from CDC DNPAO and with collaboration and expertise from each CDC DNPAO, the University of North Carolina at Chapel Hill (UNC), and Healthy Places By Design (HPBD), developed a new Physical Activity Assessment Tool. Developed and designed from the premise of The Community Guide and the Community Preventive Services Task Force’s recommendations, this tool will assist local public health (and partner) users by examining current infrastructure and progress in achieving interventions specifically related to pedestrian and bicycle transportation system, land use, and environmental design improvements. Related physical activity indicators and modules were developed and pilot tested by nine pilot teams comprised of representatives from public health, planning, parks and recreation, and/or education. An advisory council provided input into the total project process of tool development during the fiscal year. It is anticipated that this tool will be used in the future by DNPAO-funded grantees and will allow CDC to gain more information on the types of efforts being achieved in local communities and states towards active transportation improvements.

 The NACDD project team, along with UNC and HPBD, currently are finalizing the tool for DNPAO, which will go through an extensive clearance process. Once the clearance process is finished, NACDD will work with DNPAO to share the new tool broadly with the Association’s Members.

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New NACDD School Health Resources to Support Student Learning and Health

Posted By Laura DeStigter, Tuesday, July 17, 2018

The National Association of Chronic Disease Directors (NACDD) has released several new resources to assist state health and education departments, schools, and partners in supporting student learning and health through the Whole School, Whole Community, Whole Child (WSCC) model. The resources, which were developed with funding from the Centers for Disease Control and Prevention (CDC), are designed to facilitate adoption and strengthen implementation of the WSCC model.

The WSCC model PowerPoint presentation is a ready-made presentation that can be used or adapted to meet the needs of various audiences. The presentation, which includes detailed speaker notes, explains the value and importance of the WSCC model and describes how it can be put into practice. It highlights brief examples from districts that have successfully implemented the WSCC model and provides relevant resources.

 Three new success stories showcase school districts that have made significant strides in implementing the WSCC model. The stories feature Denver Public Schools (Colorado), Milwaukee Public Schools (Wisconsin), and Westport Public Schools (Connecticut).

The School Health Online Resource Guide has been expanded to include an interactive WSCC model with national and state resources related to each of the 10 components of the model, such as example potential partners to engage at the state and school levels.

NACDD hosted the webinar “Using the Whole School, Whole Community, Whole Child (WSCC) Model to Build Bridges and Break Down Silos” on April 24. The webinar featured school districts that have used the WSCC model as a framework for integrating health and learning, enhancing coordination within the school district, and increasing collaboration with community partners.

 To access these new resources and learn more about NACDD’s work in school health, visit

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NACDD’s Partnership with the Association of State and Territorial Dental Directors Promotes Oral Health and Chronic Disease Integration Efforts

Posted By Barbara Park, Monday, June 18, 2018

Poor oral health can be a contributing factor to many chronic diseases, or a symptom and consequence of chronic disease. The National Association of Chronic Disease Directors (NACDD) has demonstrated its support of state oral health programs. In September 2016, this commitment strengthened when NACDD entered into a Memorandum of Understanding (MOU) with the Association of State and Territorial Dental Directors (ASTDD) to promote increased collaboration between chronic disease and oral health programs in states.

 As part of this project, a Chronic Disease Collaboration Workgroup came together to develop tools and resources for ASTDD members. In April, NACDD collaborated with ASTDD to host a member sharing session at the National Oral Health Conference, which focused on state examples of oral health and chronic disease integration. Using a “fireside chat” format, seven state oral health programs (Colorado, Georgia, Iowa, Maryland, Michigan, Minnesota, and Vermont) described the projects and approaches that are being implemented which align with four specific chronic disease prevention and health promotion priorities: 1) cardiovascular disease prevention; 2) diabetes prevention and management; 3) obesity prevention in children by limiting access to sugar-sweetened beverages; and 4) tobacco use prevention.

These types of collaborations not only enhance the ability of chronic disease programs to implement many of their evidence-based strategies, but they also can help to integrate oral health programs from “siloed” programs into more mainstream public health efforts. The session was well-timed as CDC had just announced the availability of additional funding for these types of collaborative efforts in a recent NOFO DP18-1810.

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California Prepares to Offer National Diabetes Prevention Program to 13 million Medicaid Members in Multiple Languages

Posted By Susan Lopez-Payan, Monday, June 18, 2018

California, rich with cultural and linguistic diversity, is home to 40 million people; more than 12 million of those individuals are Medicaid (Medi-Cal) members. Many Medi-Cal members will have the opportunity to prevent type 2 diabetes by enrolling and completing a one-year lifestyle change program as part of the National Diabetes Prevention Program (National DPP). This benefit will be available in 2019, and the agency overseeing Medi-Cal will provide services in English, Spanish, and 17 threshold languages.

A threshold language is a language identified on the Medi-Cal Eligibility Data System (MEDS) as the primary language of 3,000 beneficiaries, or five percent of the beneficiary population, whichever is lower, in an identified geographic area.[1]  In 2016, 38% (4,483,455 members) of Medi-Cal eligible persons reported a language, that met the criteria for a threshold language, other than English as their primary language. Seventeen distinct languages met the criteria for a threshold language: Arabic, Armenian, Cambodian, Chinese, English, Hindi, Farsi, Hmong, Japanese, Korean, Laotian, Punjabi, Russian, Spanish, Tagalog, Thai, and Vietnamese.[2] 

The legislature approved a request for a budget of $500,000 for translation services of the National DPP curriculum, and a separate budget request of $10 million to support marketing of the new benefit. Both are awaiting full approval by the Budget Conference Committee. The National Association of Chronic Disease Directors will continue to work with the State Health Department and their partners to expand the National DPP. One partner, Health Policy Advocates, mobilized independently to secure Medicaid coverage for the National DPP and leads a coalition to develop implementation details for successful roll-out and uptake of the program. The coalition gathered input and submitted the budget request. For more information, contact Susan Lopez-Payan.

[1] California Code of Regulations, Title 9, Rehabilitative and Developmental Services, Section 1810.410(f)(3) Cultural and Linguistic Requirements.

[2] Frequency of Threshold Language Speakers in the Medi-Cal Population by County for January 2015. Medi-Cal Statistical Brief. September 2016. Available at:

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