Wednesday, November 6, 2013

Closing session challenges public health workers to ‘move this nation forward’

As he sat on the panel of speakers at the Closing Session of this year’s APHA Annual Meeting and Exposition, Donald Warne told a story.

Three sisters were walking along the river, when they saw a group of babies in the water. One sister jumped in to save the babies.

One sister said, “We need to teach these babies to swim.”

The third sister kept walking up the river. When the others called to her, she said, “I’m going to find out who’s throwing these babies in the water and I’m going to stop them.”

He paused.

“That’s public health.”

It was a fitting story to help wrap up this year’s Annual Meeting, which ended with a Closing Session about “Improving the Health of Native Peoples” and featured a keynote address by Evan Tlesla Adams, British Columbia’s first Aboriginal Health physician advisor and current deputy provincial health officer for Aboriginal health.

Adams sought to bring to light some of the issues faced by native people in the U.S. and Canada, but also to note that many indigenous people are actually faring quite well.

“I don’t want to tar us,” he said. “We are also very happy, very vibrant people. Only some of us are at risk. Many of us are flourishing.”

As evidence, he pointed to statistics regarding youth suicides among First Nations — or indigenous — people in Canada. In British Columbia, which has 32 languages, 203 tribes and 226,000 indigenous people, almost half of the tribes had no youth suicides from 1992 to 2006.

“We have solved the problem of youth suicide in those places,” he said. But on the other side of the coin, the news is much darker. Ninety percent of the youth suicides that did occur happened in 10 percent of the villages.

Many of the social determinants of indigenous health are the same as they are for the rest of the population — poverty, education, housing — but native people also face issues of self-determination, or the right to participate in decisions about the issues that affect them.

Adams said Canada has made strides in that area, signing partnership agreements that grant more self-determination to native people and bringing them to the table for discussions.

“Nothing about us, without us” has become the rallying cry.

The panel discussion after Adams’ keynote focused on the needs of native people in the United States and became a conversation about how much more progress Canada has made addressing such needs.

For example, Warne, who comes from the Oglala Lakota Tribe of Pine Ridge, South Dakota, noted that tribes rely on block grants for funding. But block grants from the federal government don’t go directly to the tribes; they first go to the states, which distribute the funds.

“Are all states friendly to American Indians? No,” said Warne, who directs the Master of Public Health Program at North Dakota State University.

Pointing to his own experience in South Dakota, he said that the state had historically been happy to count infant deaths in Indian Country in its overall infant mortality statistics to help get more block grant money. But when that money came in, the funds were never distributed to the tribes.

He called the distribution of block grant funds “low-hanging fruit” and an easy way to make sure funds get distributed where they’re needed most.

As always, the Annual Meeting closed on a note of hope.

APHA Executive Director Georges Benjamin, after handing off the gavel to new APHA president Joyce Gaufin, said he hoped attendees — of which the meeting welcomed more than 12,500 — will leave with renewed energy.

“I hope this meeting began a dialogue,” he said. “As the new APHA, I can tell you, we’re very much about science, advocacy and health. As you go home today, I want you to think about all the things we can do as an Association to move this nation forward.”

See you next year in New Orleans!

— C.T.

Above from top to bottom: Closing Session keynote speaker Evan Tlesla Adams; session moderator and new APHA President Joyce Gaufin sits with Adams and fellow panelists Donald Warne, second from right, and D. Kawika Liu of the Consolidated Tribal Health Project; and APHA's Benjamin, left, smiles for the camera alongside Gaufin and outgoing APHA President Adewale Troutman. Photos by Jim Ezell/EZ Event Photography

Photo finish

For your viewing pleasure, just a handful of the many photos from another successful APHA Annual Meeting. To view more photos from the Boston meeting, visit APHA's Flickr page.

Above from top to bottom: The National Public Health Week booth at the Public Health Expo; attendees at Wednesday morning's APHA Caucus Breakfast; Expo visitors at one of the hundreds of poster sessions; attendees at the American Indian, Alaska Native and Native Hawaiian Caucus Social; and snapping photos at APHA's International Health Section booth. Top two photos by Jim Ezell/EZ Event Photography, bottom three by Michele Late, courtesy The Nation's Health

A little birdie told me so: Tweet of the day

On this last day of the 141st APHA Annual Meeting and Exposition, the tweet of the day goes out to @the2x2project, whose organizers wrote: We had a wonderful time at #APHA13. It's hard to leave! Loved connecting with so many people passionate about #publichealth. Keep in touch!

Keep that passion alive! We'll see you next year!

Read all about it!

Stories of your public health work are making it well beyond the walls of this year’s convention center. Reporters from the around the nation — and world — have been covering the research coming out of the 141st APHA Annual Meeting and Exposition and bringing your messages of good health and prevention directly to the masses. Below is just a snapshot of this year’s media coverage. For more news from the Annual Meeting, visit APHA’s Public Health Newswire.

Gap seen in exposure to smoke on the job, Boston Globe

Internet can help mums prevent kids' obesity: Study, Times of India

Talking to Partners About STDs Often Awkward: Survey, Newsday

Gabriel Scally: A grotesque parody of fairness, BMJ Group Blogs

Gun Injury Hospitalizations Cost $75k on Average, Becker’s Hospital Review

On the Table: For loads of fiber, eat more beans, News & Observer

Tai Chi and Exercise Keep Seniors Upright, Medscape Medical News

Professor Who Links Nutrition to Birth Defects Honored by the March of Dimes, Sacramento Bee

Fast food companies still target kids with marketing for unhealthy products, ScienceBlog

Kanawha health officials present new app, Charleston Daily Mail

The other local food movement

Most Americans know that nutrition impacts their health. But where you live often determines what you eat — and what you know about healthy food.

The “act local” half of APHA’s 141st Annual Meeting and Exposition theme dominated a Wednesday session on nutrition advocacy in rural, urban and diverse socioeconomic communities. According to presenters, the problem isn’t that people don’t want to eat healthy.

It’s that no one’s educating them on how to do it.

“People aren’t going to go on ( before they chow down on Chinese takeout,” said session presenter Michelle Ramos of the Mount Sinai School of Medicine. “MyPlate and Harvard’s Healthy Eating Plate are great. …But people need prior knowledge of food groups to use them.”

Ramos and her colleagues set out to bring healthier diets to East Harlem, a low-income neighborhood with some of the highest rates of obesity and diabetes in New York City. The community also has an extremely high density of fast food and take-out restaurants.

Researchers attempted to change attitudes with the Healthy Plate for a Healthy Weight initiative, in which restaurant owners were asked to give instructional, bilingual plates — inscribed with nutritional guidelines — to each customer. While many customers didn’t use the plate, 75 percent of those who did reported eating smaller portions, while 100 percent reported eating more vegetables.

A second part of the initiative, called Save Half For Later, called upon restaurant servers to ask customers: “Would you like to save half your meal for later?” If customers answered yes, servers would wrap half the selection in a to-go box.

Across the country, presenters from the University of Iowa sought to promote nutrition through local media. According to researchers, 86 percent of rural adult Iowans read a local newspaper every week.

“To influence rural newspapers to include a great number of, and more, accurate stories about healthy eating, it is essential to understand the perspectives of editors,” said Faryle Nothwehr of the University of Iowa College of Public Health.

The school’s case studies found that 100 percent of editors thought readers were interested in healthy eating topics, but only 43 percent felt encouraged by readers to include nutrition-related stories. Nothwehr said that editors found difficulty “localizing” nutrition stories without a human interest angle.

