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Let’s face it. Getting a ticket in the mail for speeding or running a red light is no fun.  But the evidence suggests that photo enforcement of red lights and speed is an effective public health intervention, which is why we’re weighing in against HB2525 this upcoming week.  It would prohibit any jurisdiction from using photo enforcement technology to enforce speeding or red light running. 

Many state and local governments in AZ have turned to photo enforcement of speeding and running red lights promote public safety (and some would say to raise revenue). The theory is that drivers will pay more attention to their speed and red lights when they know they’re at risk for getting a ticket. It stands to reason that cameras would keep drivers’ speeds in check and prevent serious injuries from high-speed crashes. But do they?

A landmark study for photo enforcement was done by Retting et.al. and published in the American Journal of Public Health examining the impact that photo enforcement had in Oxnard CA after they implemented their photo enforcement program.  The researchers found that intersections that had red light cameras installed had a 29% reduction in injury crashes.  Right-angle crashes (which often happen because of red light running) were reduced by 32% and right-angle crashes involving injuries were reduced by 68%.  Overall accidents at the intersections were reduced by 7%.

In 2008, an Arizona established a statewide photo speed enforcement program on interstate highways. DPS contracted with a private company to install the cameras (along with signage to alert drivers), and they began operating that fall. Vehicles that were clocked going 11 miles per hour or more over the speed limit got tickets in the mail.  The system was in use until 2010 when the contract expired and the cameras were removed.  Did their presence have an effect on public safety?

Last year, a research team that included Dr. Chengcheng Hu, director of biostatistics for the Phoenix campus of the UA Mel and Enid Zuckerman College of Public Health, Dr. Steven Vanhoy, a recent graduate of the UA College of Medicine – Phoenix, and several colleagues from Banner – University Medical Center Phoenix, published a paper that offers some insight.

The researchers examined crash data along a 26-mile segment of Interstate-10 in Phoenix where speed cameras had been placed every 2 miles as well as a 14-mile control segment where no cameras had been deployed. They compared crash data from Jan. 1 to Dec. 31, 2009 (when cameras were in place) to data from Jan. 1 to Dec. 31, 2011 (after the cameras had been removed).  They found that the removal of the photo radar cameras was associated with a two-fold increase in admissions to Level 1 Trauma Centers from car crashes in the areas where the cameras were removed.

Nobody likes getting a traffic ticket, but we believe that photo enforcement of reasonable traffic laws can significantly reduce severe injuries.   That’s why we’re weighing in against HB2525 this week in the House Appropriations Committee on Wednesday, February 22 at 2pm in House Hearing Room 1. 

Believe me, I’m no evangelist for every single speed limit in my part of town nor the placement of some of the cameras and vans- but moving to eliminate this option for local communities would cause public health harm.  I for one  am happy that AzPHA is mobilizing against HB2525 this week. 

Our Public Health Policy Committee continues to be busy following bills making their way through the state legislature and preparing comments on AHCCCS’ 1115 Waiver application.  Here’s a snapshot of AzPHAs activities over the last couple weeks and what’s up this week.  There’s good and bad news this week.

Active Health-related Bills

We’ll be signing up in support of 3 bills in the House Health Committee this week.  We’re enthusiastically supporting HB 2426 which would set up a pathway for Community Health Workers in AZ to voluntarily become certified. Voluntary certification would be a big step forward for this important health profession because it would make it easier to get reimbursement for their services- and expand the use of CHWs.  Good news! 

We’ll also be enthusiastically supporting HB 2442 this week in House Health- which would provide for preventive dental services for pregnant women enrolled in AHCCCS.  There are a host of public health reasons why this is a good idea- you can read about them in this Issue Brief from the UA’s Center for Population Science & Discovery.

We’re also supporting HB 2208 this week, which would, under certain circumstances, let school staff administer or help a student self-administer an inhaler for things like asthma episodes.  There was a late breaking amendment to this bill this week which we think makes the bill more likely to move forward.

Meanwhile, last week:

HB 2090 which would require hospitals to offer influenza vaccines to seniors during the cold and flu months is alive and well- passing through the House Health Committee 9-0 last week. 

HB 2134 which would make it clear that kids can take sunscreen to school also got a favorable recommendation from House Health 9-0. 

