New Study Finds Link Between an Enzyme & SIDS: Should the Test Be Added to Arizona’s Newborn Screening Panel?

Every state including Arizona has a newborn screening program which tests every newborn for a series of metabolic disorders, hormone or hemoglobin problems, and other things like cystic fibrosis and hearing loss. The metabolic, hormone, and hemoglobin disorders are tested with a simple blood test right after birth and again a couple weeks later (three blood spots from a heel stick on a sheet of special paper). The paper with the blood spots is sent to a lab for the tests with special instruments. In Arizona those tests are done at ADHS’ Arizona State Laboratory.

Getting the tests turned around fast is important because if there is a problem, parents and doctors need to know right away so the baby can get on a special formula or other intervention. In Arizona, those turn- around times are 95% of samples completed within 5 days (after an intervention we did in 2013). ADHS also has folks that follow up with doctors about the results.

Over time, new disorders have been added to the screening panel. Before things are added to the screening panel public health folks do a deep dive to make sure that there is a clear relationship between the thing you’re screening for and the disease and disorder and whether there’s an intervention that can be implemented to help improve the chances pf a good outcome for the baby if he or she tests positive.

You also need clear “cut off” values, to minimize the number of false positives and negatives. After all, you want to catch all the screening tests that are truly positive while making sure you don’t say a test is positive when the baby really doesn’t have the condition (to avoid parents unnecessarily freaking out and to avoid inappropriate therapies).

Is there a newborn screening test to for Sudden Infant Death Syndrome?

For many years we’ve known about environmental risk factors for Sudden Infant Death Syndrome or SIDS. The big ones have to do with the sleep environment. Parents can do several things to minimize SIDS risk like make sure baby sleeps on her back, keep the crib as bare as possible, don’t over blanket baby so he or she gets hot, have the baby in your room BUT NOT IN YOUR BED, offer a pacifier, and never smoke around the baby and don’t smoke in the house: Sudden infant death syndrome (SIDS).

So far there haven’t been any clear blood or other tests identifying clear physical risk factors. Perhaps until now at least.

Last week a study was published called:  Butyrylcholinesterase is a potential biomarker for Sudden Infant Death Syndrome. The authors suggest that they found a relationship between a baby’s Butyrylcholinesterase (BChE) level and a risk for SIDS. In the study, the researchers compared the BChE levels of infants that had an unexpected death classified as SIDS to matched controls.

The researchers found that:

Conditional logistic regression showed that in groups where cases were reported as “SIDS death” there was strong evidence that lower BChE specific activity (BChEsa) was associated with death (OR=0·73 per U/mg, 95% CI 0·60-0·89, P=0·0014), whereas in groups with a “Non-SIDS death” as the case there was no evidence of a linear association between BChEsa and death (OR=1·001 per U/mg, 95% CI 0·89-1·13, P=0·99).’

We found that Butyrylcholinesterase Activity, measured in dried blood spots taken 2-3 days after birth, was significantly lower in babies who subsequently died of SIDS compared to living controls and other Non-SIDS infant deaths. This study identifies a biochemical marker that differentiates SIDS infants from control cases and those dying from other causes, prior to their death. We postulate that this decreased activity of Butyrylcholineserase represents an autonomic cholinergic dysfunction and therefore an inherent vulnerability of the SIDS infants.

Should we add BChE to Arizona’s newborn screening panel?

Maybe, but we’d need to answer a few questions first.

Is it possible? Yes. The ADHS instruments can test for this enzyme.

Is there a clear relationship between the enzyme level and a baby’s risk for SIDS? Maybe. This study is new and had a small sample size, although the statistical relationship was clear. More research confirming the link should be done before routinely testing for and reporting BChE levels.

Is there a clear intervention? Yes. Even though all parents are encouraged to follow the SIDS prevention techniques, it’s reasonable to think that parents that were told their child is at higher risk for SIDS because of their blood BChE level would be more vigilant about making sure they’re always following all the recommendations.

Next steps: Arizona’s Newborn Screening Advisory Committee is likely to hear about this new study and will likely explore whether it should be added to Arizona’s panel. No doubt the committee will also explore the questions above before making a recommendation to the (next) ADHS Director about whether the ADHS Arizona State Laboratory should add this new test to the screening panel.

AzPHA President Elect & Author Kelli Donley Williams Has A New Book: DESERT DIVIDE

From the author of the acclaimed novel Counting Coup comes Desert Divide, a gripping, ripped-from-the-headlines story of family, revenge, and justice spanning the ranches of southern Arizona to the dinner tables of Mexico City’s elite. It’s 2016.