Prince George’s County “has it all in terms of people,” said presenter Diane Hill Taylor of the Prince George's County Health Department in Maryland. With a mix of affluent and low-income areas, the department has to share information in equally varied ways. But before receiving a Community Transformation Grant from the Centers from Disease Control and Prevention, the task proved difficult.

“People knew their grandma’s health department, but it was important to let (county) residents know we’re a new health department,” said presenter Stephanie Cook McDaniel, also with the Prince George's County Health Department. “Our residents were far more tech savvy than we were, so our leadership said we’ve got to get better.”

Through its grant, the department renovated with a dramatic social media push, including roughly 250,000 messages disseminated to its residents every Friday. Free flu shots and “Take Your Loved One to a Doctor Day” communications are changing attitudes in every pocket of the county, McDaniel said.

“By the time our (grant) ends in September 2014, we’ll just be hitting our stride,” she said.

— D.G.

Above, researchers from the Mount Sinai School of Medicine partnered with the Communities Impact Diabetes Center on a food initiative called Save Half For Later. In East Harlem, restaurant servers ask customers if they would like to save and box half of their order for a later meal. Video courtesy Communities Impact Diabetes Center

Awards season

Last night, Annual Meeting attendees gathered to cheer on some of the best and brightest in public health at the APHA Public Health Awards Reception & Ceremony. Also during the reception, APHA presented a check for more than $13,000 to Groundwork Lawrence, a local organization working to create healthier communities. The donation was made possible by APHA members who participated in this year's Help Us Help Them campaign. Above are photos of just a few of the night's recipients.

From top to bottom: Past APHA President Deborah Klein Walker, on right, presents Andrea Gielen, director of the Johns Hopkins Center for Injury Research and Policy, with the APHA Award for Excellence; Rex Archer, director of health in Kansas City, Mo., accepts the Milton and Ruth Roemer Prize for Creative Public Health Work; Shelley Hearne, managing director of the Pew Health Group of the Pew Charitable Trusts, accepts the APHA Executive Director Citation; and a representative from Groundwork Lawrence accepts a donation from APHA's Help Us Help Them campaign. Photos by Jim Ezell/EZ Event Photography

Building safer workplaces for construction workers

Safety audits of 171 construction sites in New Jersey turned up only eight harnesses, which can protect workers from falls, according to an Annual Meeting session on Tuesday that focused on construction worker health and safety.

Only 43 percent of the construction workers wore hard hats, 32 percent wore hearing protection and 34 percent wore eye protection, according to audits conducted in 2010–2012.

Lack of fall protection and shoddy scaffolding were major problems, said presenter Elizabeth Marshall, of Rutgers University.

“Scaffolds, which are used quite a bit in urban construction, were generally poor,” she said. “They seemed to be slapped up with whatever they could think of. There was very little fall protection and there was a mish-mash of platforms.”

Previous research has shown that Hispanic construction workers have a higher rate of injuries, so researchers in Massachusetts set out to create an intervention and training program to try to increase the focus on safety.

Presenter Luz Stella Marín and her team from the University of Massachusetts-Lowell targeted construction supervisors, who have the power to improve working conditions. They conducted pre- and post-testing after a five-hour supervisor training that focused on protective equipment, social support, and non-retaliation against workers who speak up about unsafe workplace conditions.

The training addressed the supervisors’ responsibility to create a culture of safety and taught them how to analyze job hazards and create a safety plan. The training also increased knowledge of how to prevent falls and reduce silica exposure.

Pre-test, the supervisors said they understood silica dangers, but further questions revealed they were actually talking about asbestos and weren’t as informed about silica. Breathing in silica dust, which is commonly found in building materials, can permanently damage a worker's lungs.

In the follow-up survey of contractors’ attitudes toward safety three to six months later, evaluation scores improved 26 percent, Marín said.

“One supervisor said he had never worn hard hats before [our training],” she said.

Following the study, a train-the-trainers program was implemented.

“Now we have 10 trainers who are permanently teaching our program,” Marín said. “We believe that construction safety intervention that is focused on the key people that have the opportunity and power to change the workplace will be most successful. These types of trainings that focus on the construction supervisor help avoid [incidences in which] workers are blamed for injuries [even though] they don’t have the possibility to change their worksite conditions.”

— M.P.

Call to action on climate change

This past Monday, APHA members jumped into action again. Members of the Climate and Health Topic Committee, a group of APHA's Environment Section, let their public health voices be heard at a special listening session hosted by the U.S. Environmental Protection Agency at their Boston-based New England offices. The session was held to gather public input on the agency's upcoming carbon pollution standards for power plants, which are the largest single source of carbon pollution in the nation. If you'd like to submit comments to EPA too, click here or email

Above, APHA members call for action on climate change outside the EPA offices in Boston. Photo courtesy the APHA Environment Section Climate and Health Topic Committee

The calm after the storm: Public health leaders reflect on preparedness after Hurricane Sandy

David Abramson remembers a 2008 preparedness forum in Queens, N.Y., where a woman from the Rockaways asked New York City Department of Health and Mental Hygiene officials how her neighbors — especially the elderly — would get out of their high-rise apartment in case of a disaster.

“They said, ‘Don’t worry. We’ll call you. We’ll tell you what to do,’” said Abramson, deputy director of the National Center for Disaster Preparedness. “And that was it. It was actually kind of stunning.”

Abramson said he wonders what happened to her after Hurricane Sandy stormed its way through the Rockaways — one of the areas hardest hit a little more than a year ago on Oct. 29, 2012. Abramson spoke Tuesday at an APHA special session on lessons learned in the aftermath of the hurricane, which battered the Northeastern U.S.

Public housing in areas such as the Rockaways took major hits during the storm. Nearly 80,000 residents at 400 New York City Housing Authority buildings were affected, said Peggy Shepard, executive director and co-founder of West Harlem Environmental Action Inc. — also known as WE ACT for Environmental Justice. Residents on higher floors sheltered in place during the storm without electricity, extra food or medication for weeks, she said.

Multiple groups, such as the city’s housing authority and the city’s health department, are now partnering to create a training tool that prepares apartment residents on what to do in the event of future disasters. They're looking for public housing residents to join focus groups and help create a culture in which residents gain the skills to protect themselves and their neighbors in an emergency.

“We’re really looking forward to getting to work on this because we have not found the city or the state is thinking about human resilience,” Shepard said.

Shepard said mold and unrepaired leaks remain a problem in empty ground-floor apartments, which can worsen and aggravate conditions such as asthma, said Kim Knowlton, senior scientist with the Natural Resources Defense Council’s Health and Environment Program.

Mold removal is not a “quick and easy” fix, and in New York state, 370,000 children and 1.1 million adults are living with asthma, Knowlton added.

Knowlton suggested updating housing policies to target children with asthma problems in public housing. She also suggested asthma be listed as a condition under the Americans with Disabilities Act so it’s accounted for in indoor air quality standards.

“It’s not just about exposure, it’s about underlying health vulnerabilities,” Knowlton said.

Knowlton said there needs to be a “significant bridge” between the public health and emergency risk management communities in the wake of future storms as powerful as Sandy. The time to build is now, she said.

“It’s like looking at our grandkids and saying ‘I don’t care about you. You don’t matter to me,’” Knowlton said. “We have to prepare. We have to do it now. It’s totally urgent.”

— N.M.

Tuesday's storyboard

Enjoy some of the best moments from Tuesday's Annual Meeting activities, courtesy APHA Storify.

