Pierce County Research Articles

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Asthma Symptoms and Successful Wood-Smoke Reduction Strategies Implemented in Urban Tacoma-Pierce County, Washington

Asthma Symptoms and Successful Wood-Smoke Reduction Strategies Implemented in Urban Tacoma-Pierce County, WashingtonAbstract Number:1720 Anar Shah* and Erik Saganic Anar Shah* Washington State Department of Health, United States, E-mail Address: [email protected] Search for more papers by this author and Erik Saganic Puget Sound Clean Air Agency, United States, E-mail Address: [email protected] Search for more papers by this author AbstractThe Tacoma-Pierce County region in Washington State is home to over a half million people. Unfortunately, this area was recently over the federal air quality limit for fine particle pollution (PM2.5). Our studies show a major cause for poor air pollution in this densely populated area is due to the 80,000 wood-burning stoves and fireplaces used in homes in the region. In Western Washington, PM2.5 is highest in the winter months. Many studies support a link between exposure to PM2.5 and asthma morbidity. During 2009-2011, the age-adjusted hospitalization rate per 100,000 people in Pierce County was 95 (95% CI: 91-99), compared to 72 (95% CI: 71-73) for Washington State overall. During 2006-2011, 15% (95% CI:11-21) of adults with lifetime or current asthma (asthma) in Pierce County reported visiting the emergency department due to asthma at least once in a year compared to 10% (95% CI:8-11) of adults in the rest of the state, excluding Pierce County. 13% (95% CI:8-21) of adults with asthma in Pierce County reported 7 or less days of symptom-free days in the past 2 weeks, which reflects poor asthma control. For the rest of the state, 11% (95% CI: 9-13) of adults with asthma reported the same during 2006-2011. The difference was not statistically significant. 25% (95% CI: 20-30) of adults with asthma in Pierce County reported using a wood burning fireplace or stove compared to 28% (95% CI: 26-30) in rest of WA. Over the last few years, the Puget Sound Clean Air Agency, WA State Department of Ecology, and their partners have worked on reducing diesel and wood smoke pollution in this sensitive community through special grants and enforcement programs, and have made significant progress. This presentation will include analyses on asthma and air pollution, how we’re fixing the wood smoke problem, recommendations for people with asthma to cope with air pollution, and our encouraging progress to reduce air pollution in the region and state.

Pierce County Wins a 35-Year Battle with I/I

Pierce County Wins a 35-Year Battle with I/I

Do educational interventions targeted to nail salon workers and customers improve infection control practices in these salons?

The Tacoma-Pierce County Department of Health, the Pierce County Antibiotic Resistance Task Force, and the Washington State Department of Licensing (DOL) designed an intervention to determine whether nail salon infection control practices could be improved by educating salon employees and their customers about good infection control practices. Twenty intervention salons and 26 control salons completed the 3-month study. The intervention group received a letter asking them to "join our campaign to promote healthy people in healthy communities … ." Two DOL pamphlets on cleaning and disinfecting and a tent card with important infection control reminders-targeted to clients on one side and to salon workers on the other side-were also included. Outreach workers from the health department visited 25 (of the original 27) intervention salons once and talked about the materials included in the mailing. Inspection infractions were used to measure compliance with infection control practices. Each salon was inspected by the DOL at baseline, within 1 month after the educational mailing, and within 1 month after an outreach visit from the local health department. Both groups exhibited statistically significant decreases in infractions; however, the intervention group exhibited a higher and more significant decrease in infractions than the control group. The intervention and control groups underwent three DOL inspections, which may have resulted in a Hawthorne Effect, with both groups seeing a statistically significant decline in infractions after inspection visits. The more significant decrease in the number of infractions cited in the intervention salons may be due to the educational materials and the health education site visit they received.

Making the Case for Budget Reductions: Pierce County Library’s FY2013 Budget

This article features a discussion about how Pierce County (Washington) Library’s 2013 budgeting process and budget document explain budget cuts and service changes to users and taxpayers within the context of the library’s continuing effort to improve operational efficiency and maintain valued core, customer, and community services. Pierce County Library is an independent municipal corporation established by state law and is funded from a separate property tax levy as a junior taxing district.

