Publication of the Division of Public Health Services

Table of Contents
Diabetes in Arizona
Page 3
Pandemic or Seasonal
Influenza & Influenza
Update
Page 4

January/February 2006, Vol. 20, No. 1

What is the Best CPR?

“Getting to the Heart of the Matter”
By Ben Bobrow, MD and Lani Clark

RSV Activity in Arizona
Page 5

The recent release and media coverage of the American Heart Association
2005 Adult Basic Life Support (BLS) and
Advanced Cardiac Life Support (ACLS)
guidelines has peaked interest in the question as to what is the optimal method for
performing life sustaining cardiopulmonary resuscitation (CPR) and defibrillation
for cardiac arrest victims.

NoteWorthy
Page 6

Outcome Depends on
Intervention:

The State Epi's Corner
Page 5

New Year's Resolutions
Page 7

New Recommendations
for Use of Antivirals
to Treat or Prevent
Influenza in the
2005-2006 Season

Visit the ADHS
Web site at
www.azdhs.gov

January/February 2006

Cardiac arrest
remains a significant
cause of mortality,
accounting for more
than a thousand
deaths a day in the
United States alone.
With current health
care delivery systems
in place, survival to
hospital discharge remains extremely poor
with estimates at or below 5%. In many
of the nation’s largest cities, neurologically
intact survival is as low as 1%.
Outcome after cardiac arrest is dependent
on critical interventions; particularly effective chest compressions, early defibrillation, and advanced life support (AHA
Scientific Statement 2004). The reasons for
the dismal survival rates are many but two
major contributing factors are the lack of
bystander initiated CPR, and the apparent
under utilization of AEDs by the lay public. Both of these have been clearly documented in the state of Arizona through
instituting a statewide cardiac arrest and
AED registry termed the Save Hearts in
Arizona Registry & Education (SHARE)
Program.

The Key to Survival:

Ventricular Fibrillation (VF), a potentially
treatable dysrhythmia, remains the underlying cause in a majority of these cases,
and early defibrillation has shown to significantly increase survival.
However, defibrillation is not always
immediately available and thus CPR is
required to support the victim’s brain and
heart with vital oxygen until a defibrillator
arrives. Thus the combination of CPR and
AED use is key to survival from
out of hospital cardiac arrest.
The lack of bystander initiated
CPR (currently 65% of cardiac arrest victims in Arizona
receive no bystander CPR) can
potentially be overcome in our
state and globally by teaching chest-compression-only,
or continuous chest compression CPR (CCC-CPR). Chest
compression only CPR has been shown
in animals to be dramatically better than
no bystander CPR and even better than
mouth-to-mouth rescue breathing when
chest compressions were interrupted for a
realistic 16 seconds for rescue breathing.
Because time to defibrillation remains a
critical element in a successful resuscitation, the Automated External Defibrillator
(AED) was developed to broaden the pool
of available rescuers. The addition of AED
training to CPR training in lay volunteers
has shown superior survival benefit to
conventional CPR training alone. Several
studies have even demonstrated that very
young previously untrained children can
be taught to successfully operate an AED.
Continued on page 2
1

What is the Best CPR?

Continued from page 1

In fact, in 2005, a collaborative research study conducted by
the Mayo Clinic and the SHARE
Program clearly showed that 8th
grade Arizona public school students can safely and efficiently be
taught and retain the skills to properly perform CCC-CPR and AED use
in a condensed 1-hour course on
campus.

What Have We Learned
About CPR?

To be successful, CPR must be
started as soon as a victim collapses, thus it is the public that MUST
know to call 9-1-1 immediately,
then perfrom effective chest compressions and use an AED.
We have learned that when these
events occur in a timely manner,
CPR makes a difference and saves
lives. We have also learned that
chest compressions are the vital
component of CPR that many times
are interrupted too frequently and
performed in a suboptimal fashion.

New Developments:

The new AHA 2005 Guidelines
have increased emphasis on the
importance of chest compressions:
“Rescuers will be taught to “push
hard, push fast” (at a rate of 100
compressions/min), allow complete
chest recoil, and minimize interruptions in chest compressions.”