Tuesday, November 5, 2013

Wednesday’s Have You Heard

Last chance for booth hopping: The Public Health Expo closes its doors Wednesday at 12:30 p.m., so don’t miss out on hundreds of exhibitors before they pack up and head home. Among this year’s Expo highlights, the APHA Public Health Policy Center booth, #1283, is hosting an official Affordable Care Act navigator, who can help you shop the new Health Insurance Marketplace to find a plan that’s right for you.

Peace and good health: Sometimes the world can be a scary place. And for those people in the middle of it, public health can make a difference. Learn what you can do at session 5035, “Public Health Impacts of Migration, Civil Unrest and War,” from 8:30 to 10 a.m. in room 260 of the Boston Convention and Exhibition Center. During the session, you’ll hear from presenters on improving health among veterans, immigrants and refugees.

What a waste: With all the money Americans spend on health care, you’d think we’d be the healthiest nation on the planet. But we’re not — far from it. Join your fellow public healthers to explore how we can be smarter in how we spend our billions of health care dollars at session 5092, “The Waste in Healthcare: Spending $750 Billion More Wisely,” from 10:30 a.m. to noon in Grand Ballroom A of the Westin Waterfront.

Act local: Take some tips from Massachusetts and learn how your state or local public health association can help implement health reform during session 5145, “The MA Model and the Role of Local Public Health Associations in the Affordable Care Act," from 12:30 to 2 p.m. in Westin Waterfront, Webster.

A session to send you off: Don’t miss today’s Closing Session from 2:30 to 4 p.m. in Grand Ballroom West of the convention center. The session will focus on “Improving the Health of Native People: A Public Health Approach” and feature keynote speaker Evan Adams, who served as British Columbia’s first Aboriginal health physician advisor and in 2012 was appointed deputy provincial health officer for Aboriginal health.

Creating the 'ideal doctoral student’

These days, just 6 percent of scientific doctoral degrees are going to minority students, but a program at one of the nation’s most diverse schools is taking steps to change that.

California State University-Long Beach is reaching out to promising science students and guiding them through the process of attaining advanced degrees in health and other science fields, according to Britt Rios-Ellis, director of the school’s Center for Latino Community Health, Evaluation and Leadership Training. Rios-Ellis spoke as part of a panel on how to engage more minorities in public health, which took place during a Tuesday Annual Meeting session on public health workforce development.

“Our goal is to support racial and ethnic minority students to become skilled researchers,” she told session attendees.

The Research Infrastructure in Minority Institutions, or RIMI Project, is working to create a pipeline that will lead students into the behavioral and biomedical sciences via mentorships, training and research experience. It also seeks to increase interest in health disparities research.

The project takes minority students — three to five per year — who are enrolled in the university’s master’s program and are in good academic standing and grooms them for further work in the sciences. Specifically, the program looks for students who have an interest in health equity research and experience working in ethnically diverse populations.

Since the program began in 2009, it has hosted students from numerous backgrounds, including Mexican, Honduran and Nigerian. About 58 percent speak Spanish, Rios-Ellis said.

“What we’re really trying to do is to create the ideal doctoral student,” she said.

Because the programs have become so competitive, getting accepted into a California school is “harder than getting into Hopkins and Harvard,” she added.

Students in the program enroll in a graduate course on health disparities, attend bimonthly research skills training, present at national conferences and work as research assistants.

“We really want to build their CVs,” Rios-Ellis said.

So far, the results have been good. About 50 percent of students are admitted right away to PhD programs, one student is attending medical school and another is seeking an advanced degree in England.

— C.T.

Future public health leaders

Epi-what? Many high school students may not even know how to say “epidemiology,” let alone know what it is or be enrolled in an epi course.

But 15 Virginia high school seniors taking an epidemiology seminar are attending the APHA Annual Meeting to learn how epidemiology is used in the real world. The students attend Maggie L. Walker Governor’s School, a magnet school for government and international studies in Richmond, Va., and were awarded a grant to support their trip to Boston.
Many of the students are interested in a health career, soaking up the information offered at Annual Meeting sessions and the Public Health Expo. They eagerly discussed the research and ethical issues they learned about in sessions on corporate monopolies and the global food supply, the epidemiology of criminal violence in relation to the Sandy Hook school shooting, and the effects of cancer survivorship on diet and family stress.

In fact, the students didn’t miss the opportunity to start networking with public health professionals — they already spoke with representatives of APHA’s Health Informatics Information Technology Section about potential partnerships.


Above, high school epidemiology students from Richmond, Va., visit the APHA Annual Meeting and Exposition in Boston. Photo by Melanie Padgett Powers

Rewatch Sarah Weddington's best Opening Session moments

Don't forget to check out video of Opening Session speaker and Roe v. Wade attorney Sarah Weddington, who reminded thousands of Annual Meeting attendees that "leadership is the ability and the willingness to leave your thumbprint."

For this and more video from the Opening Session, visit APHA's YouTube channel.

APHA adopts 17 new policies

Earlier today, APHA’s Governing Council adopted 17 new policies that will lead the Association in its work to improve the public’s health.

The new policies address issues such as paid sick leave, opioid overdoses, noise pollution, access to nature, solitary confinement and much more. To read brief descriptions of the newly adopted policies (full policy descriptions will be available early next year online), view our news release.

The ACA needs you!

If you build it, they will come.

Unfortunately, the famous movie line isn’t so true for health care reform, said Karen Pollitz, moderator at a Tuesday Annual Meeting session on Affordable Care Act navigators and assistors.

“Health care reform is finally here, after years of waiting,” Pollitz said, however public awareness of the law’s provisions and how it all works is on the low side.

But public health practitioners can make a difference. Regardless of what state you live in, there are ways public health professionals can help spread the word and get people insured, said presenter Jessica Kendall of Enroll America.

First, Kendall shared a few success stories. Despite the website struggles, several states are doing just what was intended: lowering their ranks of uninsured. Oregon has already reduced its uninsured population by 10 percent and Arkansas by 14 percent, Kendall reported at the session. Kentucky is leading all 50 states with its success story, enrolling more than 32,000 residents — more than 1,000 a day — in health plans.

According to Kendall, past research shows that almost everyone in the United States, 91 percent, believes health insurance is necessary or very important. Cost and affordability are the biggest barriers, while financial and health security are the biggest motivators. Still, there is deep skepticism and confusion among consumers, she said.

To educate consumers about the health care marketplace, Enroll America recommends using the following four key messages, which resonate with 89 percent of the population, including 87 percent of the uninsured:

1. All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room care and prescriptions. “Let them know that coverage is available that will cover all the care they need because they’re starting from a place of not believing that,” Kendall said. “Essential health benefits” is too wonky to say to the average person, she added, so give illustrative examples instead.

2. You might be able to get financial help to pay for a health insurance plan. “Because if it’s that good of care, they are going to think they can’t afford it,” she told the audience.

3. If you have a pre-existing condition, insurance plans cannot deny you coverage.

4. All insurance plans will have to show the costs and what is covered in simple language with no fine print. “Anyone who has had to apply for coverage in the past knows that it’s complicated and it doesn’t make sense,” Kendall said.

“If you’re thinking about what you can do, it’s know these and share these,” she said. Also, know where people in your state can go for help — every state has navigators.

To learn more about health care reform, see APHA’s online Health Reform Resources.

— M.P.

