Publication of the Division of Public Health Services

January/February 2005, Vol. 19, No. 1

Current Trends in Pertussis
by Susan Goodykoontz

Pertussis continues to be one of
the most common vaccine preventable diseases reported in Arizona. The
overall trend shows pertussis cases
increasing with seasonal fluctuations
due to outbreaks (Figure 1).
Nationally, following a dramatic
decrease after the introduction of
diptheria tetanus pertussis vaccine,
pertussis cases have been increasing
since the 1980s. The Arizona
Department of Health Services is
particularly concerned about the high
percentage of infant cases as well as
the increasing proportion of cases
reported among adolescents and
adults.
Surveillance has demonstrated a
sustained high level of cases currently

reported in young infants, especially
in the absence of any reported
outbreak. Figure 2 shows the percentage of cases reported from each age
group from 2000-2004. Infants are
most susceptible to serious respiratory
illness, complications, and even
death, particularly infants less than six
months who are too young to have
completed the primary vaccination
series (1, 4). In Arizona, three deaths
have been reported in infants less
than four months of age during the
past three years. The high level of pertussis among infants does not appear
to be attributable to suboptimal
immunization rates among children.
According to the July 2004 Centers
for Disease Control and Prevention

Figure 1

(CDC) National Immunization Survey,
96 percent of Arizona’s children ages
19 to 35 months received three
vaccines of diptheria tetanus acellular
pertussis, which is equal to the
national rate. Although Arizona
continues to have pockets of underimmunized children, the majority of
cases reported the past two years have
been from communities with high
immunization rates.
This high level of infant pertussis
is a trend seen nationwide. The average annual incidence of reported pertussis cases and deaths among U.S.
infants during 1980–1998 increased
50 percent. The majority of morbidity
and mortality occurred among infants
less than four months of age (4). In
2002, the CDC initiated a multistate
case-control study to characterize the
contacts and exposures associated
with the transmission of pertussis to
U.S. infants less than four months of
age. Arizona is one of four states participating in the study. Infants less
than four months of age confirmed by
culture, polymerase chain reaction
testing, or epidemiological linkage to
a laboratory-confirmed case are eligible for enrollment in the study. The
original goal for study enrollment
across the four states was 100 cases
and 200 controls. ADHS began
enrolling cases into the study in mid2003 and to date, 43 cases and 86
Continued on page 2

Visit the ADHS Web site at www.azdhs.gov
Chronic Disease
Surveillance
Indicators 2004
Page 3-5
January/February 2005

Helping Protect
Arizona’s Children
Page 5

National Children’s
Dental Health
Month
Page 6

Communicable
Disease
Summary
Page 7

Arizona
Nutrition
Network
Page 8
Prevention Bulletin

1

Current Trends in Pertussis

continued from page 1

Percentage of reported cases

Figure 2
controls have been enrolled. Case enrollment
Percentage of Reported
will cease by the end of the year.
Confirmed and Probable Pertussis Cases
Although traditionally considered to be a
by Age Group, Arizona, 1998-2004 (as of 12/9/2004)
childhood disease, pertussis is increasingly
100%
being recognized and reported in adolescents
19+y
(1)
90%
and adults . This trend is reflected in the two
5-18y
most recent pertussis outbreaks in the state
80%
(Pima County, 2001-2002, 504 reported cases,
6m - 4y
70%
and Yavapai County, 2002-2003, 487 reported
60%
< 6m
cases), both of which began in middle schools
50%
(2)
. Waning immunity following receipt of the
40%
last dose of pertussis vaccine renders older
30%
children, adolescents and adults susceptible to
20%
pertussis. A vaccine is currently being devel10%
oped in the United States for this susceptible
0%
population that combines acellular pertussis
1998
1999
2000
2001
2002
2003 2004 to
vaccine with tetanus and diphtheria toxoids
date
Year of Report
(TdaP)(3). TdaP vaccines that can be given to
adolescents and adults have been licensed and
are available in other counties including
For more information on pertussis epidemiology,
Australia, Canada, France and Germany.
laboratory testing, and antibiotic treatment and prophylaxThere are several barriers to the diagnosis and surveil- is, please refer to the CDC online manual Guidelines for
lance of pertussis cases including the following (1, 3, 4, 5, 6, 7):
the Control of Pertussis Outbreaks at the following web

