Health Policy News - January 11, 2016

Dear Friends,

Welcome to the inaugural issue of Health Policy News for the 2016 Session of the Washington State Legislature! We will come to you each week with updates about legislative action impacting community health.

Expectations are low for many policy bills to pass this session. It is a "short session" in an election year. Legislators will want to conclude business in their scheduled time and hit the campaign trail. As they return to Olympia, lawmakers face a budget deficit caused by increased caseloads and enrollments, and the McCleary state Supreme Court case on education. In August, the state Supreme Court delivered a unanimous order and began fining the legislature $100,000 a day for failure to develop a plan to fully fund K-12 public education as directed by its 2012 McCleary decision. The McCleary case directs legislators to boost education by billions of dollars by the 2017-18 school year. Thursday, during a briefing with reporters, legislators reviewed a plan to fund McCleary, but acknowledged finding the funding will take a year.

The Legislature will also face funding of charter schools, which were ruled unconstitutional by the state Supreme Court, the Friday before the Labor Day weekend. Initiative 1366, passed by Washington voters in November puts in the Legislature in a position where it must either send a constitutional amendment to the people requiring a two thirds vote in the legislature or a public vote for all tax increases or the state sales tax is lowered by 1% from 6.5% to 5.5% on April 15, 2016. This one percent reduction in the state sales tax would result in about a $1 billion loss in tax revenue.
Here, you can find helpful links to help you navigate during the legislative session, as well as the full text for this week's Health Policy News You Can Use!


Health Policy News You Can Use January 11 2016.pdf

Health Policy News Special Edition: E-cigarettes

Dear Friends,
The e-cigarette epidemic has grown exponentially over the past few years and continues to present challenges to communities and public health officials. Calls to the Washington Poison Center have nearly doubled every single year since 2010 when the first e-cigarette poisonings were reported in this state. 
E-cigarettes are not subject to federal regulations, nor are the liquids used in them. The FDA is currently considering rules to regulate the fledgling industry, while the industry innovates product at an astonishing speed, while research has shown the liquids contain a wide variance in nicotine content. Consumers who wish to use the devices for cessation may actually be using higher levels of nicotine then if they were smoking combustible cigarettes. 
In the last 2 years, the Washington State Legislature has considered various policy options to deal with e-cigarettes without the passage of final legislation. The policy options on the table have included: taxation, retailer licensing, child-safe packaging, restricting the age of sale to those age 18+, requiring disclosure of nicotine content and toxic or carcinogenic chemicals in the liquids, prohibiting internet sales, etc. Meanwhile, local health departments are considering policy regulations through board of health ordinances, or are leading community conversations about the devices. However, the infancy of the health impact research complicates policy discussions. 
E-cigarettes, or vape pens, are increasingly popular products that deliver nicotine and other harmful ingredients to users and bystanders, yet no federal regulation of these products currently exist. The American Public Health Association has recommended that states and municipalities enact laws prohibiting the use of e-cigarettes in enclosed public areas and places of employment due to their potential as a source of pollutants. Recent researchhas suggested that contrary to some opinions, e-cigarettes may not be effective tobacco cessation aids and may even inhibit the ability to quit. In 2014 and 2015, 33 Attorneys General submitted letters urging the FDA to require warning labels and childproof packaging, as well as restricting advertising, prohibiting flavoring, and other restrictions. Although the FDA is considering warning label and childproof packaging regulations, there is still no way to verify ingredients or safety claims made by manufacturers.
Impacts on Children & Youth
The 2014 Healthy Youth Survey found that one in five high school seniors in Washington reported e-cigarette use, almost triple the amount reported in 2012. This dramatic increase indicates the growing social acceptance of e-cigarettes among teens, which threatens to undermine decades of anti-tobacco education and advocacy. This is worrisome for many reasons, including because nicotine is particularly harmful to brain development in children and adolescent smokers are more likely to continue into adulthood. There is also early evidence that teens who vape are more likely to take up traditional combustible cigarettes. Manufacturers of e-cigarettes are not subject to the same advertising rules as the tobacco industry and therefore can market their products using celebrity endorsements or cartoon characters that appeal to children. Vaping products are also available in candy-like flavors that are attractive to younger users.
E-liquid, the nicotine-containing component, presents a poisoning threat to children via ingestion, inhalation, and skin contact. Exposure to even tiny amounts of e-liquid can cause vomiting, seizures, and death. A CDC study found that the number of calls to poison centers related to e-cigarettes had increased from one per month in September 2010 to 215 per month in February 2014. More than half of these calls concerned children under the age of 5. In 2015, the Washington Poison Center has reported 58 e-cigarette poisoning exposures, including 40 pediatric cases. Eighty-five percent of these exposures concerned children between the ages of 1 and 3.
The use of e-cigarettes to consume marijuana and synthetic drugs is also a growing public health concern. A recent study of high school students in Connecticut found high rates of vaporizing marijuana. Because vaping can be almost completely odorless, users are able to smoke marijuana in public places without detection. Marijuana use on school property is of particular concern for this reason. E-cigarettes can also be used to vaporize highly dangerous drugs such as synthetic marijuana. 
E-cigarettes pose unique regulatory challenges to state and local authorities. In Washington, it is illegal to sell e-cigarettes or other vaping products to minors under the age of 18. However, because vaping products can be purchased online sales are difficult to monitor. Grant CountyKing County,Pierce CountyClark County, and the city of Pasco currently have ordinances in effect prohibiting the use of e-cigarettes in all areas where smoking is prohibited. Clark, King, and Pierce Counties also prohibit free sampling of vaping products. Grant County prohibits possession of any vaping product or device by anyone under the age of 18. King, Pierce, and Snohomish counties are currently considering new or revised e-cigarette ordinances.
The American Academy of Pediatrics just yesterday issued this statement: "The AAP now strongly recommends the minimum age to purchase tobacco products, including e-cigarettes, should be increased to age 21 nationwide."
"Tobacco use continues to be a major health threat to children, adolescents and adults," said Karen M. Wilson, MD, MPH, FAAP, chair of the AAP Section on Tobacco Control and section head of Pediatric Hospital Medicine at Children's Hospital Colorado. "The developing brains of children and teens are particularly vulnerable to nicotine, which is why the growing popularity of e-cigarettes among adolescents is so alarming and dangerous to their long-term health."
It seems to me, we may not know everything there is to know about e-cigarettes, but we know enough to adopt policies to protect children and adolescents.


