Public Health Actions
Low fluoride concentrations in drinking water (e.g., up to 2 mg/L) can help prevent dental cavities. However, too much fluoride can cause adverse effects. Getting the right amount of fluoride takes awareness and a little effort.
A common way for people to get fluoride is through drinking water. Sometimes the amount of fluoride in drinking water is too low and therefore a dental patient could benefit from fluoride treatments or fluoride in dental products. Sometimes the amount is just right so fluoride treatments would not be necessary. Having a grasp of the amount of fluoride a person might be getting through drinking water can help a dental professional in decision-making for treatments and better tailor dental care for their patient.
Although the local dental community sometimes has data and knowledge about fluoridation of water from a local community water system, that type of information for patients who drink water from private wells is often not on their radar. Approximately 20 percent of New Mexico's population relies on private wells for drinking water.
The New Mexico Environmental Public Health Tracking Program's Private Well Initiative, in partnership with the New Mexico Private Well Program, collected and analyzed drinking water and fluoride data for New Mexico including for private wells. This information was compiled in various formats, inclusive of visuals, to be used to educate the public, but most importantly the dental community.
The New Mexico Department of Health's Oral Health Office requested this information be disseminated and presented to key audiences inclusive of dental decision makers, and professionals in the dental field. Audiences for this information included the New Mexico Oral Health Coalition, the Dental Directors of the New Mexico Primary Care Association, and subscribers of the New Mexico Dental Association quarterly report.
New Mexico Oral Health Coalition obtained critical information about the fluoride well levels in the state. That information was applied as part of a public safety net which was monitoring the levels of fluoride and educating the public how to deal with low or high levels of fluoride in their private wells. Further, this information was presented to the ABQ Water Utility Authority during a testimony at hearings related to community water fluoridation.
As a result of these first-time presentations, members of the New Mexico Primary Care Association Dental Directors became educated and better informed about the fluoride levels throughout the state. They have applied this to monitor dental fluorosis and prescriptions of fluoride to their patients. Most of the dental directors are from rural areas of the state and therefore access to such information is limited. The facts, data, and figures provided through this outlet has been decisive intel in their work.
An article was published in the New Mexico Dental Association report reaching dentists throughout the state, many in rural areas, many whom would have not received this information otherwise. This article emphasized the need for dental service providers to inquire about patients' sources of drinking water.
Further the Office of Oral Health has applied the information in its educational components which includes teaching the public and consumers of public or school-based dental programs about the difference between fluoride concentrations in water of 0.7 mg/L and 4.0 mg/L. The lower is the optimal level - the safe level in our preventive efforts to reduce the incidence of tooth decay.
To learn more about CVD and hear attacks visit: https://nmtracking.org/environment/Fluoride.html
Article Contributors: Barbara Toth and Miriam Wamsley. Special thanks to the NM DOH Private Wells Program, the NM DOH Office of Oral Health, the New Mexico Primary Care Association, the New Mexico Dental Association and these public health professionals: Miriam Wamsley, Rose Galbraith, and Rudy Blea.
Although the prevalence of toxic lead in the environment, particularly in older housing, has been a continuing concern in New Mexico, several health care provider's offices and agencies serving young children and families might think lead testing is not warranted for their patients. The results of blood lead testing of children enrolled in Head Start and Medicaid programs in the state tell a different story. Testing is required by law for children enrolled in Head Start and Medicaid programs which has been instrumental in reaching children and the data helps paint a picture of lead exposure occurrences. What about children not enrolled in these programs? How could they be included in testing?
Utilizing blood lead data and data on housing age and poverty status, the New Mexico Environmental Public Health Tracking Program (NM EPHT) conducted an assessment identifying areas in the state where the highest risk for lead exposure existed and the lowest test rates occurred. This information was relayed to the NMDOH Childhood Lead Poisoning Prevention Program (CLPPP). Reducing or eliminating exposure to lead in paint and lead dust in residential housing is a primary focus of the CLPPP. The CLPPP used the findings to focus health education to those identified areas through a robust and comprehensive health education project initiated in 2013.
The CLPPP first focused on medical providers (MD, DO, Advance Nurse Practitioners, and Nurse Midwives) and an additional focus was on agencies serving Native American populations with aid from the NMDOH Tribal Liaison. The health education project provided these audiences with the NMDOH Childhood Lead Screening and Case Management Guidelines, health resources and the CLPPP and NM EPHT websites.