Sarah McDaniels receives a call in the night that her mother has died unexpectedly. Returning to the family’s ranch in the high desert of southeastern Arizona, Sarah finds her childhood home and her father’s health in tatters.

More than a decade ago, Sarah left to chase a dream in New York City. Now, faced with burying her mother and trying to arrange care for her father, Sarah takes a walk across the family’s land to clear her head. When she stumbles over something on the desert floor, the last thing she expects to find is the body of a young woman her own age.

Who was this woman? Why was she on their family’s ranch? Who killed her?

Desert Divide is a true-to-life story of secrets, sacrifice, and redemption as one woman tries to face down her demons while saving what’s left of her family.

We encourage you to get Desert Divide at your local bookstore (like Changing Hands) but you can also find it on Amazon Desert Divide – Kindle edition by Donley , Kelli. Literature & Fiction Kindle eBooks @

About the author: Kelli Donley is a native Arizonan. She is the author of four novels, Under the Same Moon, Basket Baby, Counting Coup, and Desert Divide. Inspiration for this novel was found after seeing an exhibit of the Migrant Quilt Project. Kelli lives with her husband Jason, animals, and unruly vegetable garden in Mesa, Arizona. She works in public health, and blogs at:

Community Health Worker Training Program

Deadline Approaching

Community Health Workers are frontline public health workers who have a trusted relationship with the community and facilitate access to a variety of services and resources for community members. Building CHWs into the continuum of care has been proven to both improve health outcomes and reduce healthcare costs.

For a picture of how CHWs can fit into a continuum of care, take a look at this report from the NAU Center for Health Equity Research in collaboration with the UA Prevention Research Center (AzPRC) which provides insight into innovative strategies for integrating, sustaining and scaling of the CHW workforce within Medicaid (AHCCCS).

Building CHWs into the healthcare continuum requires that a certification process be in place. The public health community tried for many years to get such a process in place, finally meeting with success 4 years ago with the passage of HB 2324 (sponsored by Representative Carter), which charged the ADHS with implementing a program for the voluntary certification of Community Health Workers.

After 4 years of anticipation (and advocacy trying to get the ADHS to write the rules) the agency is finally adopting those rules, meaning we are finally on the threshold of bringing CHW’s into the care network.

The US Department of Health & Human Services recently announced availability of $226.5 million for a new program building the pipeline of public health workers at the community level.  The multiyear effort will support training and apprenticeship programs for the critical role of trusted messenger connecting people to care and support. 

Administered through HRSA’s Bureau of Health Workforce, the program will train as many as 13,000 community health workers who will address needs in rural and underserved communities.  These roles, providing culturally competent and individualized services, are critical in rural areas where health services are limited

Interested folks can Apply for New Community Health Worker Training Program  but the Deadline is June 11. 

Registration is still open for the annual AZCHOW conference : Roots Annual Conference Tickets, Wednesday, June 22, 23 2022

Roots: The Beginning of the CHR CHW Movement | Recognizing a Resilient Workforce

Vee Quiva Hotel & Casino, 15091 South Komatke Lane, Laveen Village, AZ 85339

Deadline Approaching to Apply for Arizona’s Primary Care Loan Repayment Programs

Arizona has several successful loan repayment programs for primary care providers designed to incentivize them to practice in rural and underserved parts of the state. In exchange for a commitment to serve, providers can get direct relief for a significant portion of their student loans.

The Arizona State Loan Repayment Programs include the Primary Care Provider Loan Repayment Program for public, non-profit providers and the Rural Private Primary Care Provider Loan Repayment Program for providers in rural private practice sites.

Arizona’s State Loan Repayment Program is currently accepting applications for an initial two-year commitment, but the June 1 application deadline is rapidly approaching. Interested providers should review the Provider Application and Program Guide before submitting their application online. To apply, please sign up and access our PCO Portal, by clicking here

Below are some additional resources to assist providers in successfully applying:

These programs aim to promote the recruitment and retention of health care professionals by repaying their qualifying educational loans in exchange for their two-year commitment to provide primary care services in federally designated Health Professional Shortage Areas (HPSA) or Arizona Medically Underserved Areas (AzMUA)

Legislative Roundup: Two More Harmful Preemption Bills Have Final Votes Today

History Suggests They’ll Pass with A Party Line Vote & A Ducey Rubber Stamp

The House opened for business on Monday but then promptly adjourned for the rest of the week (basically not doing any business). The Senate worked a bit on Tuesday, but that’s it. 