A little birdie told me so: Tweet of the day

Today's tweet of the day goes to @raxrun, an Annual Meeting attendee all the way from New Zealand, who tweeted: Suitcase was already jam-packed for trip to #APHA13 but will need to squeeze heaps of great resources in for return. Worth it.

Thanks @raxrun! Glad you could join us!

Dental project in Zambia opens door to broader efforts

Bringing an oral health program to a country where such services are limited has the potential to make a major impact on residents — one that stretches even beyond healthy teeth.

In a Tuesday Annual Meeting session on global oral health efforts, Kerry Maguire of the Forsyth Institute in Cambridge, Mass., discussed her work in Zambia and the ways that building an oral health program in an isolated area has transformed a village.

In 2004, Maguire, a dentist who typically works with Boston-area kids in the Forsyth Institute’s dental health program, began traveling to Zambia to treat children in an orphanage. When her team arrived, less than half of the kids had no dental problems that required treatment. Now, with yearly follow-ups and education about oral health care, that figure is closer to 80 percent. The only kids who now present with major dental issues are those who are new to the orphanage and haven’t seen a dentist before.

“That’s what I love about oral health,” she said. “You can get in there and really mop up disease pretty quickly.”

Next, Maguire and her companions traveled to Muchila, a small village two hours by car from the nearest hospital, where conditions were considerably different than what dentists are used to in the U.S.

The village had no running water and no electricity beyond a few solar panels. Those problems, combined with Zambia’s 14.5 percent HIV infection rate, made working conditions difficult.

The trip to Muchila has become an annual one — last year they saw 800 patients in just three days — and one that the group bolsters by recruiting locals to help sustain the oral health message after the team leaves.

Everyone who is seen by the dental care team receives a fluoride varnish application as well as a toothbrush and toothpaste.

However, the dental project is opening the door for other health efforts in Muchila as well, including two more water boreholes, a microfinance project to teach local women skills such as bead-making and help them gain economic independence, and the construction of a maternity hospital. And now, each year, when the dentists visit Muchila, an HIV prevention nurse tags along.

“One of the best things to come of this was the interdisciplinary approach,” Maguire said. “The magnetism of a dental component can’t be overestimated. Providing this least accessible service has opened the door to other health providers.”

— C.T.

Don't miss APHA's Social Media Lab!

Today's the last day to check out APHA's new Social Media Lab, where you can get expert one-on-one help in developing a social media strategy that fits your public health goals. Click here to book an appointment online or stop by the lab in-person to inquire about open time slots, pick up informational materials or just join the social media discussion. The lab is open today until 6 p.m. in the southwest lobby of the Boston Convention and Exhibition Center.

Above, Annual Meeting attendees take advantage of the new Social Media Lab. Photos by Michele Late, courtesy The Nation's Health

Excessive texting increases risk of cyberbullying; sexual minorities face higher school violence risk

Nearly half of Los Angeles middle schoolers send more than 50 text messages a day, which increased their risk of being a victim or perpetrator of cyberbullying, according to researchers who presented today at a session about violence and bullying in schools.

Other reports have shown that up to 28 percent of middle school students are perpetrators of cyberbullying, while up to 34 percent are cyberbullying victims, said presenter Robin Petering, of the University of Southern California School of Social Work.

“Cyberbullying is different from traditional bullying in a couple of ways: It can be anonymous, you can be victimized in your own home, it can come across in various different platforms, and it can have a larger audience,” Petering said.

Researchers analyzed a survey of 1,285 students in grades sixth through eighth in the Los Angeles Unified School District. They also found that 70 percent of the students have cell phones, 53 percent have smartphones, 27 percent use the Internet three times or more a day, and 54 percent have Internet rules at home.

The most likely way to be bullied was via Facebook, at 63 percent, followed by texting at 29 percent. Thirty-seven percent of students were bullied in more than one venue.

“We found cyberbullying is really more of a female-oriented phenomenon, which is different from what we know about traditional bullying,” Petering said.

Sexual minority students are also at increased risk for cyberbullying, as well as traditional bullying. As shown in session presenter Emily Olsen’s study, sexual minority students were consistently more likely to feel threatened, bullied or afraid to go to school than their heterosexual counterparts.

“We know that victims of school violence and bullying are a lot less comfortable attending school; they feel unsafe, less connected, perform poorly academically and are more likely to drop out of school than their nonvictimized counterparts,” Olsen said.

Olsen, with the Centers for Disease Control and Prevention, used the CDC’s Youth Risk Behavior Surveillance Survey to study 71,950 students in 10 states and 44,199 students in 10 districts and cities.

In the districts, 26 percent of bisexual males and 25 percent of gay males had been threatened or injured with a weapon on school property, compared with 9 percent of heterosexual males. Fifteen percent of lesbians and 11 percent of bisexual females in the districts experienced threats or injuries, compared with 5 percent of heterosexual females.

Nine percent or more of sexual minority students stayed home from school at least one day in the past month because they felt unsafe at school or on their way to school. Furthermore, sexual minority males were three times more likely than heterosexual males to miss school because of fear.

“Sexual minority students are routinely experiencing these increased risks for school violence and bullying, and that puts them at increased risk for suicide and other mental health problems, multiple other health risk behaviors, as well as poor academic performance,” Olsen said. “These indirect risks have the potential to be, over the course of their life, really detrimental.”

Olsen shared three evidence-based strategies schools can implement to help prevent bullying among sexual minority students:

•    Implement school anti-bullying policies with language that includes prohibition of harassment on the basis of sexual orientation or identity.
•    Create a student gay-straight alliance.
•    Institute small-scale interventions, such as having teachers supervise hallways and having an adult advocate who is well known for being supportive of sexual minority students.

To learn more about the connections between school environments and health, visit APHA’s Center for School, Health and Education.  

— M.P.

Into the mix

APHA Annual Meeting attendees catch up, take a break and plan their days in the Mix and Mingle Lounge in the north lobby of the Boston Convention and Exhibition Center.

Photos by Jim Ezell/EZ Event Photography

Smoking bans bad for business? Hardly.

Smoking bans in bars and restaurants are common in many parts of the U.S., but they still frequently face opposition from workers and proprietors who worry that the bans will hurt business.

But to the contrary, such bans rarely have a negative effect on business and their potential for reducing exposure to secondhand smoke make them an important part of safeguarding employees against the dangers of tobacco smoke, according to researchers at a Monday afternoon session of APHA's 141st Annual Meeting and Exposition.

“There is no risk-free level of exposure to secondhand smoke,” said session presenter Cristina Gibson. “Breathing even a little secondhand smoke can be harmful to your health.”

In fact, research shows that 40 percent of adults who work in places where they're exposed to secondhand smoke have heart disease.

Still, bars and restaurants in Savannah, Ga., where a smoking ban had recently been passed, were wary of the effect the ban would have on their businesses. They worried that patrons would go elsewhere.

So the researchers conducted interviews in January 2011, just as the smoking ban went into effect in the city. They talked to patrons and employees as well as bar owners and managers to gauge each group's impressions of the ban's effects.

They found that more than half of patrons supported the ordinance and about 33 percent opposed. Supporters cited better air quality as the best effect of the law. Those opposed worried about business owners' rights to decide for themselves whether smoking would be allowed. Some also thought the ordinance infringed on individual rights to smoke.

However, employees of bars and restaurants affected by the ban supported the ordinance by nearly 70 percent. They cited air quality improvements as well as easier clean up of upholstery and equipment.

Bar owners and managers also generally supported the law, both because it made the bar atmosphere more pleasant and did not, for the most part, have a negative effect on business.