•

Lack of availability of pertussis culture

•

Challenges in culturing the fastidious B. pertussis
organism

•

Infants may show apnea only

•

Vaccinated children may have a milder cough of
shorter duration

•

Adolescents and adults often show milder illness

•

All age groups tend to experience classic symptoms at
night rather than in the presence of the diagnosing
provider

•

Tendency of persons to delay or avoid seeking medical
care for a cough illness

•

Myth that pertussis is predominantly a childhood
illness

address: http://www.cdc.gov/nip/publications/
pertussis/guide.htm
If you have any questions, please contact your local
health department or the ADHS Infectious Disease
Epidemiology Section at 602.364.3676.
References:
1. Friedman, D., Curtis, C, Schauer, S, et al. Surveillance for transmission and
antibiotic adverse events among neonates and adults exposed to a healthcare
worker with pertussis. Infection Control and Hospital Epidemiology. 2004
Nov; 25(11): 967-73.
2. Everett, S. Jacobsen, M., et al. School-associated pertussis outbreak –
Yavapai County, Arizona, September 2002-February 2003. Morbidity and
Mortality Weekly Reports. 2004 Mar 19; 53(10): 216-19.
3. Wharton, M. Prevention of pertussis among adolescents by vaccination:
taking action on what we know and acknowledging what we do not know.
Clinical Infectious Diseases. 2004 Jul 1; 39(1): 29-30.
4. Centers for Disease Control and Prevention. Pertussis deaths--United

Reported pertussis cases tend to represent a small pro- States, 2000.Morbidity and Mortality Weekly Reports. 2002 Jul 19;
portion of true pertussis incidence (2). Infant cases are often 51(28):616-8.
more likely to be diagnosed due to increased awareness
5. Jones, T, Gasser, M, Erb, P, Oeschslin, H. Cough and fear of sleep: early
clinical signs of Bordetella pertussis in an adult. Brazilian Journal of Infectious
and severity of illness. High levels of infant cases are typically seen during outbreaks. Therefore, high levels of infant Diseases. 2004, Aug; 8(4): 324-7.
6. Tozzi, A, Rava, L, et al. Clinical presentation of pertussis in unvaccinated
cases appear to be indicative of widespread community
and vaccinated children in the first six years of life. Pediatrics. 2003 Nov;
pertussis. Clinicians should consider pertussis as a possible 112(5): 1069-75.
cause of acute cough illness in adolescents and adults who 7. Bisgard, K, Pascual, B, et al. Infant pertussis – who was the source?
have contact with infants, especially parents and siblings of Pediatric Infectious Disease Journal. 2004 Nov; 23(11): 985-89.
infants (4). In addition, if you become aware of any poten8. Skaggs, P, Jennings, C, et al. Pertussis outbreak among adults at an oil refinery – Illinois, August-October 2002. Morbidity and Mortality Weekly Reports.
tial clusters or outbreaks, especially in schools, please
2003, January 10; 52(01): 1-4.
report these to your local health department. The Arizona
State Laboratory offers pertussis culture free of charge to
Susan Goodykoontz, Epidemiologist, Vaccine-Preventable Diseases. She can
Arizona providers; culture kits are available by contacting
be reached at 602.364.3676 or goodyks@azdhs.gov.
your local health department.
2

