NC's "Sugar" Problem

Nearly 1 in 10 North Carolinians has diabetes. In the past decade the prevalence of the disease has doubled.  It is not an exaggeration to say that diabetes is a major public health problem that is affecting the quality of people's lives and costing the state billions of dollars a year.  Among African-American women, diagnosis of the disease has increased more than 30% in recent years which puts them at risk for other medical problems including heart disease, stroke, blindness, kidney failure, amputations and nerve damage. 

Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Doctors are not sure what causes diabetes but it appears that both genetics (traits we inherit from our parents) and lifestyle choices, including body weight and exercise, play a role in its development.  

There are three different types of diabetes. Type 1, also known as juvenile diabetes, typically develops early in life (before age 30) and is the result of the pancreas producing little or no insulin. Type 1 diabetics must get insulin shots daily or use an insulin pump. 

Type 2 diabetes usually occurs after age 30 and is the result of lifestyle choices and related risk factors. These include obesity, physical inactivity and poor diet.  Type 2 can be controlled with changes to diet and exercise routines as well as with pills. The majority of diabetes cases (90-95%) are Type 2.  Increasingly, we are seeing this type develop in younger people, a sign that more sedentary lifestyles and obesity are causing more health problems earlier in life.

The third type of diabetes, gestational diabetes, is related to high blood sugar levels during pregnancy and appears to be related to the same risk factors as Type 2. Women who develop gestational diabetes are at greater risk for developing diabetes later in life. In addition, there are millions of adult women in our country with pre-diabetes; those who have increased blood sugar levels but not high enough to be diagnosed with diabetes.  These women can control their blood sugar with diet and exercise but, unfortunately, many of these cases are undiagnosed until the full disease develops.

By 2050 it is expected that women will account for the majority of diabetes cases in the United States.  For women in North Carolina, which currently ranks 17th in the nation for adult diabetes, it means they must be proactive with their health to avoid this debilitating and potentially fatal illness. A healthy diet and body weight, controlled with regular exercise offers the best protection. Studies show that for some people decreasing blood sugar levels by even 1% and minimal weight loss, 5-10% of current body weight, can significantly reduce the risk of developing Type 2 diabetes and its devastating side effects.

To learn more about how to develop and maintain a healthy diet, visit Eat Healthy and Folic Acid). 

To learn more about diabetes prevention and control, visit www.ncdiabetes.org.  In addition, you can access The Burden of Diabetes in North Carolina: Prevalence, Complications and Cost (2008),  a report published by the N.C. Department of Health and Humans Services, Division of Public Health.

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What is ASIP?

The Association of SIDS and Infant Mortality Programs (ASIP) provides national leadership for professionals working in the field of SIDS risk reduction and infant death prevention services. The organization offers support for those who respond to infant and child deaths as well as bereavement services.  Through professional support, educational programs, webinars, policy development and advocacy work, ASIP is the only professional membership association dedicated exclusively to serving Sudden Unexplained Infant Death (SUID) and SIDS professionals.

As a member of ASIP, the North Carolina Healthy Start Foundation has easy access to other organizations working to promote infant safe sleep across the country as well as the opportunity to seek advice, share ideas, discuss issues and network with colleagues on a national level. Some of these opportunities are available to nonmembers as well. 

Last month, ASIP, in collaboration with PLIDA (Perinatal Loss and Infant Death Association) and several other national sponsors, hosted the International Conference on Perinatal and Infant Health in Alexandria, VA.  Marta Pirzadeh, North Carolina’s Infant Safe Sleep Campaign Coordinator, was honored to present a session entitled "Safe Sleep in the Hospital Setting" which described the Foundation's HOPES Program (Hospital Outreach and Partnerships for Education About Infant Safe Sleep) – a hospital-based, outreach and training initiative. 

Very few states are working on comprehensive hospital-based infant safe sleep initiatives and this was an opportunity to showcase a model program from North Carolina.  Workshop attendees were given an overview of the history of HOPES, successes and challenges, the critical role that hospital staff have in safe sleep education and modeling risk reduction practices as well as tips about starting a similar program in their state. The session was well attended and participants from across the country were enthusiastic to learn more about what North Carolina is doing to expand safe sleep education through hospital outreach.

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Tis the Season for Sharing Your Health History

It's the holiday season. For most it is a time for planning special gatherings with family and friends and celebrating the spirit of giving. It is also a perfect time for individuals to share their health history with loved ones. According to the Centers for Disease Control and Prevention (CDC), 96% of Americans believe that their family history is important to their health. However, only 30% have tried to collect and organize their family history. 