Model for Heart Failure Education

Heart failure (HF) is the heart's inability to meet the body's need for blood and oxygen. According to the American Heart Association 2013 update, approximately 5.1 million people are diagnosed with HF in the United States in 2006. Heart failure is the most common diagnosis for hospitalization. In the United States, the HF direct and indirect costs are estimated to be US $39.2 billion in 2010. To address this issue, nursing educators designed innovative teaching frameworks on HF management both in academia and in clinical settings. The model was based on 2 resources: the American Association of Heart Failure Nurses (2012) national nursing certification and the award-winning Pierce County Responsive Care Coordination Program. The HF educational program is divided into 4 modules. The initial modules offer foundational levels of Bloom's Taxonomy then progress to incorporate higher-levels of learning when modules 3 and 4 are reached. The applicability of the key components within each module allows formatting to enhance learning in all areas of nursing, from the emergency department to intensive care units to the medical-surgical step-down units. Also applicable would be to provide specific aspects of the modules to nurses who care for HF patients in skilled nursing facility, rehabilitation centers, and in the home-health care setting.

Pierce County trains future IT professionals

Pierce County trains future IT professionals

Improving Immunization Coverage in a Rural School District in Pierce County, Washington

Washington State has some of the highest percentages of school immunization exemptions in the country. We compared school immunization records in a rural school district in Pierce County, Washington, to immunization records in the state immunization information system (IIS) and parent-held records. Correcting school immunization records resulted in an increase in the number of students classified as fully immunized from 1,189 to 1,564 (p < .0001). We conducted school-based immunization clinics that increased the number of fully immunized students to 1,624 (p = .013). Immunized students with certificates of exemption on file suggest exemptions of convenience. Strategies to improve school immunization services include assigning IIS access to school administrative staff and educating school staff and parents on the importance of immunization.

Results of the Large-Scale Pilot Investigation of the DEMON® Nitrogen Removal System in Pierce County, Washington

Results of the Large-Scale Pilot Investigation of the DEMON® Nitrogen Removal System in Pierce County, Washington

The utilization of geographic information systems to create a site selection strategy to disseminate an older adult fall prevention program

Public health programmatic interventions are increasingly required to address the prevention needs of aging populations. Falls in adults age 65 and older are the leading cause of injury hospitalization in the U.S., and a leading cause of international fatal injuries in older adults. This project used geographic information systems (GIS) to create a site selection strategy for the dissemination and pilot evaluation of a community-based fall prevention program for older adults in Pierce County, Washington. Potential site addresses ( n = 84), 2000 U.S. census data for adults ≥65 years of age, and local road networks, which were converted into service areas using actual travel time, were entered in a GIS. Potential sites were then ranked by census densities of older adults who lived within 10 min travel time. Nine sites launched the program, with the goal recruiting 20 older adult program participants at each site ( n = 180). At the end of 12 months, participation exceeded program goals ( n = 331). GIS can be used to determine actual travel time, and may facilitate the selection of community-based prevention program sites to maximize accessibility and utilization by targeted populations.

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Bridging the early literacy gulf

This study assessed the impact of public library initiated early literacy training for in-home childcare workers. The results of this research demonstrate that, in this context, public libraries can play a significant role in bridging the large gap between children‟s difficulty and success in learning to read. The researchers used a pretest-posttest experimental design with childcare workers randomly assigned. The intervention consisted of training treatment group childcare providers in early literacy principles and activities that could foster specific early literacy skills. The training was provided by staff of the Pierce County [WA] Library System. The impact was assessed through two different methods. The providers responded to pre-post surveys about their early literacy knowledge and activities within their childcare. These surveys were examined for any change between the pre and postsurvey responses. The impact on the 86 three and four year olds within the childcares was measured through a pre and post one-on-one assessment using Early Literacy Skills Assessment (ELSA) developed by Highscope. Researchers from the University of Washington Information School trained library staff in data collection methods, provided guidance in proper research procedures, analyzed data, and reported results. The intervention had statistically significant results with demonstrated growth in the children‟s competence related to 3 of the 4 early literacy principles and in the variety of activities related to literacy principles that the providers implemented. This study begins to fill a research gap because despite a decade of emphasis on early literacy virtually no scientific studies relating to libraries‟ impact on early literacy competency exist. Such studies are essential to libraries both in program planning and in securing financial support.

Evaluation of a voluntary menu-labeling program in full-service restaurants.