Health Policy News You Can Use - E-cig Special Edition.pdf

NEAR@Home Toolkit

How are social services professionals using NEAR (Neuroscience, Epigenetics, Adverse Childhood Experiences, and Resilience) science and knowledge? Home visiting and mental health professionals, along with other experts have come together to create, review and test a new toolkit designed as a training manual with guided processes to safely and effectively talk about the trauma of Adverse Childhood Experiences.

The NEAR@Home toolkit, designed over a three plus year period by federal Health Resources and Services Administration Region X (Alaska, Idaho, Oregon and Washington), Quen Zorrah (Thrive WA), Laura Porter, and others, is a "guided process to talk about trauma and resilience in Home Visiting".  

Download the NEAR@Home toolkit from the Thrive WA website here

Health Policy News - 2015 Session Wrap-up

The 2015 Washington State Legislature adjourned on Friday, July 10th. This was officially the longest legislative session in history at a record 176 days and three special sessions to reach agreement on a two-year $38.2 billion operating budget. The 2015-2017 operating budget includes $180 million in new revenue after closing and extending some tax preferences and increases spending by $4.4 billion from the current 2013-2015 biennium operating budget. Details are shared here in this article from Crosscut.
A $3.925 billion Capital budget and a $16.08 billion transportation package was passed before the legislature adjourned Sine Die. For details about all three budgets, including links to bills and project maps, click here.
And for more Health Policy News You Can Use, and what we were tracking this legislative session, read on here
Health Policy News You Can Use_ 2015 Session Wrap-up.pdf

Healthy Living Collaborative - 2015 Strategies

The Healthy Living Collaborative (HLC) is constantly focusing on upstream solutions that support community-based initiatives to improve health and wellness. The HLC is committed to strengthening families, neighborhoods, and systems in order to ensure health equity. HLC brings together partners from all sectors, combining resources and ideas, to improve the lives of everyone.