If you're a healthcare professional encourage your clients to discuss and document their health history and any disease and/or medical condition in their family. Stress that a family health record is essential to help you determine what early screenings and tests might be needed. Genetic (inherited) factors play a significant role in chronic diseases such as diabetes, high blood pressure and heart disease.

According to the U.S. National Library of Medicine, a complete family health history includes information from three generations of relatives including: children, brothers and sisters, parents, aunts and uncles, nieces and nephews, grandparents and cousins. The North Carolina Healthy Start Foundation’s My Health Journal includes a section for documenting family health history. This self-help, interactive booklet was developed in response to RICHES Project participants (Resources In Communities Helps Encourage Solutions) asking for a tool to help women document questions regarding their health and to record test results. The Men’s Body Maintenance Manual also includes a family health history section. Both publications are free and available on the Foundation's website  (click on catalog).

When compiling a family health history, the Mayo Clinic advises individuals to include the following information:

• Sex
• Date of birth
• Ethnicity
• Diseases or other medical conditions
• Age when disease was diagnosed
• Diet, exercise habits, smoking habits or history of weight problems
• For deceased relatives, age at the time of death and cause of death

The CDC also recommends that individuals take note of the following:

• Diseases that occur at an earlier age than expected (10 to 20 years before most people get the disease)
• Disease that does not usually affect a certain gender (for example, breast cancer in a male)
• Certain combinations of diseases within a family (for example, breast and ovarian cancer or heart disease and diabetes)

The RICHES Project is dedicated to educating and training community-based organizations on ways to address the health and health-related needs of women within their communities. Through RICHES, organizations are able to form partnerships, network and share resources to better serve their clients. The ultimate goal is to improve the health of women of reproductive age, particularly those of low economic status and/or who are ethnic or racial minorities, to adopt healthier lifestyles and behaviors.

For more information on RICHES and how you can join, please visit www.NCHealthyStart.org (on homepage or click on
For Professionals, then Partnerships) or email RICHES@NCHealthyStart.org.

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Digital Disparities

Do you text, tweet, tag and blog? Every day we hear about new technologies and new ways to connect. There's Facebook, Twitter, LinkedIn and YouTube to name just a few. The social media landscape is constantly evolving allowing us to reach others in new and innovative ways. This can be very exciting and yet, how many Latinos in North Carolina have access to these new social media platforms? Are they the best way to reach the Latino population? Are there disparities in the digital world?

Research by the Pew Hispanic Center found that use of technology by Latinos varies greatly depending on if the individual is born in or outside the U.S.  The difference is huge in terms of Internet use: 85% of Latinos born in the U.S. use the Internet, compared to 51% of Latinos who are foreign born. Age plays a significant role. U.S. born Latinos are younger and those between 16 to 19 years of age are actively using the Internet (between 90-97% of them).

The Pew Hispanic Center survey also found that there were gender differences within age groups. Among Latinos 26 years of age and older, only 57% of women reported using the Internet, compared to 65% of men. In addition, those Latinos who reported speaking English were more likely to use the Internet (85%) compared to Latinos who reported Spanish as their dominant language (35%).

Although the survey did not break down the information by state, a small survey done by the North Carolina Healthy Start Foundation in 2009 mirrors these results. Thirty-seven percent of participants reported that they used the Internet for health information and respondents who rated themselves as "good" or "very good" in English were more likely to report using the Internet.

The gaps in social media use underscore the importance of using a variety of communication strategies to reach Latinas and their families with health information.  In focus groups conducted by the North Carolina Healthy Start Foundation in 2010, many participants in rural and urban settings stated that they do not use the Internet to get their health information and prefer to speak to a healthcare professional.  As healthcare professionals, we shouldn't assume everyone has Internet access. Take the time to check with your clients. If they do have access, direct them to Web sites that have credible health information. Consider if your organization, clinic or health department can make Internet access available for clients.

It is important to know our audience and try different approaches. In May 2009, there were more than one million U.S. based Hispanic Facebook users who preferred using the Spanish version of the application.  It is important to keep up with technology and share with our clients, but also remember that traditional forms of communication such as written materials and face to face talks are still strongly valued by Latinos as a way to receive health information.

For the full article by the Pew Hispanic Center.