We assessed whether labeling restaurant menus with information on the nutrient content of menu items would cause customers to alter their ordering patterns. Six full-service restaurants in Pierce County, Washington, added nutrition information to their menus, and they provided data on entrée sales for 30 days before and 30 days after the information was added. We assessed the prelabeling versus postlabeling difference in nutrient content of entrées sold, and we surveyed restaurant patrons about whether they noticed the nutrition information and used it in their ordering. The average postlabeling entrée sold contained about 15 fewer calories, 1.5 fewer grams of fat, and 45 fewer milligrams of sodium than did the average entrée sold before labeling. Seventy-one percent of patrons reported noticing the nutrition information; 20.4% reported ordering an entrée lower in calories as a result, and 16.5% reported ordering an entrée lower in fat as a result. The concentration of calorie reduction among 20.4% of patrons means that each calorie-reducing patron ordered about 75 fewer calories than they did before labeling. Thus, providing nutrition information on restaurant menus may encourage a subset of restaurant patrons to significantly alter their food choices.

The Business Case for Optimizing the Operations, Maintenance, and Distribution of Pierce County's Biosolids Fertilizer Manufacturing Facility

The Business Case for Optimizing the Operations, Maintenance, and Distribution of Pierce County's Biosolids Fertilizer Manufacturing Facility

The Business Case for Optimizing the Operations, Maintenance, and Distribution of Pierce County's Biosolids Fertilizer Manufacturing Facility

The Business Case for Optimizing the Operations, Maintenance, and Distribution of Pierce County's Biosolids Fertilizer Manufacturing Facility

The Use of Assessment in Promoting Secondhand Smoke Policy in a Local Health Jurisdiction

Clean indoor air regulations reduce both exposure to secondhand smoke and use of tobacco, two significant causes of death in the United States. In 2003, the Board of Health in Pierce County, Washington State, adopted a resolution prohibiting indoor smoking in all public places. Assessment activities were used in three key steps during the secondhand smoke policy development process: (1) setting prevention priorities, (2) monitoring and evaluating interventions, and (3) adopting local policy change. Step 1 included calculating attributable risks for morbidity and mortality caused by preventable health behaviors. Step 2 involved designing logic models and outcomes-based evaluations to collect and analyze data from prevention efforts. Surveillance of restaurants documented voluntary adoption of smoke-free policies. Step 3 included conducting telephone surveys to track public support for tobacco policy approaches. Results demonstrated tobacco's high impact on morbidity and mortality, illustrated a plateau of restaurants' voluntary smoke-free policies, and identified growing public support for secondhand smoke policy. Assessment results were included in multiple policy and support documents and cited by Board of Health members during policy adoption. Assessment data contributed critical support to local public health decision makers during key steps of a lengthy secondhand smoke policy development process.

Transforming the Cross Cultural Collaborative of Pierce County Through Assessment Capacity Building

Underserved populations are underrepresented in public health initiatives such as tobacco control and in cancer clinical trials. Community involvement is crucial to interventions aimed at reducing health disparities, and local health departments increasingly are called upon to provide both leadership and funding. The Tacoma Pierce County Health Department (TPCHD), in conjunction with 13 key community-based organizations and healthcare systems, formed the Cross Cultural Collaborative of Pierce County (CCC) that successfully employs needs-assessment and evaluation techniques to identify community health initiatives. Community leaders from six underserved populations of the CCC were trained in needs-assessments techniques. Assessments measured effectiveness of the collaborative process and community health initiatives by using key informant (n = 18) and group interviews (n = 3). The CCC, facilitated by its partnership with the TPCHD, built capacity and competence across community groups to successfully obtain two funded public health initiatives for six priority populations. Members expressed overall satisfaction with the training, organizational structure, and leadership. The CCC's diversity, cultural competency, and sharing of resources were viewed both as a strength and a decision-making challenge. Public health department leadership, collaboration, and evidence-based assessment and evaluation were key to demonstrating effectiveness of the interventions, ensuring the CCC's sustainability.

First Report of Infection of Poison Hemlock and Celery by Apium virus Y in Washington State.