Their one complaint had to do with litter. Now that smokers were being forced to go outside to smoke, they were leaving cigarette butts on the ground outside bars, which owners were responsible for cleaning up or else they'd be fined by the city.

Some owners and managers also noticed that customers were frequenting the bars less often, but the affected bars were most often located on the edge of town. By crossing the street, the patrons could be outside the city and in the county's jurisdiction, where for a while at least, smoking in bars was still permitted.

“Then the county adopted its own smoking ban and the playing field was again level,” Gibson said.

― C.T.

Monday's storyboard

Catch up on what happened yesterday at the APHA Annual Meeting and Exposition, courtesy APHA Storify.

Monday, November 4, 2013

Tuesday's Have You Heard

Tragic lessons: The aftermaths of Superstorm Sandy and the mass shooting at Sandy Hook Elementary School will be the focus of discussions at two special sessions, both running from 10:30 a.m. to noon. Session 4090, "Preparedness Lessons from Hurricane Sandy," will gather in room 205A of the Boston Convention and Exhibition Center and examine the role of public health, climate change implications and resilience within New York City's public housing community. "Sandy Hook: Reflections & Solutions," session 4091, will offer a parent's perspective of the shootings as well as a policy perspective. The Sandy Hook session will take place in room 253A of the convention center. (Check back here Tuesday afternoon for coverage of the Superstorm Sandy session.)

Get graphic: Find it difficult to put public health's return on investment into words? Well, we're here to help. Check out session 4188, "Public Health is ROI: NPHW Infographic Session," from 12:30 to 2 p.m. in Commonwealth Ballroom B of the Westin Waterfront. The session will feature presentations from the winners of last year's NPHW infographic contest. And click here to view the super cool infographics for yourself.

Transformers: Learn about the people and communities taking charge of their health thanks to the Affordable Care Act's Prevention and Public Health Fund during session 4284.1, "Lessons Learned from Community Transformation Grant Communities," which takes place 2:30 to 4 p.m. in Westin Waterfront, Quincy.

Into the blue: They cover most of the Earth's surface, so it's not surprising that the world's oceans and their inhabitants are connected to human health. Learn more about those connections during session 4393, "Our Planet's Blue Heart: The Interrelationships Among Human Activity, Oceans, Seafood and the Public's Health," from 4:30 to 6 p.m. in room 152 of the convention center.

The envelope please: Celebrate the achievements of your fellow public health workers, advocates and supporters at APHA's Public Health Awards Reception and Ceremony. The event starts at 6 p.m. and runs until 8:30 in Grand Ballroom West of the convention center.

Film fest depicts sexualized culture

As 12-year-old Winnifred walks down a New York City street, we see the city from her eyes, as she is assaulted by billboard after billboard of nearly nude women in a variety of sexual poses.

We are there when a young adult woman talks to a physician about her desire for labiaplasty, a cosmetic genital surgery. She’s concerned that her labia is too large and wants it to look more “normal,” like the women in porn videos.

We watch as a 4-year-old dances in her house, gyrating on the floor and making kissing faces like the singer in the video she’s watching.

The film “Sexy Baby” shows us image after image of Madison Avenue billboards and magazine ads, as well as online porn sites and scenes at a strip club. The ads on the public street aren’t that much different from the X-rated scenes.

As shown in the movie, the adult entertainment industry is becoming mainstream, said film co-director Ronna Gradus at a session of the APHA Film Festival held earlier today.

“One thing we’ve constantly been hearing from kids is that sex ed is awful, that it’s completely out of touch and hard-core online porn is their sex ed,” said Gradus, who appeared at the film fest with co-director Jill Bauer.

Today, four films were shown, focusing on the objectification and sexualization in our culture and the importance of empowering girls.

The film “Miss Representation” shows us that each week teenagers are exposed to:

31 hours of TV
17 hours of music
three hours of movies
four hours of magazines
10 hours online

As film fest co-chair Pamela J. Luna said: “We are up against a great force in our society — the media.”

“Miss Representation” addresses the message that many girls and young women receive every day: That it’s not about what they have achieved or how smart they are, but whether they’re young and beautiful.

“The film has such a huge potential to spark conversation,” said Jessica Lee, distribution director for the film and the Representation Project. “People have come up to us and said, ‘This has helped me understand the media landscape, that my daughters and sons are facing a very different family hour than I grew up with.’”

In the film “Girl Rising,” we learn that 33 million fewer girls than boys attend school worldwide. The film includes nine chapters, telling the story of nine girls around the world and how the lack of education has affected them. But it’s an inspiring film, as we learn what these girls ultimately achieve.

In “Stop Objectification,” fashion designer Norma Kamali showcases four women’s experiences of being harassed and belittled in their lives because they were women. She started her campaign in 2010 to call attention to the issue and to empower women.

Many of these films are more than movies; they've started grassroots movements. To get involved, visit the films’ websites, which provide school curriculums from elementary through college as well as information on how to host screenings and get involved on social media.

— M.P.

Video from the Opening Session is here!

Missed the Opening Session? No problem! Visit APHA's YouTube channel for video of yesterday's speakers.

Above is the first part of the session's keynote presentation from internationally acclaimed epidemiologist Michael Marmot, who spoke to thousands of public health workers about the social determinants of health and health inequity.

R U ready?

Technology’s role in public health is not a new development, but with each passing year, public health professionals are finding new ways to embrace technology and use it to their advantage, according to speakers at a Monday session on the use of social media and mobile apps to disseminate information about emergencies.

And the Centers for Disease Control and Prevention is at the forefront of these efforts, as highlighted by the agency’s work preparing for and responding to Superstorm Sandy in 2012.

Sandy was the No. 2 most talked-about topic on Facebook in 2012, 1.1 million people mentioned the word “hurricane” within a 21-hour period of the storm’s landfall, and at the height of posting, 10 storm-related pictures were posted to Instagram every second, said Jay Dempsey, a health communications specialist who presented at the session.

The bad news is that social media can also be a key way of sharing misinformation — a point driven home by the fact that a Photoshopped image of a storm looming over New York has become one of the most popular images associated with Sandy, although it is completely fictional, Dempsey said.

CDC prepares for emergency events by combing its websites and preparing materials that can quickly be tweeted out to followers before, during and after a storm or other emergency event. The agency has a plan in effect that includes phases of information – everything from how to prepare for an event such as a storm to how to respond even weeks later.

For instance, in the aftermath of Sandy, @CDC_DrPortier, the Twitter handle of then-director of CDC’s National Center for Environmental Health, linked to a CDC Web page that provides information on cleaning up mold. In the weeks after that storm, the site clocked 14,000 hits, whereas it had only about 700 in the weeks before the Tweet.

“Retweets are key,” Dempsey said, explaining how the message could spread far beyond Portier’s followers when others repeated it. “Retweets really amplified the messaging. We would post and then it would be shared on other channels and would ripple throughout state and local and individuals.”

There’s little doubt about the importance of social media, but other presenters noted that it can be difficult to spread the word to those who need it most during or after an emergency. If phone lines, cell towers and electricity are out, those most in need of response messages might be those least likely to receive them, said Rahul Gupta, of West Virginia’s Kanawha-Charleston Health Department.

To address the problem, the county developed KCHD Ready, a free app available to smartphone users that lives on the phone’s memory card rather than online. That way, if cell towers are down, people can still access information about disaster preparedness as well as maps detailing how to evacuate from the area, whom to contact in the event of an emergency and links to other important information.