The Senate has posted a few bills for Third Read (final floor vote) on Monday including a couple of harmful preemption bills that had been languishing for a few weeks. Several bills that preempt other jurisdictions from taking needed action for disease control have already passed on a party line vote- and there’s no reason to think tomorrow will be different. Our action alerts on the previous preemption bills were unsuccessful so I’m not going to send one out on the two up for a vote tomorrow:

HB2453 governmental entities; mask requirement; prohibition

Prohibits the state or any political subdivision, including the judiciary, that receives or uses tax revenue (governmental entity) from imposing any requirement to wear a mask or face covering on the governmental entity’s premises, except where long-standing workplace safety and infection control measures that are unrelated to COVID-19 may be required.

HB2086 DHS; school immunizations; exclusions

Says that the ADHS Director can never implement a rulemaking that would require the COVID-19 vaccine (or its successors) to be required for school attendance.

There has been little observable progress on the state budget. Perhaps things are happening in back rooms- but if so nothing has been transparent. One of the rumors about what’s holding up budget development is around water. The Governor’s budget called for a $1B for a new organization called the Arizona Water Authority and it’s unclear whether there is support to create the entity (outside of the Arizona Department of Water Resources) or not.

AHCCCS’ “Get Ready to Renew” Messaging Toolkit Available to Help Medicaid Members Prepare for Upcoming Renewals

An updated messaging toolkit about the end of the public health emergency (expected in July) is now available on the AHCCCS Return to Normal Renewals web page.

The toolkit includes suggested social media posts, text messages, on-hold messages, and fliers you can use to help AHCCCS members get ready for their renewals. Community partners, health plans, advocacy organizations, and providers are welcome to use this messaging guidance in their communication to AHCCCS members.

The federal public health emergency (PHE), which suspended most Medicaid disenrollments, is expected to end on July 16, 2022. When the PHE ends, many temporary programmatic changes that were implemented during the pandemic will also end and normal business processes will be reinstated.

You can help AHCCCS members take steps to get ready for their renewal. To make sure that eligible members do not experience any gap in health care coverage, AHCCCS asks them to: Ensure that their mailing address, phone number, and email address on file is correct in, or by calling Health-e-Arizona Plus at 1-855-HEA-PLUS (1-855-432-7587), Monday through Friday 7:00 a.m. – 6:00 p.m.  Find more information, please refer to the AHCCCS Return to Normal Renewals web page

Journal Article of the Week: In-person Schooling & COVID-19 Risk Spring 2021

In-person schooling and associated COVID-19 risk in the U.S. spring semester 2021

Because of the importance of schools to childhood development, the relationship between in-person schooling and COVID-19 risk has been one of the most important questions of this pandemic. Previous work in the United States during winter 2020–2021 showed that in-person schooling carried some risk for household members and that mitigation measures reduced this risk.

Here, we use data from a massive online survey to characterize changes in in-person schooling behavior and associated risks over that period. We find increases in in-person schooling and reductions in mitigations over time. In-person schooling is associated with increased reporting of COVID-19 outcomes even among vaccinated individuals. 

Teacher masking was associated with the greatest risk reduction across all COVID-19–related outcomes, followed by daily symptom screens, universal student masking, and restricted entry (Fig. 4B).

Looking to Make a Career Move?

The Arizona Public Health Association’s Career Center might be the ticket you’re looking for to find the right opportunity or candidate.

Looking for a Job?

One of your AzPHA member benefits is access to our career center, where you can find a multitude of jobs in the public health, healthcare, laboratory sciences and many other fields. Simply visit the site from time to time and check out what’s out there. You can also set up an account as a ‘Job Seeker” under that navigation tab at the top of the site.

There’s also a job center resource room to help you make your resume stand out, interview tips, and pointers to use social to help your search. You can also upload your resume to get more visibility by setting up the free job seeker account.

I’m in the process of priming the pump with more jobs at our organizational members’ workplaces, so be sure to check back from time to time to check what’s out there.

Interested in Posting a Job?

If you’re interested in posting a job on our site, simply create an employer account. We have several product categories depending on what your needs are, including Basic Posting, Passive Job Seeker Package, and Enhanced Posting- ranging from $99 to $199.

The $199 package includes getting your job emailed to to over 27,000 people, a 30 day posting period. Your job will be highlighted and will stay near top of list on job board too. There are additional package deals for posting multiple jobs.