Prevention Bulletin

January/February 2005

Chronic Disease Surveillance Indicators 2004
Veronica M. Vensor

Figure 2

Chronic disease accounts for
seven of the 10 leading causes of
death in Arizona (Arizona Health
Status & Vital Statistics, 2002). They
are the most prevalent, costly and preventable of all health problems.
Increased opportunity for primary and
secondary prevention of chronic disease has resulted in the expansion of
chronic disease programs within the
Public Health Services of the Arizona
Department of Health Services
(ADHS) (Office of Chronic Disease
Prevention and Nutrition Services,
2004). Health indicators address the
need for a chronic disease surveillance system. Indicators were chosen
if the disease, condition, or risk factor
imposes a considerable public health
burden and if the surveillance data
are available for its inclusion into the
surveillance system. These include
cardiovascular disease, cancer, asthma, chronic lower respiratory disease,
arthritis, blindness, diabetes, amputations, end stage renal disease (ESRD),
nutrition, physical activity, overweight,
obesity, tobacco, hypertension, high
blood cholesterol, immunization status, and health insurance status
(Chronic Disease & Epidemiology
Work Group, ADHS, 2004).
The data systems used include
mortality, hospital discharge,
Behavioral Risk Factor Surveillance
System (BRFSS), Youth Risk Behavior
Surveillance System (YRBSS), United
States Renal Data System (USRDS),
and United States Census data.

Age-Adjusted
Mortality:

Hospital Discharge Rate per 100,000 population by
Principal Diagnosis of Chronic Conditions,
Arizona Residents, 2000-2002
Age-adjusted
Chronic
Conditions
2000
2001
2002
mortality rates are
Cardiovascular
Disease
1674
1691
1640
available for the
376
375
359
following chronic Cancer
Asthma
100
96
114
diseases: cardiovasChronic Lower Respiratory Disease
243
220
249
cular disease,
Arthritis
275
275
343
cancer, chronic
lower respiratory
Diabetes
133
144
147
disease, and diaAmputations
37
29
31

betes. The principal
components of cardiovascular disease
are heart disease and stroke, which
were the first and fourth leading
causes of death in Arizona for 2002;
10,551 deaths were due to heart
disease, and 2,448 deaths were due to
stroke (Arizona Health Status and Vital
Statistics, 2002). Cancer was the
second leading cause of death in
Arizona. The American Cancer
Society, Inc. estimates that 1,368,030
people in the United States will be
diagnosed with cancer and approximately 23,560 Arizonans will be
diagnosed with cancer in 2004.
Chronic Lower Respiratory Disease
(CLRD), which includes chronic bronchitis and emphysema, was the third
leading cause of death in Arizona for
2002. CLRD is comprised of many
conditions including chronic bronchitis and emphysema. Diabetes was the
eighth leading cause of death in 2002.
Approximately, 262,686 Arizonans
had diabetes in 2002 (Disease
Estimates for 2002, ADHS, Figure 1).
Figure 1

Hospitalizations:
The rates of hospital discharges
for chronic diseases and conditions
were calculated using the state-based
hospital discharge data, which contains diagnosis and treatment
information for non-federal facilities
(i.e. hospitalizations in federal facilities, such as the Veterans Affairs or the
Indian Health Services hospitals, are
excluded, Figure 2).

Prevalence:
Three methods were used to estimate the prevalence of chronic disease or conditions and risk factors.
The first method was the BRFSS for
the State of Arizona. The BRFSS provides prevalence estimates for asthma,
arthritis, diabetes, nutrition, physical
activity, overweight, obesity, smoking
status, hypertension, high blood cholesterol, and immunization status. The
second method utilized the National
Health Interview Survey 2001. In
order to calculate prevalence estimates with this method the national
estimate was applied to the population denominator for the State. The
final method applies only to blindness
and ESRD. The National Eye Institute’s
2002 Vision Problems in the USA
Report was used to report on blindness. According to this report, approximately 2.75 percent of Arizonans 40
years of age and older have vision
impairment or are blind. ESRD estimates were calculated using the End
Stage Renal Disease Network #15
Data System. Approximately 97.7 per
100,000 population in Arizona have
January/February 2005

Prevention Bulletin

3

Chronic Disease Surveillance Indicators 2004
ESRD. The following table provides the prevalence estimate
for the year 2002 for chronic disease or conditions only.
Prevalence estimates for risk factors are presented in the
next section (Figure 3).
Chronic Disease
or Condition

Prevalence
(NHIS
Estimate)