Click on the link to the Healthy Living Collaborative's 2015 Strategy document to see what the policy priorities are for this year. 

Healthy Living Collaborative 2015 Strategies

Health Policy News - Thank you Governor Inslee

Dear Friends,


Please join us in thanking Governor Inslee for protecting the historic transportation investments our members worked so hard on this session. Please find details in the action alert from the Childhood Obesity Prevention Coalition attached. To thank Governor Inslee, use the link here from Washington Bikes.


I finally feel like it really is Sine Die to the 2015 Washington State Legislative Session 
- at long last!


Thank you for all of your active engagement the last week! 





Health Policy News_Thank you Governor Inslee.pdf

Webinar: Adversity, Resilience and the Role of Health Systems in Prevention

The Learning Institute's Laura Porter participated in a recent webinar for the National Association of State Mental Health Program Directors (NASMHPD) on Adverse Childhood Experiences (ACEs) and the role of health systems in building resilience:

Adversity, Resilience and the Role of Health Systems in Prevention

Adversity in childhood, particularly in the absence of protective factors, can have profound developmental consequences. If not addressed, childhood adversity can initiate a “cascade” of risk factors, often leading to behavior problems, school failure, substance abuse and other negative outcomes. Health care personnel are in a unique position to identify and intervene early in this process. By educating families, strengthening protective factors, and working with children to build resilience, health care workers can help to prevent the onset of problems later in childhood or adolescence. 

This webinar provides a brief overview of adversity, resilience, and implications for prevention of substance abuse and other negative outcomes. It also describes effective prevention approaches in a variety of healthcare settings, including pediatric hospitals, emergency departments, school health clinics, and home visiting programs. Particular attention is paid to a dual-generation approach and to building partnerships for prevention. 

Click here to view the recorded webinar. 


Health Policy News - Urgent Federal Item & State Update Special Edition

We are bringing you a special edition of Health Policy News because of events happening at the federal and state levels of government.   Last Monday, the Trust for America's Health alerted partners to an amendment in the U.S. House Rules Committee, offered by Congressman Joe Pitts (R‐PA), to use $8.85 billion of the Prevention and Public Health Fund (PPHF) to offset the costs of H.R. 1190. The PPHF represents approximately 16% of the Center for Disease Control's total budget and 38% of the chronic disease budget. In Washington, we receive funding from the PPHF for programs such as; 
  • The Preventive Health and Health Service Block Grant
  • Childhood Immunization Program (317 Grant)
  • Heart Disease and Stroke Prevention
  • Cancer Programs 

What should you do?

  • E-mail or phone Congressman McDermott to thank him for his remarks in support of the PPHF today.
  • Send an e-mail or call your member (or the entire Washington State Congressional Delegation if you are a statewide organization) and let them know you/or your organization are opposed to using the PPHF to offset H.R. 1190.
  • Click here for a list of the Washington State Congressional District Directors, Health LAs, and numbers to the DC offices to contact your local representative.


Meanwhile, here in Washington State there is still no agreement on an operating budget for 2015-2017. Without an operating budget by June 30, the Washington State government will begin a potential partial shutdown.

For more Federal and State updates, see the full Health Policy News You Can Use


Health Policy News You Can Use_ URGENT Federal Item & State Update Special Edition.pdf

Special Edition Health Policy News You Can Use, June 3rd 2015

Since the Washington State Legislature concluded their first special session without action on a 2015‐2017 operating budget, capital budget or transportation revenue package they are now in a second 30 day special session.   On May 28th, the final day of the first 30‐day special session, Senate Republicans released their latest operating budget. The Senate Republicans' budget proposal increases spending on higher education, state parks, drought relief and wages for caregivers in assisted living facilities. It adds $66 million to pay for collectively bargained state employee pay raises,  contingent on a new bill requiring contract negotiations to be open to the public. The Senate Ways and Means Committee voted their Republican budget bill out of committee on Thursday. See this link for the budget details.  For more special session and budget info, click on the link for the full Health Policy News You Can Use
Health Policy News You Can Use_ Special Edition June 3, 2015.pdf

Health, Safety & Resilience: Foundations for Health Equity (Washington State Adverse Childhood Experiences data, Winter 2015)

This report presents breaking news from the people of Washington State, viewed through the lens of a bundle of science we are calling "NEAR": Neuroscience, Epigenetics, Adverse Childhood Experiences (ACEs), and Resilience.