— C.T.

Public health and the power of law

Public health workers would be more likely to respond in emergencies if the law guaranteed they would receive personal protective equipment and recovery services, according to preliminary data presented today at an Annual Meeting session on law and the public health workforce.

For instance, more than 75 percent of public health workers said they would be more willing to respond to incidents of anthrax or bioterrorism, a dirty bomb or pandemic flu if they knew they’d have the proper equipment. For a weather-related event specifically, 83 percent said they would be more willing to respond if equipment was guaranteed.

Researchers questioned 1,100 urban and rural public health workers in Florida, Minnesota and Missouri. They examined public health workers’ willingness to respond to disasters if state laws guaranteed them things like family priority access to health care for any condition related to the emergency as well as individual access to mental health services during and after the response.

But what are the implications to policy and practice, asked presenter Lainie Rutkow, a public health lawyer at Johns Hopkins Bloomberg School of Public Health. Is it ethical to give certain people priority access to health care? Would guaranteeing personal protective equipment be an unfunded mandate?

“And for something like provision of mental health services during an actual disaster response, how would something like that be operationalized?” Rutkow asked.

Mark Pertschuk, director of Grassroots Change in Oakland, Calif., also examined how law affects public health locally. He noted that grassroots movement building is much more effective than the use of “pre-emption,” which can get in the way of strong local efforts. Pre-emption is when state laws supersede local ordinances that communities have already enacted.

For example, Pertschuk took session attendees through the history of legal requirements for fire sprinklers in homes. While an effective sprinkler head was patented in 1874, the safety tool is still mostly used in commercial buildings.

However, 85 percent of all fire deaths occur in one- to two-family homes. In 2010, there were 3,120 fire deaths (excluding fire fighters) and 17,720 injuries, according to Pertschuk.

“While the numbers of those who are impacted directly by this are smaller than, for example, alcohol-related problems or tobacco, the nature of these deaths and injuries resulting from fires are often very expensive and very horrific,” he said. 

As of 2011, there were 368 local ordinances requiring fire sprinkler system installation in all new residential buildings, while only two states have statewide requirements. The numbers show the power of grassroots movements, Pertschuk said, and represent a diversity of political leanings.

“These are not blue states or red states,” he said.

As a result of the movement for better fire safety, California and Maryland passed statewide codes. But it was not until 31 communities in Maryland and 146 in California had passed local ordinances.

“That illustrates the innovative power of local public health policy advocacy,” Pertschuk said.

— M.P.

Photos by Melanie Padgett Powers


APHA is all smiles! From top to bottom, attendees smile for the camera at the APHA Membership booth at the Public Health Expo; attendees enjoy the LGBT Caucus of Public Health Professionals Networking Social Hour; lucky expo visitors get a seat in massage chairs; and this meeting attendee even smiles as she's getting her flu shot at the Walgreens expo booth.

All photos by Michele Late, courtesy The Nation's Health

Which nutrition labels are most helpful to shoppers?

Grocery shopping for nutritious food can be overwhelming for even the most educated consumer, as illustrated by preliminary studies presented today at APHA’s 141st Annual Meeting and Exposition.

While there is no standardization of front-of-package nutrition labeling, the Institute of Medicine has proposed a graded star rating system. The food industry, however, is already using Facts Up Front, which displays nutritional information on the front of packaging.

Researchers examined consumer reaction to five different labeling systems to determine which helped them accurately identify healthier products, accurately compare nutrients among products, and ultimately purchase a healthier product.

In an online survey, approximately 1,000 participants were shown various food labels and asked to buy items. Two systems performed better than the others: the NuVal Nutritional Scoring System, which rates food from 1–100 based on nutrients, and a multiple traffic light labeling system, with green being healthier than yellow, which is healthier than red.

The NuVal system, which was developed by an independent panel of nutrition and medical experts, shows the information on shelf price tags and is currently being used at participating supermarket chains.

“I think the big message from this is the Institute of Medicine symbol didn’t really shine in any of these outcomes,” said session presenter Christina Roberto, a Robert Wood Johnson Foundation Health and Society Scholar at the Harvard School of Public Health.

In fact, the IoM star rating system seemed to confuse consumers — people saw a star and thought a product was healthy when it wasn’t.

Presenter Dan Graham, a psychology professor at Colorado State University, also found that certain labeling techniques fare better than others. Graham is using eye-tracking cameras to show which areas of packaging people look at.

Preliminary data of 153 parents showed they viewed nutrition labels, which are now on the backs and sides of packages, 279 times, compared with viewing front-of-package labeling 1,442 times. Further analysis showed that people weren’t just accidentally glancing at the labels either.

“It does seem to be an intentional effort to look at [front-of-package labeling], but there appears to be little understanding of how to use them effectively,” Graham said. “A key piece of whatever system is adopted [needs to include] more education of how to use these products and what they mean.”

— M.P.

A little birdie told me so: Tweet of the day

Well, this is definitely a new one for APHA.

Today's tweet of the day (and a big Congratulations!) goes to @derrhea, who wrote: He proposed at #APHA13 :-) I said Yes!

How about an APHA wedding, too? I hear New Orleans is nice in November :)

U.S. health lags behind peer nations

Steven Woolf said he usually tells his audience to take an anti-depressant before he discusses the report he presented Monday morning at APHA’s 141st Annual Meeting and Exposition.

That’s because there’s very little good news in his report comparing health in the U.S. to 16 peer nations.

We have the second highest mortality from noncommunicable diseases.

We’re fourth highest in death from communicable diseases.

And men in the U.S. have the lowest life expectancy at birth than men in 16 other countries. Women don’t do much better: they’re 16th out of 17.

Is there any good news? A smidge. The U.S. is good at keeping older people alive.

“For every five year age group from birth to age 75, the U.S. ranking for life expectancy is either at the bottom or near the bottom,” Woolf told a standing-room-only crowd at the morning session. “Older age groups appear to [fare better].”

Those figures show that the shorter U.S. life expectancy cannot be tied to diseases of middle age or infant mortality, Woolf said.

“We’re seeing a pervasive problem across all age groups,” he told attendees.

The Institute of Medicine report Woolf was presenting, “U.S. Health in International Perspective: Shorter Lives, Poorer Health,” compared health in the U.S. with 16 peer countries — generally democracies with large economies and high incomes.

One of the findings is that the situation appears to be getting worse, not better.

In 1980, for example, life expectancy for U.S. women was about average — in the middle of the peer group. But since then, U.S. women have joined men at the bottom of the heap.

On specific measures, the U.S. is not gaining ground as fast as other countries. For example, from 1995 to 2009, mortality from transportation accidents fell about 40 percent in the 17 countries studied, Woolf said. But it fell just 11 percent in the U.S.

Reasons for the unhealthiness of Americans are myriad, but according to the report, they include lack of access to preventable care, higher rates of drug abuse, consumption of more calories per person and higher rates of poverty.

Despite all of these problems, Woolf reported that Americans’ perception of their own health is actually a high point of the study.

“Americans are much more likely to rate their health as excellent than people in other countries,” he said.

To download a copy of the IoM report, click here.


The alternative approach

Some APHA Annual Meeting sessions take a more interactive approach to sharing best practices, such as this Monday morning session of roundtable discussions on complementary, alternative and integrative health practices.

Above from top to bottom: HIV researcher Michelle Teti, with the University of Missouri, discusses how to use the concept of “photovoice” — taking photos to express yourself and share ideas — to improve the quality of life among people living with HIV.