Prevalence ESRD
(BRFSS
Network
Estimate) #15

Figure 3
National
Eye
Institute

Rate/100,000

Percent

Rate/100,000 Percent

Asthma

11,325.8

13.9

NA

NA

Arthritis

NA

26.6

NA

NA

Blindness

NA

NA

NA

2.75

Cancer

7,045.0

NA

NA

NA

Cardiovascular
Disease

8,084.3

NA

NA

NA

NA

NA

NA

Chronic Lower
Respiratory Disease NA
End Stage
Renal Disease

NA

NA

97.7

NA

Diabetes

4,799.9

6.4

NA

NA

continued from page 3

5. Hypertension is a diagnosis by a health care
professional. In 2001, approximately 23.6 percent of
Arizona’s adult population were told they have hypertension by a health care provider.
6. High blood cholesterol is a diagnosis by a health care
professional. In 2001, approximately 30.3 percent of
Arizona’s adult population were told they have high
blood cholesterol levels.
7. Immunization status is a yearly flu shot or a lifetime
pneumonia vaccine. In 2002, 31 percent of Arizona’s
adult population received a flu shot within the past 12
months and 28 percent had received a pneumonia
vaccine.
8. Health insurance status is the lack of health insurance.
Arizona has one of the highest rates of uninsured
individuals and it is greater than the national rate
(United States Census Bureau, 2003).

Data Sources:
Multiple sources contribute to data collection of surveillance of chronic disease indicators.
• BRFSS is a telephone survey conducted by the ADHS,
who uses BRFSS data to track health problems and
evaluate public health programs. Standard procedures

Risk Factors:

Percent

Prevention of risk factors could prevent much of the
morbidity and mortality from chronic disease. The common risk factors for the chronic diseases or conditions
Figure 4
addressed in this report are unhealthy eating habits,
Proportion of Arizonans Not Eating '5-A-Day'
physical inactivity (Figure 5), obesity, current tobacco
use, hypertension, high blood cholesterol, immunizaArizona BRFSS, 1999-2002
tion status, and health insurance status. These risk fac100.0%
77.3%
74.5%
tors are as follows:
69.8%
80.0%
63.1%
1. Unhealthy eating is eating fewer than five servings
60.0%
of fruits and vegetables per day. In 2002, approximately 77.3 percent of Arizona’s adult population
40.0%
self-reported eating fewer than five servings of fruits
20.0%
and vegetables per day (Figure 4).
0.0%
2. Overweight is a Body Mass Index (BMI) > 95th per1999
2000
2001
2002
Year
centile for children and teens and a BMI between
< 5 servings
HP 2010 Goal
25.0 and 29.9 for adults. In 2003, approximately
10.8 percent of Arizona’s youth were overweight
Figure 5
while 13.6 percent were at-risk for overweight. In
2002, approximately 36.6 percent of Arizona’s
adult population was overweight (Figure 6).
3. Obesity is a BMI > 30.0 for adults. In 2002,
approximately 19.6 percent of Arizona’s adult
population was obese.
4. Tobacco use is the self-identification of current
smoking status. In 2002, approximately 23.4
percent of Arizona’s adult population were smokers.
In 2003, approximately 20.9 percent of Arizona’s
youth reported smoking cigarettes on one or more
days within the past 30 days compared to 7.3 percent who reported smoking cigarettes on 20 or
more days within the past 30 days (Figure 7).
4

Prevention Bulletin

January/February 2005

Chronic Disease Surveillance Indicators 2004
continued from page 4

•

•

•

•

through monthly telephone
interviews with adults (persons
aged 18 and older) are used to
collect data.
Hospital Discharge Data are
records associated with a
patient’s stay. The data contains
diagnosis and treatment information. The state-based hospital discharge data does not
include federal facilities, such
as the Veterans Affairs or Indian
Health Service hospitals.
Death certificates are completed for all deaths that occur in
the state. The data used only
reflects that of Arizona residents. Death data are used to
monitor the underlying cause of
death.
The USRDS is a national data
system that collects, analyzes,
and distributes information on
ESRD.
The YRBSS monitors risk behaviors among youth. The risk
behaviors include tobacco use,

unhealthy dietary behavior,
inadequate physical activity,
alcohol and other drug use,
risky sexual behaviors, and
behaviors that contribute to
unintentional injuries and violence. The YRBSS includes local
representative samples of students in Grades 9-12. The
YRBSS was conducted for the
first time in 2003 for Arizona.