The health education project is reaching its intended objectives. Based on follow up data, New Mexico has shown an average increase in testing rate of 0.8 percent since 2013. Communities identified by the data as underreported communities report an average 5.6 percent increase with the highest increase of 12 percent. Testing rates in a county with a 40 percent Native American population increased from six to 11 percent. This effort, when coupled with planned sub-county analyses of blood lead levels and exposure factors will inform a more refined model of identifying vulnerable and under-measured communities and will form a decision analytical framework for future service planning.
To learn more about CVD and hear attacks visit: https://nmtracking.org/health/poisonings/CarbonMonoxidePoisoning.html
Article contributor: Anthony Fristachi. Special thanks to the New Mexico Childhood Lead Poisoning Prevention Program, the EHEB Lead Work Group, and to these public health professionals: Alexander Gallegos, Tammy Thomas, Crystal Begay.
Illustrated through the state's mortality data, cardiovascular disease (CVD) is a public health concern in New Mexico. The New Mexico Health Department set out to impact this health status by establishing a coordinated data-driven approach to reduce mortality associated with CVD.
Although multiple entities within the state health department addressed CVD and the associated factors, a directed method within the department for changing this health status did not exist. The need for a data-driven approach to concentrate efforts on a common goal and achievable objectives was immediately recognized. The Cardiovascular Disease Mortality Health Status Workgroup was formed to create direction by identifying common objectives to reduce mortality, synchronizing efforts and identifying best approaches to impact CVD. The first intent was to fully understand the contributors to the disease in this state and then carefully select sustainable interventions that best influence the health status.
The workgroup pinpointed a challenge; cardiovascular disease has multiple risk factors, including environmental exposure to PM2.5. To advance the understanding of CVD risk factors and protective factors, this group needed access to all these data in a comprehensive package. This collection of data would direct interventions. The department would use it to delineate the best approaches for reaching key audiences and gear services toward the most impacted populations.
The New Mexico Public Health Tracking program collects such data, has expertise on exposures, and the ability to access and analyze other relevant datasets. Serving on the workgroup, NM EPHT presented a solution to the multi-entity team; Cardiovascular Disease Community Health Risk Profiles. This key contribution by NM EPHT entailed compiling data for variables inclusive of census tract-level mean PM2.5 concentrations, spatial location data on PM2.5 monitors, median household income, unemployment, educational attainment, a lack of health insurance, household fuel use, race-ethnicity, housing values, and age of housing, for example.
The profiles were instrumental in the workgroup's ability to institute a data-driven approach to distinguish departmental objectives. The Cardiovascular Disease Mortality Health Status Workgroup used profiles to create the health department's CVD services logic model, the springboard for a coordinated departmental plan. The workgroup identified interventions that would best influence health behavior in the long-term, reduce risk factors and increase protective factors to ultimately affect the health status. Already with this data-driven approach to planning and assessment, the department maximized its current capacity to deliver existing interventions by strategically selecting primary service populations and establishing key audiences for health promotion such as patients in chronic disease management programs.
The data-driven logic model and plan lists a reduction in cardiovascular mortality in New Mexico as the department's ultimate long-term goal. The outcomes expected as result of strategically planned and delivered interventions include a reduction in CVD emergency room and hospital admissions.
Early expected outputs from the associated public health activities include: 1) an increased number of facilities submitting data to STEMI and stroke databases, 2) health initiatives in communities educating the public about high blood pressure and factors to prevent and manage CVD and, 3) health systems and EMS utilized profiles to provide services to communities with greatest need. The location for services and the prioritization for implementing those interventions will be based in part on the data from the Cardiovascular Disease Community Health Risk Profiles created by NM EPHT. Additionally, as a result of the profiles, needs and gap areas were identified. Continuing with its data-driven logic model and plan, the workgroup has selected desired future evidenced-based interventions and has initiated capacity-building to implement these future services and interventions.
To learn more about CVD and hear attacks visit: https://nmtracking.org/health/cardio/HeartAttack.html
Special thanks to the NM DOH Cardiovascular Disease Mortality Health Status Workgroup, NM DOH Epidemiology and Response Division, NM DOH Chronic Disease Bureau and these public health professionals: Brian Woods, Heidi Krapfl and Barbara Toth.
Wanting to expose their children to the benefits of country living, a young family with toddlers traded the urban lifestyle for a more serene rural way of living. They purchased a quaint home in the New Mexico mountains and began living in a forested community near where each of the parents had grown up. However, as with any house purchase, moving into a new home raised questions about environmental exposures and indoor air quality. Both parents are health conscious; one parent is a professional in cancer epidemiology. It was in this profession where the parent saw the connections between radon exposure with lung cancer, in part, from interactions with the NM EPHT program. Radon is the top cause of lung cancer deaths in non-smokers. The parents did not want their children to face the dangers of radon.