HB 2190 which would ask ADHS to compile stroke statistics was held in committee, meaning it’ll need to be approved this week or it’s probably toast this year. O

Last week AzPHA signed up in support of and testified for HB 2335 which if it passes would move the age at which folks can buy cigarettes and other tobacco products (including e-cigarettes) from 18 years old to 21.  There’s good evidence that when a person starts smoking before they’re 21 they’re far more likely to be a life-long smoker (because people that start in their teens are more highly addicted as a result of changes in the brain).   HB 2335 passed in the House Health Committee 7-2, but still needs to get through the House Commerce Committee and then of course get a full House floor vote.  It didn’t get a hearing in the House’s Commerce Committee this week, and the committee chair has said he won’t hear the bill in his committee-  which would effectively kill it.  Sad!

No news this week about House Bill 2082 sponsored by Jesus Rubalcava and, which would require all schools to have 50 minutes of recess per day from K through 5th grade. That bill passed 11-0, but there’s still a ways to go and plenty of hurdles to overcome before this would become law.

Meanwhile, over in the Senate,  SB 1368 passed through the Senate Health and Human Services Committee.  If it passes, it would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests. This one is looking good.

We’re watching the Legislature’s hearing calendar closely and will offer our support and/or information.  If you’re interested in joining our Public Policy Committee, you can contact [email protected] and she’ll get you on our list.  We have a weekly call every Monday at 11 am and someone from the committee is always down at the Legislature for key hearings.

AHCCCS Waiver

The AzPHA’s Public Policy Committee is finishing up our comments on AHCCCS’ 1115 Medicaid waiver application (as required by a state laws that passed in 2015).  AzPHA will be submitting comments on the Waiver application focusing on 4 key areas: 

• The proposed requirement for all “able-bodied” adults to become employed or actively seeking employment or attend school or a job training program.

• The proposed requirement for able-bodied adults to verify on a monthly basis compliance with the work requirements and any changes in family income.

• The authority for AHCCCS to ban an eligible person from enrollment for one year if the eligible person knowingly failed to report a change in family income or made a false statement regarding compliance with the work requirements.

• The authority for AHCCCS to limit lifetime coverage for all able-bodied adults to five years except for certain circumstances. 

Our Committee will present our proposed letter to the AzPHA Board on Friday and we’ll share the final letter here on the blog right after it’s approved.  If you’d like to participate in the editing process you can always contact [email protected] and she’ll get you on our Public Health Policy Committee list.

Adios

Good question.  Often those of us in public health tend to focus on the importance that access to care has in public health outcomes.  But we also know that having a robust economy that provides opportunities is a key driver in the social determinants of health that dramatically impact health status of populations.

The Children’s Action Alliance commissioned the W.P. Carey School of Business at ASU to study the economic impact of removing the federal funds that are coming into Arizona as a result of the Affordable Care Act.  Among the report’s conclusions is that if all federal and state ACA-related funding including tax credits were eliminated, the Gross State Product in AZ would decline by $5 billion with a loss of $3.5 billion in personal income. Employment losses in all sectors would be about 62,000 with the health care sector losing 29,000. 

The 25-page report has a host of results that demonstrate repealing the ACA’s healthcare funding provisions would do more than just reduce access to care, it would result in impacts to Arizona’s economy that would affect those social determinants that are so important to maintaining population health.

Some members of the U.S House of Representatives and the U.S. Senate have vowed to repeal and replace the Affordable Care Act.  A key public health question is “what does replace mean and what does it look like”.  If you’d like to have your voice heard, you can take action now by using this APHA tool to send your message to Senators McCain and Flake and your Representative (based on the address you use). 

The time to voice your opinion is now!

A couple of weeks ago AzPHA signed up in support of and testified for HB 2335 which, if it passes, would move the age at which folks can buy cigarettes and other tobacco products (including e-cigarettes) from 18 years old to 21.  There’s good evidence that when a person starts smoking before they’re 21 they’re far more likely to be a life-long smoker (because people that start in their teens are more highly addicted as a result of changes in the brain).   

HB 2335 passed in the House Health Committee 7-2, but still needs to get through the House Commerce Committee and then of course get a full House floor vote.   It didn’t get a hearing in the House’s Commerce Committee this week, and the committee chair has said he won’t hear the bill in his committee-  which would effectively kill it.