Conclusion:
The health indicators addressed
in this report were chosen if they
impose a considerable public
health burden and if the data were
available for its inclusion. The main
purpose of this report is to serve the
needs of several chronic disease
programs through the ongoing
systematic collection, analysis and
interpretation of data.
Veronica M. Vensor, Epidemiologist,
Epidemiology Unit, Public Health Prevention
Services. She can be reached at 602.542.1223.

Figure 6

Figure 7

Proportion of Youth Smokers, Arizona YRBSS, 2003
25.0%

Percent

20.0%

20.9%

10.0%

7.3%

0.0%

Smoked cigarettes on 1 or more
days within the past 30 days
January/February 2005

Jan Kerrigan, RN and Polly Turpin

The Arizona Child Fatality Review Board
reported last month that 48 percent of
the 386 deaths of children age 1 through
17 years were preventable.
Reinforce these important messages
with parents and caregivers:
◆ Children age 12 and under should
ride in the back seat.
◆ Children under 40 pounds should
be in a child car seat with a harness.
◆ Children 40-80 pounds should be in
a booster seat with a shoulder/lap
seatbelt.
◆ Babies should ride rear-facing until
one year of age AND at least 20
pounds.
◆ Never put a rear-facing car seat in
front of an airbag.
◆ Harness straps should be snug on
child - no more than one finger
should fit under strap.
◆ Chest clip on harness should be at
armpit level.
◆ The car seat should be buckled so it
cannot move more than one inch
from side-to- side, or move forward
when pulled on at the belt path.
◆ Four out of five car seats are used
incorrectly – have them checked by
a trained car seat technician.
◆ Ask teenagers about their seatbelt
use.
◆ Kids riding any kind of wheels need
to wear a helmet.
◆ Pools need a four-sided fence and
self-locking gate.
If you have any questions call
Arizona Safe Kids at 602.542.7340.

15.0%

5.0%

How Can Healthcare
Providers Help Protect
Arizona Children?

Smoked cigarettes on 20 or more
days within the past 30 days

Jan Kerrigan, RN, Safe Kids & EMSC Coordinator
Office of Women’s and Children’s Health. She can
be reached at kerrigj@azdhs.gov or
602.542.7340.
Polly Turpin, Maricopa County Department of
Public Health. She can be reached at pollyturpin@mail.maricopa.gov or 602.506.6860.