Having become aware of the potential health implications of radon exposure the family wanted to ensure that they, especially the young children, were safe living in the house. The parents turned to https://nmtracking.org knowing the NM EPHT website portal is not only a resource for data seekers, it is an outlet of practical environmental health tips and a good resource for health enthusiasts. On the site, the parents learned how testing is a crucial first step in health protection and discovered how a low-cost short-term test could be ordered from a state-sponsored program.
"The website is easy to follow; user-friendly and very informative. I had access to information about radon and learned how to get the kit," said one parent. "I went through the site and learned more. I was concerned."
Radon is not distributed equally throughout New Mexico. The only way to know the level is to test. The new homeowners found no records of the house ever having been tested for radon. Therefore, they did not have a baseline of potential levels of the dangerous gas seeping into structure.
Inspired by the information of the Tracking website to act, the family set about establishing a baseline of radon gas in the home. They ordered the low-cost short-term kit recommended on the website. The family then consulted with NM EPHT about the best place to put the test. They decided it would go in a high-traffic area in the center of the home where the family spends much of its time, and where the youngsters spend much of their day. They tested. It was winter. They received the results. It was a bit worrisome; just below the EPA recommended standard of 4 pCi/L, the test showed 3.9. The family had a baseline but wanted assurance the home was safe.
They then turned to the Tracking team for more practical tips. The parents were advised on the importance of periodic air flow through the home, which reduces during the winter months due to doors and windows being more frequently closed. Next, they were advised to try a long-term approach. They tested over nine months, leaving one test in the same spot as the first, another in the parents' bedroom, and one in the children's bedroom. Having tested over each of the seasons, the home's next set of results brought relief to the parents. Their home is safe. They know the children are not in danger.
The family is glad to have learned about the health impacts from radon exposure and were pleased they could get tips about making their home a safe and healthy place to live. The family has a baseline. They also know the levels could vary throughout the year and gained an understanding of why that could happen.
"We are more encouraged to have the windows open and have become aware at certain times of the year the radon level in the house could be higher, for example in the winter when the house is closed," said one parent, who takes advantages of warm days to ventilate the house.
With the guidance of the Tracking program, "now we have a solid baseline for a future comparison," said one parent. The family is committed to testing every few years, "and now we know how to do it."
Because of this learning process, the parents, say, "we have a sense of security and are relieved." Gaining this assurance leaves the family to enjoy the serenity of their new mountain home and relish in the joys of country living.
Learn more about radon and indoor air quality here: https://nmtracking.org/environment/Radon.html
Special thanks to these public health professionals: Barbara Toth, Angela Meisner, Deyonne Sandoval and to the New Mexico Cancer Concerns Workgroup, the NMED Radon Program, and the family who shared their story with us.
Wildfire season in New Mexico typically starts in May and ends in early July. Prolonged exposure to smoke is harmful to people of all ages but especially to young children, older adults, pregnant women, and people with heart and/or lung disease. Wildfires can spread fast causing air quality to change quickly. This allows little time for alerting nearby residents to take measures to protect their health.
Wildfires in 2011 spurred a proactive approach by the New Mexico Department of Health in preparing for and dealing with the wildfire season. In support, the New Mexico Tracking Program created a number of resources, including fact sheets and posters, to educate residents about ways to protect their health during wildfires. Tracking program staff developed the 5-3-1 Visibility Method to help residents more easily judge smoke danger and decide when to head indoors. In addition, they devised an [https://nmtracking.org/WildFireSmoke interactive mapping tool] to help residents determine when wildfire smoke is near enough to cause them harm
Using the tracking program's method and resources, New Mexico residents do not have to wait for official smoke alerts before making decisions about how to protect their health during wildfires. Now they can monitor their community and move more quickly if needed. More residents are learning about the tracking program's resources through the efforts of the US Forest Service, National Weather Service, and Southwest Coordination Center. The tracking program's impact also extends beyond New Mexico-two states have adopted the program's visibility tool for use in their forest management programs.
"Before the tracking network came up with the 5-3-1 tool we had a system which was wholly convoluted and complicated. It was very difficult for us to use as people trying to help inform the public and for the public to understand."-- Chuck Maxwell, Predictive Services Meteorologist, Southwest Coordination Center