Wendy Thompson, of Andrews University in Berrien Springs, Mich., on the left, and Sister Rose Carmel Scalone, with LaSalle University in Philadelphia, participate in one of the session’s roundtables.

And Kathleen Miller, with the Benson-Henry Institute for Mind Body Science at Massachusetts General Hospital, on the left, said she was fascinated by her discussion with Marlene Wilken, with Creighton University, about using American Indian talking circles for diabetes self-management.

— M.P.

Photos by Melanie Padgett Powers

More tube time equals less sleep

Kids who watch more television get less sleep, and kids with televisions in their bedrooms sleep even less, according to a study presented today at APHA’s 141st Annual Meeting and Exposition.

The study looked at 1,864 participants at age 6 months and every year from ages 1 to 7. Mothers reported the child’s average TV watching and sleep duration.

The study concluded that for each additional hour of television watching, children got seven minutes less sleep per day. Even that small amount of decreased sleep could be detrimental, according to presenter Elizabeth Cespedes of Harvard’s School of Public Health.

“Modest decreases in sleep due to TV [watching] or bedroom TV could lead to sleep deficits,” which can have major impacts, she said.

The study’s authors found that television viewing creeps up in duration over time, as does the presence of televisions in children’s bedrooms, which rose from 17 percent at age 4 to 23 percent at age 7. Racial and ethnic minority children were more likely than white children to have televisions in their bedrooms.

The difference in sleep effects of having televisions in the bedroom was clearest when white children were compared to racial and ethnic minority children, researchers found. Minority children with televisions in their bedrooms were estimated to get a full half hour less sleep than white children without televisions in their bedrooms.

— C.T.

APHA members in action

On Saturday, members of APHA's Community Health Planning and Policy Development Section participated in the group's third annual Community Action Day. This year, Section members partnered with Boston's Mattapan Community Health Center to organize HEY! Let's Eat and Dance for Good Health, a day of crafts, dance and health promotion.

Above, Mattapan community residents, health center staff and APHA members take part in fun and healthy activities, such as balloon arts and dancing. Also during the day of action, residents could get in-person help and advice in navigating the new Health Insurance Marketplace and finding affordable coverage.

Photos by Amy Carroll-Scott, courtesy APHA's Community Health Planning and Policy Development Section

The cartoon network

Good health is nothing to joke about, but there is certainly something funny about the twists and turns we take in our pursuit of it.

In the last year, two books have been released that rely on political cartoons to make the case about how we Americans relate to health and health care.

Marion Nestle, author of "Eat Drink Vote: An Illustrated Guide to Food Politics," takes a discerning look at everything from fad diets to the farm bill, all through the eye of political cartoons.

And APHA Executive Director Georges Benjamin is a co-author of "The Quest for Health Reform: A Satirical History," which follows efforts to enact meaningful change in the ways we deliver health over the years.

Both Nestle and Benjamin‚ along with "Quest for Health Reform" co-authors Theodore Brown, Susan Ladwig and Elyse Berkman, were on hand at the Public Health Expo on Sunday to sign their books and talk to fans.

"She's my hero," said Sarah Shimer, an APHA member who works on nutrition issues in Alaska, referring to Nestle, who is the Paulette Goddard professor in the Department of Nutrition, Food Studies and Public Health at New York University. "I think she has a realistic approach to public health nutrition."

Nestle's book deals with the problems of the U.S. food system — everything from low-carb diets to funding for agriculture and farming, all of which she writes are fertile ground for cartoonists.

"Cartoonists do more than entertain," she writes. "They tap into the emotional core of complicated concepts and convey at a glance what might otherwise take pages to explain."

Mary Pittman agreed.

Pittman, who works at the Public Health Institute in Oakland, Calif., bought copies of both Nestle's and Benjamin's books, saying she likes the way the cartoons can show different sides of the story.

"They allow us through satire to look at these thorny issues and maybe see that there is not just a single truth," she said.

To check out the books for yourself, visit APHA Press in the center of the Expo hall.

— C.T.

Sunday's storyboard

Below are some of the best moments from the first day of the 141st Annual Meeting and Exposition, courtesy of APHA's Storify.

Sunday, November 3, 2013

Monday's Have You Heard

Welcome to the lab: It's not what you think — there'll be no white coats, test tubes or Bunsen burners. This is APHA's new Social Media Lab, a chance to brainstorm just the right formula for using social media to reach your public health goals. The lab will offer one-on-one meetings with social media experts from APHA and, so click here to sign up in advance or stop by to learn more. Or just swing by to pick up informational materials or join the social media discussion. The Social Media Lab is open to Annual Meeting registrants on Monday and Tuesday from 10 a.m. to 6 p.m. in the Southwest Lobby of the Boston Convention and Exhibition Center.

Daily specials: Two APHA Special Sessions are scheduled for Monday's 8:30-10 a.m. slot. The first, session 3010 in Grand Ballroom A of the Westin Waterfront, focuses on "Prescription Drug Overdoses: Emerging Best Practices for Prevention" and will feature in-depth discussions about national and local strategies to curb the growing public health problem. The second, session 3012 in room 253A of the convention center, is titled "Shorter Lives, Poorer Health: A U.S. Global Perspective" and will explore how America's health stacks up to our global counterparts and why we seem to be lagging behind.

Stop the presses!: Tired of opening the newspaper to the latest health story and finding that the public health perspective is missing — AGAIN? Then make some time to attend session 3117, "Media Advocacy: Breaking Through the Crowded News Cycle," at 10:30 a.m. in convention center room 103. During the session, you'll hear from local health reporters on the best ways to pitch your public health stories to the media and get your message to the masses. Featured speakers include Kay Lazar of the Boston Globe and Michael Yudell of the Philadelphia Inquirer.

Post it: In addition to the meeting's oral scientific sessions, hundreds of poster sessions will be taking place throughout the Annual Meeting inside the Public Health Expo, Halls A/B1 in the convention center. Take a few minutes to stretch your legs, browse the poster sessions and talk with presenters about their research. Check your Annual Meeting program for each day's poster session times as well as research topics.

Madam President: Meet APHA's incoming president at session 3429, "APHA President-Elect Session: Best Practices in Public Health Leadership Development Around the World," from 4:30 to 6 p.m. in Harbor Ballroom III of the Westin Waterfront. Discussions will take you from India to the Caribbean and back to the U.S. with a focus on what it takes to become a public health leader.

Place and time

Above, Annual Meeting attendees all the way from Hawaii place stars on their home state on the "Tell Us Where You're From" map in the convention center lobby. Another meeting attendee reads about APHA's first black woman president along the Public Health History Trail, which you'll find on the convention center's first floor.

Photos by Michele Late, courtesy The Nation's Health

Roe v. Wade crusader stays overtime to hear personal stories

“Here is a woman doing something ahead of her time, standing up for what she believes in.” That’s what Mythili Ramakrishna thought when she first studied the landmark abortion case Roe v. Wade in a human rights class two years ago.

Today, Ramakrishna met that woman, Sarah Weddington, who was only 26 when she successfully argued the case in front of the U.S. Supreme Court more than 40 years ago.

Ramakrishna said it was very important for her to meet Weddington because as a young woman from India, Ramakrishna recognizes that “women leaders in India — a very paternalistic society — have a very, very tough time.”

Sarah Weddington signs her book for Mythili Ramakrishna, who was inspired by Weddington’s successful fight to make abortion legal in the U.S. 40 years ago. 