Prevention Bulletin

5

National Children’s Dental Health Month

by Tina Strickler
& Jennifer Slater

February is National Children’s
er, but can also come from another
Dental Health Month. In a society full
caregiver, through intimate contact,
of observational months, weeks, and
shared utensils, licking a pacifier to
days, this particular month sometimes
“clean” it, etc. The “window of infecreceives little attention. Oral health is
tivity” is estimated to be between 6
often overlooked because medical
and 36 months of age. A high level of
providers have so many other
bacteria in the mother’s mouth
demands.
increases the rate of transmission to
The American Academy of
the infant. Prolonged bottle or breastPediatrics (AAPD) recently announced
feeding also provides an environment
their recommendation that pediatrithat enhances the development of
cians perform an oral assessment for
early caries by providing a substrate
children one year of age deemed at
favorable to the proliferation of bacterisk. This includes anticipatory
ria. Children, who are infected at this
guidance and establishment of a
early age, have a higher lifetime incidental home, which is defined by the
dence of dental caries.
American Academy of Pediatric
In order to prevent a lifetime of
Dentistry as, “all aspects of oral
dental caries, there needs to be a
health that result from the interaction
coordinated effort among all health
of the patient, parents, non-dental
care providers – dental and medical –
professionals, and dental professionto perform a visual screening on all
als.” This parallels earlier recommeninfants and toddlers, assess risk, and
dations by the AAPD, the American
take appropriate action. In addition,
Dental disease is entirely
Dental Association, and the Arizona
there are efforts to train health
preventable and has a significant
Academy of Pediatric Dentists that
providers on the application of topiimpact on the health, growth
call for the first oral examination of
cal fluoride varnish for high-risk kids
and development of children.
children to occur by one year of age.
during Early, Periodic, Screening,
These recommendations reflect a
Diagnosis, and Treatment visits.
growing acknowledgement of the
Fluoride varnish can prevent and
need for early intervention and treatment of oral disease
reverse the decay process, is appropriate for high-risk
and the understanding that oral health is an integral part
infants/toddlers, is non-invasive, takes just minutes to
of overall health.
apply, and is cost effective at less than $2 an application.
Dental disease is entirely preventable and has a signifA recent study from Pediatrics journal showed that it
icant impact on the health, growth and development of
was most cost effective for a child to visit the dentist at
children. The 2000 Surgeon General's report on oral
an early age. Economic data was recorded involving
health indentified tooth decay in children as ". . . the
children, who were continuously enrolled in Medicaid for
single most common chronic disease . . ." and ". . . is five
five years, and who had their first preventative visit to the
times more common than asthma . . .". In fact, a survey of
dentist at different ages. The article reported that children,
preschool children in Arizona reveals that 35 percent of
who had this first visit beginning at age one year, spent
3-year-old children and 49 percent of 4-year-old children
$262 on average over the five years while others who
were found to have dental caries.
began at age four years spent $492 on average
Poor oral health at an early age can have a significant
(http://pediatrics.aappublications.org).
economic impact during a child’s later years. According to
Most oral diseases and expenditures are preventable,
the Center for the Advancement of Health, U.S. conbut early health care provider action is necessary. To learn
sumers can spend up to $60 billion on dental services
more about how to prevent dental disease in infants and
each year. Also, children lose more than 51 million hours
toddlers, and the new professional recommendations, the
of school annually to dental-related illness, and adults
entire text of First Dental Visit by Age One: A guide to the
miss more than 164 million hours of work a year due to
new recommendations can be found at www.azdhs.gov
oral problems and dental visits.
under the Office of Oral Health link.
Preschool children are most likely to obtain cavityHelp reduce the impact of dental diseases in infant
causing bacteria from their mother. Dental caries are
and toddlers - not just in February - but every day.
transmissible and Streptococcus mutans is the principal
Tina Strickler, Program Manager, Office of Oral Health.
bacterium responsible for its initiation. This bacterium is
not present at birth but is acquired, usually from the mothJennifer Slater, Public Information Officer Intern. She can be reached at
slaterj@azdhs.gov.
6

Prevention Bulletin

January/February 2005

SUMMARY OF SELECTED REPORTABLE DISEASES
Year to Date (January - November, 2004)1, 2
Jan - Nov
2004

Jan - Nov
2003

5 Year Median
Jan - Nov

VACCINE PREVENTABLE DISEASES:
Haemophilus influenzae, serotype b invasive disease (<5 years of age)
Measles
Mumps
Pertussis (<12 years of age)
Rubella (Congenital Rubella Syndrome)
FOODBORNE DISEASES:
Campylobacteriosis
E.coli O157:H7
Listeriosis
Salmonellosis
Shigellosis

1 (0)
0
1
134 (75)
0 (0)

10 (7)
1
0
119 (75)
0 (0)

6 (4)
1
1
119 (75)
0 (0)

791
28
8
711
393

772
39
12
706
507

588
36
16
713
518

262
276
1,228
1
9,520 (3,266)

260
256
990
7
9,081 (3,645)

376
195
990
9
6,105 (3,645)

577
217
44
117
11

614
224
36
N/A
30

708
208
38
N/A
30

15,066
3,623
153 (39)

12,046
3,329
170 (16)

12,046
3,612
171 (17)