How come AzPHA feels so strongly, you ask?  Pretty simple.  Cigarette sales to people under 21 account for only 2 % of total sales but because 90% of smokers start before they’re 21, under-21 sales hook 90% of new smokers.  Here’s another way to look at it.  Only 10% of lifetime smokers started after they were already 21.  That means 90% started before they were 21.  It’s easy to see why upping the age to 21 is an effective public health intervention that could pay huge dividends in the future.

Perhaps this Abstract from this 2014 Study from the Journal of the American Public Health Association says it best: The majority of tobacco use emerges in individuals before they reach 21 years of age, and many adult distributors of tobacco to youths are young adults aged between 18 and 20 years. Raising the tobacco sales minimum age to 21 years across the United States would decrease tobacco retailer and industry sales by approximately 2% but could contribute to a substantial reduction in the prevalence of youths’ tobacco use and dependency by limiting access.

Let’s cross our fingers that evidence and an interest in improving public health in Arizona eventually wins out!

One of the initiatives that we’re enthusiastic about during this year’s legislative session is the possibility that Severe Combined Immune Deficiency syndrome could be added to the state’s newborn screening panel.  We at AzPHA hope it happens!

Arizona began screening newborns for phenylketonuria (PKU) in the late 60s and early 70s. Samples were sent to the State Laboratory or were tested in hospital labs. In 1979 Arizona began testing for phenylketonuria, congenital hypothyroidism, homocystinuria, maple syrup urine disease, hemoglobin diseases.  Galactosemia and biotinidase were added in 1981.  In 1993 the Office of Newborn Screening was born and the Arizona State Lab began screening for the seven disorders in late 1994. In the 2000’s we expanded the number of screenings further to include 29 disorders in the Uniform Screening Panel. 

The goals of newborn screening are to find babies with certain, rare disorders at birth and help families and the infants get fast treatment to prevent or delay serious medical problems.  Babies born with these conditions appear to be normal at birth but without interventions the disorder may have a devastating or lethal effect on the baby’s health and development.  The good news is that early screening, detection and treatment often results in normal growth and development.  Another goal is to find possible hearing loss before one month of age and link families with appropriate assessment and intervention. 

We’re pleased that the Governor has proposed in his budget to add Severe Combined Immune Deficiency (SCID) to the AZ panel- along with an authorization to increase the fee up to $6/test to pay for it.  Babies born with Severe Combined Immunodeficiency look normal at birth but they can’t fight infections. They often die before 1 year of age without medical treatment, but if caught at birth,  before the onset of infection, a bone marrow transplant can successfully treat the disorder.  It’s particularly important to test for SCID in Arizona because the disorder is much more common in certain populations in Arizona: 1/2,000 among Navajo’s and Apache’s and about 1/20,000 among Latinos.

The Arizona Daily Star wrote a nice story this week about adding Severe Combined Immune Deficiency to the panel  from the perspective of a family.

Senate Bill 1368 is the bill that would authorize raising the newborn screening fee by $6/test which would allow the ADHS to add SCID testing to their panel…  and AzPHA will be at the hearing this Wednesday at 2 pm urging the Senate panel to recommend passage of the proposal.  

Chances are that some of your most memorable moments of elementary school were outside. Back in the day, lunchtime lasted just as long as all the other periods and we had at least one short recess period, and maybe two.  It’s still that way in some places, but in others – lunch and recess haven’t been competing for time as successfully as other academic subjects. 

That might be about to change thanks to a bill working its way through the state legislature that would require all schools to have 50 minutes of recess per day from K through 5th grade, and it needs to be unstructured meaning that kids get to make their own choices for physical activity. This week, the House Education Committee approved House Bill 2082 sponsored by Jesus Rubalcava and 14 co-sponsoors.  In the committee hearing Rep. Rubalcava explained that his experience as a teacher convinces him that kids benefit from physical activity during the school day.

Rep. Rubalcava and his co-sponsors are on to something.  There’s solid scientific evidence that they’re right.  A few years ago the CDC published a review of published studies and concluded that physical activity during the school day improves cognitive skills and attitudes, enhances concentration and attention, and improves classroom behavior.  Maybe it’s time to think about lunch and recess as a catalyst for improving overall academic achievement and classroom behavior.  Talk about the best of both worlds!