SHARE Program:

The SHARE Program is a voluntary,
statewide, HIPAA compliant cardiac
arrest network and database for
out-of-hospital cardiac arrest and
AEDs in Arizona. Since 2004, the
SHARE Program has partnered with

over 20 Fire Departments and private ambulance companies in every
Region of Arizonaand the Sarver
Heart Center CPR Research Group
to build this essential statewide
cardiac arrest network. The SHARE
AED database currently tracks over
2,500 AEDs (and who is trained on
each site to use them) in Arizona.
These databases are showing the
times and places when cardiac
arrest occurs, if bystander CPR is
performed, not performed, or could
be improved upon along with many
other vital data points. The Bureau
of Emergency Medical Services is
also working with research teams
looking at cardiac arrest all over
North America.
The focus of the SHARE Program
this coming year is on continuing
to expand the infrastructure for collecting pre hospital cardiac arrest
data from EMS providers across the
state and track their survival utilizing an algorithm of providing pre
and post shock chest compressions
for adult VF victims. This data is
helping to determine the optimal sequence of interventions for
advanced cardiac life support along
other potential new treatments that
will improve cardiac arrest survival
in Arizona and globally.

Ben Bobrow, MD is Medical Director
for the Bureau of EMS and Lani Clark is
Research and QI Director for the Bureau
of EMS. For more information visit the
www.azshare.gov website.

REFERENCES:
John J, Ewy G. Cardiopulmonary Resuscitation:
A New Paradigm is Needed, Arizona Geriatrics
Society, 2005; 10:3: 3-8
AHA Scientific Statement 2004
Cardiac Arrest Resuscitation Evaluation in Los
Angeles: CARE-LA Annals of Emergency Medicine.
May 2005:45: 504-509.
Kern KB, Hilwig RW, Berg RA, Sanders AB, Ewy
GA. Importance of Continuous Chest Compressions
During Cardiopulmonary Resuscitation, Circulation
2002:105:645-649.
The Public Access Defibrillation Trial Investigators:
Public Access Defibrillation and Survival after out of
Hospital Cardiac Arrest. N Engl J Med 351:7:637646.
Lawson L, March J: Automated External
Defibrillation by Very Young Untrained Children.
Prehosp Emerg Care, July-Sept 2002:6(3):295-8
Hubble MW, Bachman M, Price R. Willingness of
High School Students to Perform Cardiopulmonary
Resuscitation and Automated External Defibrillation.
Prehosp Emerg Care, Apr-Jun 2003:7(2):219-224.
Eighth Grade Public School Students Become
Proficient at CPR and AED Use After a Condensed
Training Program Presented at the Third
Mediterranean Emergency Medicine Conference,
Nice, France. September, 2005.
Journal of the American Heart AssociationCirculation Vol 112, No 24, December, 13, 2005

2

Diabetes In Arizona

by Magda Ciocazan, M.P.H.

manage diabetes are maintaining
direction for control efforts throughDiabetes will place an immense
a healthy weight (BMI 18.5-25),
toll on Arizona’s various health
out the state.
adequate exercise, proper nutrition
care delivery systems in the next
The Diabetes in Arizona: 2005
(especially consumption
decade. According
Status Report examines the burden
of high fiber and low
to the 2004 BRFSS
of diabetes and its complications
fat foods) and eliminatdata, 6.6 percent
in the state of Arizona. This docuof Arizonan adults,
ing the use of tobacco
ment will be placed on the ADHS
or approximately
and alcohol. Managing
Diabetes Prevention and Control
284,102, have
stress, keeping hydrated
web site by the end of January
been told by a
and adequate rest also
2006. This report, as well as other
doctor they have
helps prevent diabetes
annual and county specific reports
diabetes, and an
and associated complifor diabetes, can be accessed under
additional 1.2
cations in those most
the Resources: Annual Reports link
percent of women
at risk. Successful manat the following web site: www.
have gestational
agement of diabetes
azdhs.gov/phs/oncdps/diabetes
diabetes.
requires improvement
in physician practices,
In 2004, there
1. Harris MI, Flegal KM, Cowie CC, Eberhardt MS,
Goldstein DR, Little RR, Wiedmeyer H, Byrd-Holt DD.
modification of health
were more than
Prevalence of diabetes, impaired fasting glucose, and
care delivery systems,
91,000 people
impaired glucose tolerance in US adults. Diabetes Care.
1998;21(4):518-524.
new societal attitudes
hospitalized due
regarding nutrition and
to diabetes, with
Magda Ciocazan, M.P.H., is the Diabetes
physical activity, and the empowhospital charges amounting to more
Prevention and Control Program Manager,
than $2.5 billion. According to the
erment of patients who must take
Office of Chronic Disease Prevention and
American Diabetes Association,
charge of their disease.
Nutrtition Services, and can be reached at
602.542.2758 or ciocazam@azdhs.gov.
type 2 diabetes is being diagnosed
The
ethnic
diversity
of
Arizona
chalmore frequently than ever before in
lenges our health care agencies in
children and adolescents, particuregards to comprehensive data collarly in American Indians, Hispanic/
lection
data and effective program
Estimated Number of
Latino Americans, and African
development.
With
the
help
of
its
Americans. However, it is difficult
Self-Identified Diabetics
partners, the Arizona Department
to obtain exact figures for diabetes
by County, 2004
of Health Services (ADHS) conprevalence, because there is no sysSource: Arizona BRFSS, 2004.
tinues to monitor diabetes indicatematic collection of information on
tors
to
determine
the
appropriate
the number of cases. Additionally,
County
Total
studies have
Apache
2,911
shown that
Prevalence of Diabetes in Arizona,
about one-third
Cochise
6,369
2000-2004
of all people
Coconino
6,129
Source: Arizona BRFSS, 2000-2004.
with diabetes
Gila
2,688
have not been
1
diagnosed.
Graham
1,671
DIABETES PREVALENCE RATE
Due to the
increase of
obesity, physical inactivity, and poor
nutrition in
Arizona, the
prevalence
of diabetes is
also increasing. The main
lifestyle factors that help
prevent and