Health and education resources for Latinos:

• CuidadodeSalud.gov CuidadodeSalud.gov is the partner site of HealthCare.gov, which was launched in July 2010. It is the first Web site in Spanish to provide consumers, with either public or private health insurance, options tailored specifically for their needs in a single, easy-to-use tool.

• Migration and HIV/AIDS This resource on HIV and migration to the United States includes a compilation of successful HIV prevention strategies to be used with migrant populations such as games, songs, comic books and fotonovelas.

• Latino Student Resource Guide  This Web Site is meant to assist and provide resources for Latino students and their families as they navigate the college application process; it also provides resources for those who work with Latino students. Great resource for anyone working with Latino youth.

• Information for parents about colleges and universities Hispanic Scholarship Fund (HSF) and other institutions confirmed that parents play a critical role in their children's education. This campaign was created to overcome those barriers so more Latino children can get into college. The Web site is in English and Spanish and includes informational videos for parents.

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Breastfeeding Awareness Partnership

There's an old adage that there is strength in numbers. That certainly proved to be the case for a partnership between the North Carolina Healthy Start Foundation, the Child Fatality Task Force, the Health and Wellness Trust Fund and the N.C. Women's Infant and Children (WIC) Program. When these four organizations came together to promote breastfeeding, combining their unique areas of expertise and resources, something wonderful happened.

The Child Fatality Task Force (CFTF) and the North Carolina Healthy Start Foundation (NCHSF) share a mutual interest in improving the health of North Carolina's babies. Based on strong evidence that breastfeeding protects against many health conditions, in 2008 the two organizations collaborated and presented a proposal to the Health and Wellness Trust Fund to create a social marketing campaign to raise awareness about the benefits of breastfeeding.

The result?  In 2009, the Health and Wellness Trust Fund's Obesity Task Force awarded a two-year grant to the NCHSF to develop this campaign. The long-term goal is to increase the initiation of breastfeeding in eastern North Carolina among low wealth women, ages 20 to 34, but the immediate campaign goal is more modest: to increase knowledge of the benefits of breastfeeding, promote positive attitudes about breastfeeding and link people with resources.

An advisory group was formed combining the expertise of researchers, local program staff, lactation consultants and the state Breastfeeding Coordinator. Eastern North Carolina was selected as the target area since it has the lowest breastfeeding initiation rates in the state. Five focus groups were conducted in the region to assess what women, their partners and other family members knew/had heard about breastfeeding and to determine what barriers exist to breastfeeding.

Based on feedback from these discussions, the North Carolina Healthy Start Foundation developed two television commercials and a companion brochure featuring real moms, dads and a grandmother, all from eastern North Carolina.  They shared their reasons why they breastfed, or support breastfeeding and identified the many benefits of breastfeeding for the baby as well as for the mother. A logo for the campaign was developed and promotional baby bibs featuring the new logo were distributed to WIC offices and breastfeeding support groups across eastern N.C.  

The television spots ran in May and again in September in the Greenville/New Bern market. A total of 4,546 spots aired during the two phases of the campaign. During this time the Pitt County Health Department sponsored several local events and programs to further promote breastfeeding. Feedback from the campaign was terrific.

"I applaud and support your campaign to encourage breastfeeding. You gave a lot of reasons why, all very good."

"I want to say thank you for getting the breastfeeding message out there with the new television ad campaign. It makes me smile every time I see it."

"I hope more women will consider giving their babies this wonderful gift after watching your ads and knowing there is support out there."

Just as the campaign was starting its second year, the state WIC program issued non-competitive grants so all local WIC offices could do more to promote breastfeeding.  Because of WIC's involvement in the social marketing campaign's development, they allowed counties in eastern N.C. to request funds to extend the breastfeeding campaign. As a result, the Foundation's Communication Manager, Chrsitine Rogers has worked closely with 10 counties – sending out the television spots and artwork. Not only has this extended the original media schedule into new counties and for additional months, but several counties have also used the original messaging and images to create billboards.

It is our hope that the breastfeeding awareness message will continue to spread across the state. We know this is only possible with continued cooperation and collaboration. What started as a kernel of an idea in 2008, spearheaded by the Child Fatality Task Force (CFTF), has become a model for how partnerships can accomplish much more than each organization working alone.  We are grateful to our many partners for making this campaign possible and we extend our heartfelt thanks.

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 N.C. Healthy Start Foundation | 1300 St. Mary's Street, Suite 204 | Raleigh, NC 27605 | 919-828-1819
Information@NCHealthyStart.org