There was some debate in the Committee hearing this week from members wondering about the evidence base relating physical activity to academic achievement.  Fortunately the public health community is front and center with the data about the evidence in the CDC’s report entitled The Association Between School-based Physical Activity, Including Physical Education, and Academic Performance.  

We at AzPHA are committed to building public policy that improves health using evidence.  That’s exactly what  House Bill 2082 does- which is why it has our ringing endorsement.  

P.S. Local school districts make decisions every year about how and when to incorporate physical activity into their academic day.  Public health folks can help shape those decisions by working with schools and districts using the CDC’s School Health Index.  

Our Public Health Policy Committee has been pretty busy over the last few weeks following bills making their way through the state legislature… the latest 1115 Waiver application that AHCCCS has submitted to the Centers for Medicare and Medicaid Services… and activity at the national level regarding the possible repeal of the Affordable Care Act.  Here’s a snapshot of AzPHAs activities over the last few weeks and what’s up this week.

Active Health-related Bills

Last week AzPHA signed up in support of and testified for HB 2335 which if it passes would move the age at which folks can buy cigarettes and other tobacco products (including e-cigarettes) from 18 years old to 21.  There’s good evidence that when a person starts smoking before they’re 21 they’re far more likely to be a life-long smoker (because people that start in their teens are more highly addicted as a result of changes in the brain).   HB 2335 passed in the House Health Committee 7-2, but still needs to get through the House Commerce Committee and then of course get a full House floor vote. 

We also signed in support of House Bill 2082 sponsored by Jesus Rubalcava and, which would require all schools to have 50 minutes of recess per day from K through 5th grade… and it needs to be unstructured meaning that kids get to make their own physical activity choices.  That bill passed 11-0, but like HB 2335, there’s still a ways to go and plenty of hurdles to overcome before this would become law.

Last week we expressed support for SB1086  SB1087  SB1088… all of which address distracted driving in various ways.  None of the bills have been heard in their respective committees yet, but if and when the time comes, we’re prepared to inform the committee about the public health and safety risks posed by distracted driving.

HB 2046 went down in flames last week- it would have required motorcycle drivers and passengers operators to wear a helmet at all times unless they pay a fee to ADOT when they register their motorcycle.  That bill failed to get out of the Transportation Committee in the House and appears to be dead.

The House Health Committee will be really active this week (Thursday starting at 9 am).  There are several bills up that we’ll be supporting.  Included are: HB 2090- which would require hospitals to offer influenza vaccines to seniors during the cold and flu months; HB 2134- which would make it clear that kids can take sunscreen to school; HB 2190 – which would ask ADHS to compile stroke statistics; and HB 2208- which would authorize school staff to administer inhalers for kids having asthma symptoms (under certain circumstances). Dr. Lynn Gerald and colleagues at the UA College of Public Health have been doing active research in this area which is informing the policy development- just like things should be.

Meanwhile, over in the Senate Health & Human Services Committee (Wednesday at 2 pm), we’ll be in support of SB 1368 which will authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests.  I’ll have a blog post on that topic later this week.

We’re watching the Legislature’s hearing calendar closely and will offer our support and/or information.  If you’re interested in joining our Public Policy Committee, you can contact [email protected] and she’ll get you on our list.  We have a weekly call every Monday at 11 am and someone from the committee is always down at the Legislature for key hearings.

Budget Proposals

Our AzPHA Board met a few weeks ago and authorized AzPHA to express support for several bills that Legislators have proposed, as well as some of the elements of the Governor’s budget proposals.  We’re in firm support of proposals in the budget to: 1) add Severe Combined Immune Deficiency (SCID) to Arizona’s Newborn Screening Panel; 2) increase funding to the state’s loan repayment program by $350K (potentially allowing the state to qualify for a full $1M in matching funds from HRSA); and 3) adding up to $1,000 annually for adult emergency dental services among  all AHCCCS members.  

We believe that these are all important proposals that will improve public health in Arizona.  Since the budget isn’t being formally negotiated yet, we haven’t had an opportunity to sign in support of these proposals, but we’re poised to jump into the fray when the time comes.   