After giving a rousing keynote speech at Sunday’s opening session, Weddington rushed to the Public Health Expo, where she stayed for several hours signing copies of her book, “A Question of Choice.” She vowed to stay until every person waiting in the long line had a conversation with her.

“Some of them have talked to me about their desire to have a choice available to their daughters, so I signed [my book] to them and their daughters,” Weddington said. “I’d much rather sign the book in a meaningful way.”

This meant she continued to hear dozens of personal stories about the landmark abortion case.

Kristina Pettingill, with the Maine Public Health Association, was having a book signed for her mother, a nurse practitioner who worked at Planned Parenthood when her daughter was young.

“She was an advocate for reproductive rights all while I was growing up,” Pettingill said.

At age 43, Pettingill has known what it’s like to have reproductive choice most of her life because “the way had already been paved before me.”

But, she said, “it upsets me now to see my mother’s work and Sarah’s work being eroded….I’m worried we’re going to have to do this work all over again.”

Dianne Samarin also worries about the erosion of abortion access. The director of public health for Apache County in Arizona, Samarin was doing her prerequisites for nursing when Roe v. Wade was before the Supreme Court, adding that the case was "all the discussion” while she was in college.

“I’m a person of choice," she said. "I like to have control over my body.”

— M.P.

Photo by Melanie Padgett Powers

A little birdie told me so: Tweet of the day

With this year's Annual Meeting officially in full swing, today's tweet of the day goes to @candrews, who wrote: Why I love #APHA13: At opening session, we're talking: Racism. Poverty. Abortion rights. LGBT rights. Because these are ALL health issues.

Public Health Expo: Where you can talk with a hippo about public health

A giant hippo dancing certainly gets your attention. OK, so she was a woman in a hippo costume and I’m not sure that was really dancing, but it caused me to stop by her booth.

You may not associate George Washington University with a hippo, but the creature is the school’s unofficial mascot, as I learned on an exhilarating tour of the Public Health Expo, which features more than 700 booths.

The story goes that a former GWU president’s wife bought him a bronze statue of a hippo, which now sits on the Washington, D.C., campus. Students rub the hippo’s head for good luck before exams. Which helps explain why Mallory Boyd, executive director of student affairs at the GWU School of Public Health and Human Services, was tagged to dress up as a hippo to attract people to the GWU exhibit. But the real excitement is the school’s new building, which will open in March. At her booth, Boyd is telling prospective students, alumni and faculty members about the new building. And sometimes she has the opportunity to connect a prospective student with a faculty member who has stopped by.

Another public health school is also celebrating a milestone. Georgia State University is exhibiting at the Annual Meeting for the first time, a celebration of its public health program just becoming a School of Public Health. GSU’s first MPH students enrolled in 2004, and the first JD/MPH students enrolled this year.

“We now have 200 students and 30 faculty, and our first study abroad program was just approved for next summer to the Dominican Republic,” said Frances Marine, communications director of the GSU School of Public Health. “There’s a lot of excitement at the school right now, both among our students and our faculty.”

Stop by the booth for GSU pedometers, compact shopping bags, mouse pads, pens, and magnets.

And be sure to snag a personal memento showing off APHA’s new logo at the APHA photo and video-sharing booth, located next to Everything APHA. Grab a few friends and pose for a printed photo — which can also be emailed to you to share on social media — or choose the video option and answer a few questions specific to public health.

Get questions answered about the Affordable Care Act’s Health Insurance Marketplace at the APHA Public Health Policy Center booth, #1283. You will be able to sit down with an official ACA navigator, who can help you find your way through the new marketplace.

At the United Nations Foundation booth, you can not only learn about the many programs, you can advocate for more global health funding by immediately signing letters to Congress on the exhibitors’ iPads. And while you’re there, spin the wheel to win a rubber bracelet, desk note holder, pen or water bottle.

So, put on your comfy shoes and take a stroll through the Expo. Whether you are collecting magnets, resources or knowledge — or just want to dance with a hippo — you’ll find it all here.

— M.P.

(Photos by Melanie Padgett Powers)

Opening Session: 'We are here to be leaders'

Michael Marmot has a medical condition with odd symptoms.

He's constantly optimistic.

He's selectively deaf.

And his eyes tend to water at disadvantageous moments.

He discussed his symptoms during his keynote address at today's Opening Session of APHA's 141st Annual Meeting and Exposition and then noted that his condition is what keeps him going.

Marmot, chair of the World Health Organization’s Commission on Social Determinants of Health and a leader in health equity research, has to be optimistic in the face of dire messages about health inequity worldwide. And he has to be deaf to those who tell him that inequity is a force too big to beat.

And the tears? They come from hearing from all of the people who know we can do better and are excited to try.

Marmot's address, the centerpiece of the Opening Session, served as a rallying cry to those in attendance, urging them not to back away from the fight and, at times, goading them toward change.

At one point, Marmot noted that the U.S. ranks below Latvia when it comes to child poverty, concluding that such a low ranking must have been a choice.

“The level of child poverty is a decision governments make,” he told the audience. “You have a functioning democracy, so this must be the way you want it.”

If not, he said, public health must work to change that reality.

Public health's role in changing the status quo was a central theme of the Opening Session, starting with changes within the Association itself. APHA Executive Director Georges Benjamin kicked off the session with a video screening announcing the new APHA and its new tagline: For science. For action. For health. (More on that, plus a video about the new APHA, is here.)

In his speech welcoming APHA to Boston, Mayor Thomas Menino, who is serving his final term before leaving office, outlined what his government has done to improve the health of Bostonians. Achievements include banning smoking in bars and workplaces, keeping trans fats out of restaurants and, in what he called “the biggest fight of my political career,” getting sugary beverage vending machines out of schools.

“I've taken some lumps, but I don't regret any of those decisions,” he said. “They've been effective at improving health.”

As evidence, he cited a 10 percent reduction in smoking (from 25 percent to 15 percent), and a 50 percent drop in teen pregnancies.

“I don't want to leave the impression that we solved all the problems,” he said. “The next mayor will not be bored. But we're leaving a solid foundation.”

Menino ended with a rallying cry as well, urging public health to continue its hard work and making a dig at national politicians.

“Washington doesn't care about us,” he said. “It's gone away from the people. We've got to stay strong, we've got to send out a message out there. We've got to advocate for programs that are so, so important to us.”

The session closed with attorney Sarah Weddington, who argued for the winning side in the landmark case of Roe v. Wade. Weddington is featured in an online documentary series called "Makers" that looks at the work of groundbreaking women.

In speaking to Opening Session attendees, Weddington focused on the role of public health professionals as leaders in the fight for women's health. She urged those assembled to be bold in their work and to take risks.

“It is part of being a leader to do things you're not sure are going to work,” she said.

She recalled a time when women who sought birth control from student health services at the University of Texas had to first prove that they were within six weeks of getting married, “so they could be protected on their wedding night.”

From that history, we've come a long way, she said, but more remains to be done and that work will be done by leaders.

“We are here to think globally, but to act locally,” she said, echoing the Annual Meeting theme. “We are here to be leaders. We are here to...find the willingness and the ability to leave our thumbprints.”

Check back here in the coming days for video of the Opening Session speakers. And tell us about your favorite Opening Session moments in the comments below.

— C.T.

Above from top to bottom, Opening Session speakers Michael Marmot, Sarah Weddington and Thomas Menino. Photos courtesy Jim Ezell/EZ Event Photography