A commercial field of celery (Apium graveolens var. dulce) cvs. Conquistador and Sabroso was planted with sets between 1 June and 10 July 2004 in Pierce County in western Washington (WA). In late August, many plants were stunted and showed chlorotic line patterns. One symptomatic plant and five nonsymptomatic plants were transferred to a greenhouse and grown at 22°C with supplemental lighting to extend day length to 16 h; foliage was trimmed back. The symptomatic plant and three nonsymptomatic plants developed a distinctive chlorotic line pattern when new foliage emerged in February. Two plants remained nonsymptomatic. Young foliage was tested by ELISA with the general potyvirus monoclonal antibody (Agdia, Inc., Elkhart, IN). All symptomatic plants yielded a positive result and the two nonsymptomatic plants were negative. Celery mosaic virus (CeMV) was previously reported to be widespread in WA (3), but primers specific for CeMV did not yield amplicons in reverse transcription (RT)-PCR from RNA isolated from symptomatic leaf tissue (RNeasy Plant Mini Kit: QIAGEN, Valencia, CA). General potyvirus primers (1) were used to amplify ≈1,700 nucleotides from the 3' terminus of the virus genome adjacent to the poly-A tail. Six amplicons from each of three independent reactions were cloned into pCR2.1 (Invitrogen, Carlsbad, CA) and sequenced (GenBank Accession No. FJ010827). Comparison with the nucleotide sequence database revealed 98 and 97% identity to Australian isolates of Apium virus Y (ApVY) (family Potyviridae) from parsley (GenBank Accession No. AF207594) and poison hemlock (Conium maculatum) (GenBank Accession No. AY049716) (4) and 91% identity to North American isolates of ApVY from celery and Ammi majus reported from California (GenBank Accession No. EU515126) and Florida (GenBank Accession No. EU255632), respectively. To our knowledge, this is the first report of a natural infection of celery by ApVY in WA. No other potyvirus sequences were identified in RT-PCR products from symptomatic celery. In 2008, in an effort to locate local samples of CeMV, poison hemlock plants were randomly collected in Benton, Walla Walla, and Whitman counties of eastern WA. No symptoms were observed and no CeMV was detected by RT-PCR in any of these plants. No ApVY was detected in 10 of 10 poison hemlock collected from Walla Walla County, but based on sequence analysis of RT-PCR amplicons, two of two plants collected from Benton and Whitman counties were infected with ApVY. In contrast to the WA isolates from celery, sequences from these poison hemlock plants (GenBank Accession No. FJ010828) were 98% identical to previously reported North American isolates of ApVY (GenBank Accession Nos. EU515126 and EU255632) and only 91% identical to Australian isolates (GenBank Accession Nos. AF207594 and AY049716). To our knowledge, this is the first report of ApVY in WA and the first report of a natural infection of poison hemlock in the United States. The celery and poison hemlock isolates reported in this study were from different geographic regions of the state and were only 91% identical. As is the case for other potyviruses (2), weeds such as poison hemlock may serve as a reservoir of ApVY in eastern WA where many plants of the family Apiaceae are grown commercially.

Emotional and Behavioral Problems of 13-to-18-Year-Old Incarcerated Female First-Time Offenders and Recidivists

This exploratory study in Pierce County, Washington, compared emotional and behavioral problems of 13- to 18-year-old incarcerated female first-time offenders ( n = 38) and recidivists ( n = 78) using the Massachusetts Youth Screening Inventory, Version Two (MAYSI-2) and demographic data. The study found that adolescent female recidivists had more emotional and behavioral problems, more unstable lifestyles, and less stable family situations.

Calibrating Statistical Population Reconstruction Models Using Catch‐Effort and Index Data

Abstract:This paper illustrates how age‐at‐harvest data, when combined with hunter‐effort information routinely collected by state game management agencies, can be used to estimate and monitor trends in big game abundance. Twenty‐four years of age‐at‐harvest data for black‐tailed deer (Odocoileus hemionus) were analyzed to produce abundance estimates ranging from 1,281 adult females to 3,232 adult females on a 22,079‐ha tree farm in Pierce County, Washington, USA. The annual natural survival probability was estimated to be 0.7293 (= 0.0097) for this female population. The estimated abundance was highly correlated with an independent browse damage index (r= 0.8131,P &lt;0.001). A population reconstruction incorporating the browse index did not substantially improve the model fit but did provide an auxiliary model for predicting deer abundance. This population reconstruction illustrates a cost‐effective alternative to expensive big game survey methods.