BY AGE GROUP
16

14 .3

14
1 0 .5

12
10

8 .1

8
6
4
2

3.2
1.2

0
1 8 -3 4

3 5 -4 4

4 5 -5 4

Age Group

5 5 -6 4

65+

Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa Cruz
Yavapai
Yuma
Arizona

378
1,108
170,895
9,196
4,605
46,586
10,855
1,850
10,298
8,563
284,102

3

Pandemic or Seasonal Influenza:
Infection Control in Outpatient Settings

Of late, the news has been filled with discussions of a
pandemic influenza. Most experts seem to agree that we
are likely to face another pandemic; however, many scientific questions about the pandemic remain unanswered
- when will it occur, how severe will it be, or will H5N1
be the causal agent? Yet, we do know that every year in
the United States, on average 5% to 20% of the population gets the flu, more than 200,000 people are hospitalized for flu-related conditions and 36,000 deaths occur
from complications of the flu.
Thus, irrespective of whether it is seasonal flu, or pandemic flu, prevention and control measures need to be
in place in health care facilities to minimize the spread
of flu and other respiratory infections and the associated
burden of disease and death. Outpatient clinical settings
are prime locations for spread of infectious diseases.
Despite some possible differences between seasonal
and pandemic flu in terms of incubation period, immunogenicity, mechanisms of spread and pathogenesis, at
this time the primary strategies for preventing both are
the same: vaccination, early detection and treatment,
and the implementation of infection control measures.
Vaccination remains the primary strategy for preventing
infection and disease; health care personnel is one the
groups for which vaccination is highly recommended.
More information is available at www.cdc.gov/flu/
protect/keyfacts.htm and www.jfponline.com/Pages
asp?AID=1727&UID

by Victorio Vaz

Since a vaccine may not be available at the onset of
the pandemic, flu containment will hinge upon appropriate infection control measures in place. To that end:
•

Surveillance for respiratory illness is needed to limit
contact between infected and non-infected patients
through confinement in defined areas and/or by
encouraging social “distancing”, i.e., at least three
feet apart.

•

Respiratory hygiene/cough etiquette should be promoted at the first point of contact with a potentially
infected patient through posting visual alerts, providing tissues, no-touch receptacles for tissue disposal
and masks for patients and visitors who are coughing
or sneezing, ensuring hand washing sinks with soap
and disposable towels and/or alcohol-based hand
sanitizers, and encouraging coughing persons to sit at
least 3 feet away from others: www.cdc.gov/flu/professionals/infectioncontrol/resphygiene.htm.

•

Hand hygiene between patients and after contact
with respiratory secretions need to be adhered to.
Personal protective equipment (PPE) should be
used for standard and droplet precautions. Further
information on the selection and use of PPE can
be found at www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html and www.cdc.gov/ncidod/dhqp/
gl_isolation_droplet.html.

