Publication of the Division of Public Health Services

November/December 2003, Vol. 17, No. 6

Child Abuse Prevention in Medical Settings
By Lisa Shumaker

This year, Arizona newspapers
printed a number of stories about
children who died as a result of abuse
or neglect perpetrated by their parent,
guardian, or caregiver. Because child
abuse and neglect cause serious damage to emotional and psychological
development, abused children are at
high risk to abuse substances, experience unplanned pregnancies, engage
in violent behavior, commit suicide,
develop depression and anxiety disorders, and perpetrate abuse and neglect upon their own children when
they grow up. Medical professionals
can contribute significantly to the prevention of child abuse by identifying
parents at high risk to neglect or
abuse their child and helping those
parents take advantage of sources of
support and education.
The ability to care for, nurture,
and stimulate the healthy development of a child is directly related to a
parent’s maturity and emotional stability. Three major risk factors for per-

petration of child abuse and neglect
are: substance abuse, mental illness,
and having a child with a disability.
Children of substance abusers are
three to four times more likely to be
victims of neglect or abuse. The
majority of child removals from their
home involve parental use of alcohol
or other drugs.
Parents suffering from behavioral
health problems are at risk to neglect
or abuse their child because they are
more likely to engage in maladaptive
parenting behaviors and have inappropriate expectations regarding their
child. Parents who were themselves
abused or neglected have often
formed poor attachments with their
own parents and tend to have more
difficulty raising children.
Children with disabilities are
nearly twice as likely to be victims of
abuse or neglect. They require higher
levels of care, which can be overwhelming for parents with insufficient
resources and support. Parents of disabled children may see their child as
different or embarrassing and mourn
what they perceive as a loss. Parent
infant bonding is crucial to the prevention of abuse and neglect.
Disability related separations are
damaging to parent-infant bonding.
Children who are unaffectionate or
unresponsive to affection as a result of
continued on page 2

As Defined by
Arizona Law
Abuse: the infliction or allowing of
physical injury, impairment of bodily
function or disfigurement or the
infliction of or allowing another person to cause serious emotional damage as evidenced by severe anxiety,
depression, withdrawal or untoward
aggressive behavior and which emotional damage is diagnosed by a medical doctor or psychologist…and is
caused by the acts or omissions of an
individual having care, custody and
control of a child. Abuse shall include
inflicting or allowing sexual abuse,
sexual conduct with a minor, sexual
assault, molestation of a child, commercial sexual exploitation of a minor,
sexual exploitation of a minor, incest,
child prostitution.
Neglect: the inability or unwillingness of a parent, guardian or custodian of a child to provide that child
with supervision, food, clothing, shelter or medical care if that inability or
unwillingness causes substantial risk of
harm to the child's health or welfare,
except if the inability of a parent or
guardian to provide services to meet
the needs of a child with a disability
or chronic illness is solely the result
of the unavailability of reasonable
services.
*Neglect occurs much more frequently
than abuse.

Visit the ADHS Web site at www.hs.state.az.us
Child
Causes of Death
Fatality Review
Review
Page 3
Page 4

November/December 2003

Public Health
Directory
Update
Page 5

Communicable Tularemia and Intervention of
Disease
Rocky Mountain
Hepatitis C
Summary
Spotted Fever
Page 7
Page 6
Page 7
Prevention Bulletin

1

Child Abuse continued from page 1
case management, substance abuse treatment, counseling, and other behavioral
health services for no cost via Regional
Behavioral Health Authority (RBHA) funded programs.
Medical professionals assist in the
prevention of child abuse by screening
patients for domestic violence, substance
abuse, depression, child abuse, and
behavioral health problems and assist high
risk parents with locating sources of support and education. They can provide
their disability also have difficulty bonding education themselves about community
resources, caring for infants, non violent
with their parents.
discipline, coping with stress, bonding
Adolescent parents should receive
special attention from medical profession- with their child, child development, and
realistic expectations or refer pregnant and
als because they are more likely to be
post partum parents to agencies who
both victims and perpetrators of child
provide education. Education should be
abuse or neglect. Sixty percent of adolestailored to the developcent mothers have
mental stage and considbeen sexually abused.
Medical professionals can er the culture of the
More than a quarter of contribute significantly to
parent, while helping
them continue to
the prevention of child
parents identify and
experience sexual
abuse
by
identifying
parents
celebrate their strengths
abuse throughout their
at
high
risk
to
neglect
or
and successes.
pregnancy.
Additionally, medical
abuse
their
child
and
Arizona has one
businesses
can partner
helping those parents take
of the highest rates of
with
local
parenting
adolescent pregnancy
advantage of sources of
organizations to provide
in the United States.
support and education.
parent support groups,
Because of their age
home visitation, and
and developmental
education.
To
find
the parenting program
stage, adolescent parents are less likely to
closest
to
you
contact
the Division of
have maturity, education, knowledge,
Behavioral
Health
Services,
Office of
patience, good support, quality prenatal
Prevention
at
602-364-4630.
Together
care, and financial stability. Bonding
we
can
help
families
raise
happy,
healthy,
between adolescent parents and their
children.
child is also disrupted because adolescent

2

Prevention Bulletin

Bed wetting
Aggression
Sexual acting out
Nightmares
Problems in school
Anxiety
Low self esteem
Depression
Poor hygiene
Withdrawal
Poor school performance
Bruises, welts, burns
STD’s
Pregnancy
Malnourishment
Medical professionals who
believe a child has been a victim
of abuse or neglect are required
by state law to report this information to the police or Child
Protective Services (Arizona
Revised Statutes, 13-3620).
1-888-SOS-CHILD

Lisa Shumaker is a Community
Program Representative in the ADHS
Division of Behavioral Health Services.
She can be reached at 602.364.4600
or lshumak@hs.state.az.us.