The source of data used to generate maps, data tables and charts in this report is the Washington State Behavioral Risk Factor Surveillance System, or "BRFSS." The Learning Institute at Healthy Gen has been working consistently to improve the data and in this report presents a look at the current ACEs burden in Washington by age and geography, information on the intergenerational transmission of ACEs, and the potentially mitigating effects of social support, help and community reciprocity factors. 

Online Version_2014-2015 Statewide_4-21-15.pdf

Community Context for Academic Achievement; A Report on Community Factors that Predict Resilience & Prevention in Nine Randomly Selected Communities in Washington

January 20, 2015

Executive Summary

The context for optimal human development includes healthy families, flourishing communities, and the events and systems that shape these. Community capacity is found to be significantly correlated with positive trends in the rates of child safety and school completion (Laverack, 2006; Hall, 2012). Community capacity is described as the empowerment of communities to come together, share responsibility for alleviating crises, improve services, and build healthy environments for families and children (Chatskin, 1999).
This study provides information about the community context for child and family life in Washington, including the degree to which systems of the community operate effectively as a whole to improve outcomes. Using information from Key Informants in nine Washington communities, we consider processes that communities use to develop a sense of belonging and shared identity, come together in celebration or problem solving, reflect on past efforts, agree upon and collaboratively generate solutions, and weave a stronger social fabric as a part of considering community capacity development. Key Informant interviews and community capacity scoring of those interviews are designed to provide insight into the community contextual environment and the capacities of that environment.
Qualitative data from key informants in nine randomly selected Washington communities are considered in this report. Processes and tools used for analysis of the interviews and rating of community capacities are consistent with those used in over a decade of systematic observations of community capacity in Washington State. This includes both capacity index scores (Longhi & Porter, 2009), and correlations between interview content and descriptions of characteristics of five distinct phases of community capacity building (Flaspohler et al., 2012).
Forty-seven interviews with Key Informants in nine Washington communities, reveal common themes, as well as, significant community variation in practices that help communities to flourish. Since the instruments to assess community capacity have been consistently used from 1998 through this 2014-15 interview process, community capacity trends over time are also considered. The names of persons interviewed and the names of the communities where interviews were conducted are not used in this report in order to preserve confidentiality and optimize reporting of most promising and most challenging community capacity building stories.
Community Context Report_1-20-15_final to Dr Blodgett.pdf

No School Alone: How community risks and assets contribute to school and youth success

No School Alone: How community risks and assets contribute to school and youth success (March, 2015)

Christopher Blodgett, Ph.D. Washington State University

Report prepared for the Washington State Office of Financial Management in response to the Legislature’s directions in Substitute House Bill 2739 

In this report, we test if the levels of the challenges resulting from Adverse Childhood Experiences (ACEs) in a community’s adult population contribute to current conditions of disruption in children that make ACEs a multigenerational problem. While the effects of poverty on school performance guide long-term and significant investment policies, ACEs is a comparatively new idea and until very recently has not been tested as a policy planning tool. Several hundred peer-reviewed research studies consistently support the role of ACEs as arguably the most powerful single predictor of health and well-being in adulthood. However, equivalent results in childhood emerged only in the past few years. Exposure to ACEs begins very early in life, resulting in risks to the developing brain. This additional exposure to stress leads to the emergence of physical and social mechanisms of No School Alone 4 coping that can interfere with development during childhood and compromise life success and health in adulthood.

No School Alone_ How community risks and assets contribute to school and youth success.pdf