AHCCCS Waiver

AzPHA is also working on comments to submit to AHCCCS and the Centers for Medicare and Medicaid Services regarding Arizona’s 2017 1115 Medicaid waiver application (as required by a state laws that passed in 2015).  AzPHA will be submitting comments on the Waiver application focusing on 4 key areas: 

• The proposed requirement for all “able-bodied” adults to become employed or actively seeking employment or attend school or a job training program.
• The proposed requirement for able-bodied adults to verify on a monthly basis compliance with the work requirements and any changes in family income.
• The authority for AHCCCS to ban an eligible person from enrollment for one year if the eligible person knowingly failed to report a change in family income or made a false statement regarding compliance with the work requirements.
• The authority for AHCCCS to limit lifetime coverage for all able-bodied adults to five years except for certain circumstances. 

Our comments are due February 28.  We will be done before that deadline and will share our comment letter with AZPHA members as soon as we’re finished.  If you’d like to participate in writing the letter you can always contact [email protected] and she’ll get you on our Public Health Policy Committee list.

Distracted driving kills people just like impaired (drunk) driving does. Thousands of people each year are killed by distracted drivers.   

There are a lot of ways people can be distracted while driving… it happens anytime you take your eyes off the road.   Any non-driving activity is a distraction that increases your chances of crashing and hurting or killing yourself, your passengers or other drivers.

Let’s face the facts.  Our cell phones are an increasing part of our lives whether we want to admit it or not.  It seems perfectly natural to pick up your smart phone and check email or texts or other social media, like twitter.  Sometimes we do it while driving, like at a stop light – when the main problem is not seeing that the light has turned green and the driver behind you honks at you to get going.  You make it through the light but the guy behind you doesn’t.  That’s a harmless irritation.

But sometimes people check their phones while they’re actually driving- and that’s what’s lethal.  Sending or reading a text or checking or social media takes your eyes off the road for at least 5 seconds.  At 55 mph, that’s like driving the length of an entire football field, blindfolded.  Here’s another point of view.  Texting while driving increases your risk of crashing by 23% and slows your reaction time to an equivalent of a 0.1% blood alcohol level- which is legally drunk.  Does that sound safe to you?  Probably not, but chances are you’ve done it.  It’s super dangerous, but most of us don’t recognize how dangerous it is.  

Luckily, the National Traffic and Highway Safety Administration (NTHSA) tracks data regarding distracted driving…  allowing  elected officials to have some data with which to make public policy regarding texting or social media and driving.  Here’s a quick factoid from the mounds of data they have: In 2014, there were a total of almost 30,000 fatal crashes in the U.S. and about 10% (3,000) of those fatal crashes involved distracted drivers.

So, now we know that distracted driving is a clear and present danger.  The question is what should we do about it in terms of public policy?  There are all kinds of social media and other messaging out there discouraging distracted driving.  That might work for some folks, but let’s face it, sometimes there needs to be more at risk for people to take things seriously.  That’s where distracted driving laws come in.

NTHSA also tracks what the state laws are that address distracted driving.  You can visit their State Laws page to what the laws are in the various states.  Currently, 46 states ban text messaging for all drivers.  Forty one of those even have primary enforcement, meaning that law enforcement folks can pull you over for violating thedistracted driving law.  

Of the 4 states without an all driver texting ban (Arizona is one of those 4) , 2 at least prohibit texting by novice drivers.  In Arizona, the only restriction applies to school bus drivers.  Montana doesn’t even prohibit school bus drivers from texting. 

Over the years Arizona lawmakers have introduced bills that tried to put a little muscle into distracted driving laws, to no avail.  This year there’s increasing optimism that AZ might actually be able to pass a law that deals with distracted driving  because of the makeup of the new legislature.  

Here are the bills that have been introduced:

SB1086   Sentencing; aggravating factor; texting

SB1087   Wireless communication device; driving; prohibition

SB1088   Vehicles; collisions; injury; texting; penalty

Here at AZPHA, we’ve expressed public support for SB 1086, 1087, and 1088, all of which move the ball forward.  Our state legislature actually makes it pretty easy to stay engaged and track the progress of various bills. If you’d like to see bills like these be successful, you can track their progress online.

Interested in adding your voice and learning more about how you can make a difference?  You could always join AZPHA and participate in our Public Policy Committee which continually tracks and advocates for bills like these that enhance public health in Arizona.

Interested in learning more about distracted driving generally?  Check our NTHSA’s website on distracted driving.