18 (3)
1,246

9 (1)
895

9 (1)
895

387
2
0
112

7
0
0
70

N/A
1
0
94

3.514
188
512
443

2.321
199
468
451

1.794
199
468
451

VIRAL HEPATITIDES:
Hepatitis A
Hepatitis B: acute
Hepatitis B: non-acute
Hepatitis C: acute
Hepatitis C: non-acute (confirmed to date)
INVASIVE DISEASES:
Streptococcus pneumoniae
Streptococcus Group A
Streptococcus Group B in infants <30 days of age
Methicillin-resistant Staphylococcus aureus3
Meningococcal Infection
SEXUALLY TRANSMITTED DISEASES:
Chlamydia
Gonorrhea
P/S Syphilis (Congenital Syphilis)
DRUG-RESISTANT BACTERIA:
TB isolates resistant to at least INH (resistant to at least INH & Rifampin)
Vancomycin resistant Enterococci isolates
VECTOR-BORNE & ZOONOTIC DISEASES:
West Nile virus
Hantavirus Pulmonary Syndrome
Plague
Animals with Rabies4
ALSO OF INTEREST IN ARIZONA:
Coccidioidomycosis
Tuberculosis
HIV
AIDS
1
2
3
4

Data are provisional and reflect case reports during this period.
These counts reflect the year reported or tested and not the date infected.
MRSA was not reportable before October 2004.
Based on animals submitted for rabies testing.
Data compiled by Office of Infectious Disease and Office of HIV/AIDS Services

January/February 2005

Prevention Bulletin

7

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Arizona Department of Health Services
Public Information Office
150 North 18th Avenue
Phoenix, AZ 85007
Janet Napolitano, Governor
Catherine R. Eden, Ph.D., Director ADHS
Rose Conner, Assistant Director, Public Health Services
Contributors
Susan Goodykoontz, Jan Kerrigan, R.N.,
Sharon Sass, R.D., Jennifer Slater, Tina Strickler,
Polly Turpin, Veronica M. Vensor,
Office of Infectious Disease and Office of HIV/AIDS Services
Managing Editor: Mary Ehlert, M.S., ABC
e-mail: ehlertm@azdhs.gov
Assistant to Mary Ehlert: Jennifer Slater
This publication is supported by the Preventive Health and Health Services Block
Grant from the Centers for Disease Control and Prevention (CDC).
Its contents do not necessarily represent the views of the CDC.
If you need this publication in alternative format, please contact the ADHS Public
Information Office at 602.364.1201 or 1.800.367.8939 (State TDD/TTY Relay).

Arizona Nutrition Network
The Arizona Nutrition Network
provides nutrition education to Food
Stamp Program participants and
applicants throughout Arizona. The
Arizona Department of Health
Services and the Arizona Department
of Economic Security works with a
variety of partners in county health
departments, schools, and other community settings to provide nutrition
education.

Bobby B. Well

The Network links comprehensive social marketing and community
education efforts to change dietary
behaviors among low-income
individuals in Arizona. Utilizing social
marketing principles, the Network
conducts three message-specific
campaigns each year. The target audience is food stamp eligible women
ages 18-34, and their children. The
objective of the campaigns is to
create awareness among the target
audience that a healthier life includes:
•
•
•

Eating five or more servings of
fruits and vegetables each day.
Drinking 1 percent or less fat
milk.
Being physically active, at least 60
minutes for children and 30
minutes or more for adults, on
most days of the week.

The Network uses Bobby B. Well,
a larger-than-life animated spokesper8

Prevention Bulletin

Sharon Sass, R.D.

son, that is a fun, playful, and cool
character that encourages the target
audience to improve their health
habits. Bobby appears in television
ads, on billboards, in comic books,
and other education materials.
Creative materials for each of the
three campaigns includes: 30-second
television commercials in English and
Spanish, wallboards in Food Stamp
Offices, billboards, a web site, education materials, and a Community Tool
Kit for Network partners.
This year, Network partners
provided more than 500,000 direct
nutrition education contacts and
more than 100,000 of them
participated in food demonstrations
throughout the state. Look for
Arizona Nutrition Network materials
featuring primary prevention nutrition
and physical activity messages
at www.eatwellbewell.org.
Sharon Sass, R.D., Community Nutrition Team
Leader, Office of Chronic Disease and
Nutrition Services.
January/February 2005