Influenza Season Update
Influenza activity broke with tradition during the 2005-206
season by starting in the western part of the United States.
Frequently, high activity is noted first in the eastern states,
followed by a westward sweep across the county. This year,
Utah was the first state to report widespread activity (week ending December 17, 2005). Two weeks later, the entire southwest
corner of the U.S. (7 states) reported widespread activity, with all
other states reporting lower levels. Now, at the end of January,
activity levels are decreasing in the western U.S. and other states
are reporting increased levels.
Arizona first reported widespread activity the week ending December 24, 2005, and continued to report widespread
activity until dropping to regional activity on January 23, 2006. This is earlier than Arizona’s typical peak season.
These activity levels are determined by reports of influenza-like illness from sentinel providers around the state,
mandatory laboratory reporting of positive influenza tests, and other surveillance conducted by county health departments. A decrease in statewide activity does not indicate that influenza season is over; some regions of the state may
continue to see influenza for weeks or months. Reports of laboratory-confirmed influenza for the season are shown
in the figure.
During most influenza seasons, including last year’s, there is a mix of influenza A and influenza B circulating in
the community. This season the circulating strain so far has overwhelmingly been influenza A, with this strain
accounting for over 95% of cases in both Arizona and the U.S. as a whole.
Arizona influenza surveillance data are available on the internet at www.azdhs.gov/phs/oids/epi/flu/az_flu_surv.htm
and are updated weekly.
4

Another One
Bites the Dust…
As detailed in the current
issue of Prevention Bulletin,
CDC announced on January
14, 2006 that the adamantane
influenza antivirals are no
longer recommended for treatment of influenza during the
2005-2006 flu season, because
of an alarming 91% level of
David Engelthaler,
resistance (1). Resistance has
State Epidemiologist
become a four-letter word in
both the clinical and public
health communities. Antibiotic resistance has forced the medical
world to develop complex algorithms and alternative therapies to
respond to bacterial infections. And although antiviral-resistance
has been a threat, until now we have not seen a nearly complete
evasion of an antiviral therapy.
Whether this adamantane resistance is use-induced (conferred
by use of and subsequent adaptation to adamantanes) or is from
a natural mutation in the current flu strains circulating this season, it is still one of the more disconcerting pieces of news this
year. Time will tell us if adamantine-resistance is an ephemeral
event, based on the genetics of the circulating strains, or if it confers evolutionary advantage to human influenza strains, and will
therefore likely be a constant adaptation.
Additionally, one can only speculate about the future of the
remaining anti-influenza drugs - the neuraminidase inhibitors
(oseltamivir and zanamivir). Resistance has been documented in
children treated with oseltamivir(2), and various reports have documented varying levels of resistance to oseltamivir by the H5N1
avian influenza virus causing incidental human infections in Asia
and Eastern Europe (3,4). These unfortunate reports force us to
consider resistance when responding to our annual flu outbreak
as well as in the face of pandemic preparedness. A few things we
should take from this news:
a) Health care providers need to continue to focus on prevention of disease and transmission – encourage flu shots to all
patients, and continue to promote respiratory etiquette and
hand washing as a way of life
b) Proper diagnosis and reporting (influenza is a laboratory
reportable condition in Arizona) of illness will help not only
to better understand to epidemiology of the annual flu season, but will help identify any resistance to antiviral therapies
c) Antivirals are only one tool to help fight influenza (seasonal
or pandemic) but their overall effectiveness is tentative, and
may be fleeting. This should affect how we respond now
and prepare for the future.
1.
2.
3.
4.

CDC Health Alert Jan 14, 2006
Kiso M, Mitamura K, Sakai-Tagawa Y, et al. Lancet 2004;364:759-765.
N Engl J Med. 2005 Dec 22;353(25):2633-6.
Dr. Anthony Fauci, Dec 5, 2005, Pandemic Planning: Convening of the
States, Washington D.C.