If your employer is an organizational member of AzPHA, I can create some time-limited free coupons that you can use to post some jobs. To get one of those coupons contact me at

Abortion & Public Health on A Crash Course if Roe is Overturned & ARS 13-3603 Becomes the Law of the Land

Teen pregnancy is an important public health indicator.  Having a baby as a teenager impacts the mom, the dad, the baby and the whole community. Teen parents often don’t finish high school which, in turn, reduces their ability to financially take care of their newborn and results in increased health care, foster care, incarceration, and lost tax revenue nationwide. It’s also a key driver of inter-generational poverty, which comes with a cascade of poor public health outcomes.

Here’s a link to the CDC’s latest Birth Data for 2020 (National Vital Statistics Reports Volume 70, Number 17, February 7, 2022) which includes the teen birth rate.  Arizona’s teen birth rate decreased 10% in the last year.  In fact, since 2010 the Arizona teen birth rate has dropped more than 64%…  from 41.9/1000 in 2010 to only 16.6/1000 in 2020.

Table B: National Vital Statistics Reports, Vol. 61, No. 1 (8/2012) vs. Table 8 National Vital Statistics Reports Volume 70, Number 17, February 7, 2022

There are lots of theories as to why the teen birth rate is dropping.  The share of teens using some form of highly effective contraceptive methods is increasing. The share of sexually active female teens who have used emergency contraception (e.g., the morning-after pill) rose from 8% in 2002 to 23% in 2011-15. And a Centers for Disease Control and Prevention analysis found that the use of long-acting reversible contraceptives such as IUDs and implants rose from 0.4% in 2005 to 7.1% by 2013. It is most certainly higher than that today.

See Previous Posts:

If Roe is overturned and ARS 13-3603 becomes the law of the land, abortion will no longer be an option for women that become pregnant and are unprepared for the financial and other responsibilities of becoming a parent. Additionally, a plain reading of 13-3603 suggests that even “Plan B” and Intrauterine Devices may become illegal if they are determined to be a “… medicine, drug, substance or instrument” that causes a miscarriage, all of which will result in increased poverty and the downstream poor health outcomes that result. 

A key question then becomes… will state government step up and provide additional safety net services to support these new families? You have to say Arizona doesn’t have a strong track record in that regard.

AzPHA Action Alert: Comment on EPA’s Heavy & Medium Duty Truck Emission Standards Rule by Friday

Urge EPA to Select ‘Option 1’ for Heavy Duty Trucks & Add A Particulate Pollution Standard

The EPA has proposed new vehicle emission standards for medium and heavy-duty trucks! That’s a good thing because the last medium and heavy-duty emission standards were established in 2002, light years ago technology wise.

This important rulemaking will help to clean up and help transition the transportation sector toward lower emissions of harmful air pollutants and greenhouse gas emissions. 

Because vehicles purchased will be on the road for many years, potentially two decades, it’s critically important to start setting standards now. 

Heavy-Duty 2027 and Beyond: Clean Trucks Proposed Rulemaking – (EPA-420-F-22-007, March 2022)

Comment on the Proposed Rule Here

Heavy-duty trucks and buses drive American commerce and connect people across the country. Creating cleaner trucks is an economic opportunity to support jobs and make more efficient vehicles while reducing harmful pollution. Heavy-duty trucks and buses continue to contribute significantly to air pollution at the local, regional, and national level, often disproportionally affecting communities of color and low-income populations.

A EPA’s “Clean Trucks Plan” will result in significant emissions reductions from new medium- and heavy-duty vehicles, improve air quality, and addressing the climate crisis. The regulatory actions that make up the Clean Trucks Plan are as follows:

  • Setting stronger nitrogen oxide (NOx) standards for heavy duty trucks beginning in 2027; and
  • Tightening the “Phase 2” greenhouse gas emissions in 2027 and beyond.

The proposed standards would significantly reduce emissions of NOx from heavy-duty gasoline and diesel engines and set stronger greenhouse gas standards for heavy-duty vehicles.

EPA is proposing two regulatory options. We’re asking AZPHA members to comment on the EPA rules and urge them to select Option 1, which will implement stronger NOx standards in two steps. The first improvement would be required in 2027 with a second more stringent standard 2031 (under Option 1 the 2031 NOx standard would be 90% lower than today’s standards).

We’re also urging our members to ask EPA to include emission limits on particulate pollution in addition to the NOx standards. As it stands, the current rule only sets new goals for NOx – not particulate matter. While cutting NOx emissions can cut particulate matter emissions including more stringent particulate standards will motivate engineers to ensure that both goals are achieved

EPA’s public comment period ends Friday, May 16, 2022. It’s important that public health weigh in on the Rule because industry is pushing back.

Comment on the Proposed Rule Here

Rule: Control of Air Pollution from New Motor Vehicles: Heavy-Duty Engine and Vehicle Standards; Extension of Comment Period

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