RSV Activity in
Arizona 2005-2006
by Karen Lewis, M.D. & Shoana Anderson

Respiratory Syncitial Virus (RSV) became
a laboratory-reportable disease in October
2004. Arizona laboratories now report positive RSV tests to the Arizona Department of
Health Services (ADHS) on a weekly basis.
With this new information, ADHS can let providers know when Arizona is experiencing an
increase in RSV isolates.
Historically, the RSV season in Arizona begins
between October and December. Although
there are sporadic isolates of RSV throughout
the year, once there begins to be an increase
in RSV infections in the fall or early winter,
the number of RSV cases rapidly increases
and high numbers of RSV infections continue
for several months.
RSV cases in Arizona began to be reported
sporadically in the middle of October 2005.
In November, ADHS notified health care providers to expect to see increasing RSV activity. RSV was reported steadily throughout
December, and reports escalated at the end
of December. As of January 14, 2006, there
had been 246 laboratory confirmed cases of
RSV in Arizona.
Monitoring RSV activity in Arizona can assist
health care providers who provide RSV immunoglobulin injections to high-risk infants.
In November 2005, when ADHS received
increasing reports of RSV in Arizona, ADHS
sent out electronic notification to health care
providers to assist them with their plans for
RSV immununoglobulin administration.
Conversely, once RSV activity starts to slow
in the state, ADHS will send electronic notification to health care providers about the
decrease in RSV cases. Providers will benefit
by having real time data to help decide when
to stop monthly RSV immunoglobulin injections. RSV cases are expected to remain high
in January and February.
The tally for RSV cases reported in Arizona is
posted weekly at the ADHS web site at www.
azdhs.gov/phs/oids/epi/flu/az_flu_surv.htm
along with influenza surveillance information.
Numbers of new RSV and influenza cases are
updated every Monday.
Karen Lewis, M.D. is Medical Director, Bureau of
Epidemiology and Disease Control and can be reached
at 602.364.4562.
5

2004 Infectious Disease
Epidemiology Annual Report
Available Online

Want more information on our
record high number of reported
cases of coccidioidomycosis in
2004? Or 20 year low rates of
reported shigellosis cases? The 2004
Infectious Disease Epidemiology
Annual Report is now available
online at www.azdhs.gov/phs/oids/
reports.htm. The report includes
statistics on communicable diseases,
outbreak investigations, and an evaluation of recent trends in infectious
diseases in Arizona.

Hurricane Katrina Arizona
Epidemiology Report Posted
on the ADHS Web site

As part of the response activities to
Hurricane Katrina, Arizona housed
and provided medical care to over
800 hurricane evacuees. Analysis
of available clinic data indicated

that one of the primary reasons for
medical visits were lost medications/personal health items, followed
by gastrointestinal and respiratory
symptoms. Surveillance activities identified no major infectious
disease outbreaks among shelter
residents. The Infectious Disease
Epidemiology Program prepared a
report on the health status and epidemiology of evacuees seen at the
Red Cross shelter medical clinic.
The entire report can be viewed at
www.azdhs.gov/phs/oids/pdf/adhs_
katrina_epi_report.pdf

Joint Vector-Borne/Zoonotic
Diseases and Bioterrorism/
Public Health Threats
Conference:
March 29-30, 2006;
Glendale Civic Center,
5750 West Glenn Drive,
Glendale, AZ 85301
Presented by: ADHS

30th Annual Vector-Borne and
Zoonotic Diseases Conference
With emerging disease threats like
Rocky Mountain spotted fever,
West Nile virus and possibly Avian
influenza, the need to prepare
and respond to vector-borne and
zoonotic diseases has never been
greater. This conference will feature
a combination of local, state and
federal experts to present the
latest updates on vector-borne and
zoonotic diseases in the Southwest.
6th Annual Bioterrorism and Public
Health Threats Conference
This conference provides the
opportunity to learn about an
important emerging threat:
pandemic influenza. Various aspects
of local and national pandemic
influenza preparedness efforts will
be addressed. You can register for
the conference online by visiting:
http://www.azdhs.gov/phs/edc/
edrp/es/conf.htm

Amantadine and Rimantadine Should Not Be Used for Influenza This Winter
by Karen Lewis,M.D.

On January 14, 2006, the Centers for Disease Control and Prevention (CDC) announced that clinicians should
not use amantadane antivirals (amantadine or rimantadine) to treat or prevent influenza during the remainder of
the 2005-2006 influenza season. Tests on influenza A (H3N2) isolates, the predominant strain currently circulating
in the United States, show that they are resistant to both amantadine and rimantadine.
CDC tested 120 influenza A (H3N2) virus isolates from the 2005-2006 season and found that 91% were
resistant to both amantadine and rimantadine. This contrasts with last year when only 14.5% of isolates tested were
resistant; the previous year, 1.9% were resistant. The global prevalence of adamantane-resistant influenza viruses
has increased from 1.9% to 12.3% over the past 3 years.
Fortunately, all H3 and H1 influenza viruses tested to date in the United States are still susceptible to the
neuraminidase inhibitors (oseltamivir [Tamiflu®] and zanamivir [Relenza®]). Therefore, if an antiviral medication is
needed this season for influenza, CDC recommends that either oseltamivir (Tamiflu®) or zanamivir (Relenza®) be
prescribed. Oseltamivir is approved for either treatment or prophylaxis; zanamivir is approved only for treatment.
Since amantadine is used to treat the symptoms of Parkinson’s disease, it should continue to be used for this
indication. Viral resistance to adamantanes can emerge rapidly during treatment because a single point mutation of
an amino acid can confers cross-resistance to both amantadine and rimantadine. Adamantane-resistant viruses are
equally as transmissable as adamantane-sensitive viruses.
Additional information about the prevention and control of influenza is available at www.cdc.gov/flu. Specific
information regarding the use of the neuraminidase inhibitors is available at http://www.cdc.gov/flu/protect/
antiviral.
Karen Lewis,M.D.is Medical Director,Bureau of Epidemiology and Disease Control and can be reached at 602.364.4562 or lewisk@azdhs.gov.
6

Arizona Department of
Health Services
Public Information Office
150 North 18th Avenue
Phoenix, AZ 85007
Janet Napolitano, Governor
Susan Gerard, Director ADHS
Niki O’Keeffe, Assistant
Director, Public Health Services
Contributors:
Shoana Anderson
Ben Bobrow, MD
Lani Clark
Eric Day, M.B.A.
Lisa DeMarie, M.A.
David Engelthaler,
Will Humble M.P.H.,
Bob Gomez, R.S., M.P.H.,
Karen Lewis, M.D.,
Victorio Vaz, M.D.,
Tthe Office of Infectious
Disease Services,
The Arizona Immunization
Program Office,
The Office of HIV/AIDS Services
Managing Editor:
Mary Ehlert, M.S., ABC
e-mail: ehlertm@azdhs.gov
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).

Strategies to Help Your Patients Keep New
Year’s Resolutions and Live Healthier Lives
For many people the New Year is a time to
make health-related resolutions. Whether
it’s to lose weight, control stress, or adopt
healthier eating habits, such resolutions
can be difficult to keep. However, working
toward these and other goals can improve
a person’s health. Setting realistic goals
year round - and not just at the beginning
of the New Year - can lead to a healthier lifestyle, improved self-esteem, and
increased confidence.
1. Don’t try everything at once. The temptation of the New Year is to create a list
of everything a person has ever wanted
to change. Generally, your patients will
experience greater success fulfilling
one or two goals than they will a list
of ten. If eating healthier and getting
more physical activity is their goal, ask
them to start small. For example, if your
patient is currently drinking whole milk,
suggest they switch to 2% and work
gradually towards 1%. For physical
activity, have your patients identify one
activity that they enjoy, such as walking
or biking, and encourage them to be
consistent with this activity.
2. Be specific. When your patients think
about their goal, ask them to be as exact
as possible. People who set specific
goals are more likely to succeed. For
example, instead of saying “I will drink
more water”, suggest they set a specific
goal to drink 6-8 glasses of water a day.
If your patient’s goal is to add more
physical activity into their day, encourage them to set a goal of using the stairs
instead of the elevator or taking a 10mintue walk break every day.
3. Set realistic goals. When your patients
think about setting goals, make sure
that they are within their reach. For
instance, if they currently lead a sedentary lifestyle, have them begin by
incorporating three 10-minute bouts of
a physical activity, such as walking, per
day. For better eating habits, one example might be to not eliminate an entire
food group entirely, such as grains, but
to instead try consuming whole grains
such as oats, whole wheat breads and
pasta and brown rice into their meals.

January/February 2006

by Lisa DeMarie, M.A. and Eric Day, M.B.A.

4. Believe it can be done, be flexible and
remember rewards. Stay positive about
a patient’s progress. Keep in mind that
setbacks can happen, and if patients
slip up, encourage them to keep trying.
Acknowledge their achievements, even
the small ones. Remind patients that
their reward should not interfere with
their overall goal. For example, treating
yourself to your favorite movie is a more
effective reward than an ice cream cone
for sticking with a healthy diet.
Resources for Professionals and Patients:
http://www.mypyramid.gov
http://www.nhlbi.nih.gov/health/public/
heart/obesity/lose_wt/index.htm
http://www.healthierliving.org/newsletter/
200201/resolve.html
http://family.samhsa.gov/be/goals.aspx
Lisa DeMarie, M.A., is the Nutrition and Physical
Activty Program Manager, Office of Chronic Disease
Prevention and Nutrition Services, and can be
reached at 602.542.2851 or demaril@azdhs.gov.
Eric Day, M.B.A., is the Physical Activity Coordinator,
Office of Chronic Disease Prevention and Nutrition
Services, and can be reached at 602.364.2804 or
daye@azdhs.gov.

7