Number of Reports Received by Major Category for
Period of April 1, 2002 through September 30, 2002

Number of Reports

mothers are less likely to smile, make eye
contact, and verbally communicate with
their baby. They are more likely to have
unrealistic expectations about their child
and more likely to experience stress,
impatience, anger, and frustration, and use
harsh discipline.
Child abuse is preventable. Effective
prevention strategies include peer support
groups, home visitation, mentoring,
education about child development &
discipline, and structured opportunities for
parent-child bonding. Arizona is home to
numerous, free, high quality parenting
support and education programs throughout the state. Parents eligible for Medicaid
can receive additional support including

Symptoms of
Abuse or Neglect

Neglect

Physical
Abuse

Sexual
Abuse

Emotional
Abuse

Categories
November/December 2003

Child Fatality Review Report Released
The year 2002 was the eighth full
year in which Arizona’s Child Fatality
Review Program has reviewed the
deaths of Arizona children. The mission of the program is to reduce child
fatalities by identifying preventable
child deaths through case reviews. A
child’s death is considered to be preventable if an individual or the community could reasonably have done something that would have changed the circumstances that led to the child’s death.
Using this data, the Program develops recommendations for legislation,
public policy and community education to help prevent deaths in the
future. There were 979 child deaths
reported in Arizona during 2002 and
935 of these deaths (95.5%) have been
reviewed for this report.

Findings
• Almost 30 percent (277 of the 935
deaths) were preventable.
• Over 52 percent of the deaths of children ages 1 through 17 years were
preventable.
• There were 36 deaths that were due
to child maltreatment and 33 (92%)
were preventable.
• In 18 of the 36 (50%) child maltreatment deaths there was family history
of substance abuse and in 11 of the
36 (30.5%) there was a history of
domestic violence.
• There were 46 homicide deaths in
2002; 40 (87%) were preventable.
• During 2002, 38 Arizona children
died due to gunshot wounds and 28
(74%) of these deaths could have
been prevented.
• There were 24 suicide deaths and 19
(79%) of these deaths were determined to be preventable.
• Approximately 60 percent of all preventable deaths were due to accidents (unintentional injuries).
• Of the 277 preventable deaths 102
(37%) were associated with lack of
supervision of the child or adolescent.
• Over 85 percent of the deaths due to
motor vehicle crashes were preventable.
• Unintentional drowning deaths
decreased from 40 in 2001 to 31 in
2002.
November/December 2003

Recommendations
to Prevent Child Deaths

False Rumors About
Recalled Influenza Vaccine

For Elected Officials:
• Expand Healthy Families Arizona
and other child maltreatment
prevention programs.
• Increase funding for Child Protective
Services so that every report can be
investigated, caseloads for workers
can be reduced and there are sufficient workers available to oversee the
care of Arizona’s dependent children.
• Fund adequate, appropriate
and timely behavioral health services
including substance abuse treatment
for children, adolescents, and their
families.
• Support efforts to increase the
primary enforcement of appropriate
automobile restraints for all children
and adolescents.
• Support statewide legislation and
enforcement of pool fencing ordinances.
• Increase enforcement of laws
prohibiting persons under age 18
from possessing a firearm.

Rumors have been circulating
that a “contaminated” lot of flu vaccine has been recalled by the Food
and Drug Administration. This is
false. No contamination of any flu
vaccine has been identified anywhere in the U.S., and the FDA has
not recalled any lot of flu vaccine.
Flu vaccine is routinely tested for
safety, purity, and potency and all lots
released have met these standards.
As with any vaccine, flu vaccine
is capable of causing some side
effects; these are very rarely severe.
Most side effects from flu vaccine are
mild, such as arm soreness, redness
or swelling where the shot was given,
fever, or achiness. More serious reactions to the flu vaccine do occur, but
they are rare. While FDA and CDC
are currently investigating several
recent reports of possible significant
allergic reactions to flu vaccine, it is
important to note that the number
and type of reactions reported to date
are not unexpected.

For the Arizona Public:
• Report all suspected child abuse and
neglect to Child Protective Services.
• Keep guns away from children and
adolescents.
• Learn how to recognize children at
risk for suicide and seek intervention
for these children.
• Do not let people drive when under
the influence of drugs or alcohol.
• Always buckle up and use child
safety seats.
• Recognize the importance of
age-appropriate supervision of
children and adolescents.
• Install and maintain secure backyard
pool fencing.
To view a copy of the 2002 Child
Fatality review report, go to www.hs.
state.az.us/cfhs/azcf/pr01_toc.htm.
For more information on the
Child Fatality Review Program, call
602.542.1875.

First Flu Case Confirmed
in Pima County
In October, the State Health
Laboratory confirmed the state’s first
case of influenza in a Pima County
resident. Arizona is among the first of
only a handful of states to report
influenza activity early in the season,
including neighboring states Texas
and Colorado.
While influenza activity in the
United States usually starts in
November or December and reaches
peak levels from late December
through April, the timing of influenza
activity is highly variable from year to
year and influenza outbreaks have
been reported in October in some
previous years. Influenza cases and
isolated outbreaks can occur at any
time of the year.
ADHS relies on a surveillance
network of reporting sites around the
state to track influenza levels and
identify circulating strains of the
virus. The State Health Laboratory
types selected influenza isolates
when warranted.
Prevention Bulletin

3

Review Of Causes Of Death Among
Arizona Residents in 2002
Based on Number
of Deaths
In 2002, there were 42,320
Arizona residents who died from
all causes combined. The leading
cause of death in 2002 continued
to be heart disease, accounting for
10,551 or 24.9 percent of all
deaths. Cancer remained the second most frequent cause of death
to residents of the state, comprising 21.6 percent of all deaths.
Deaths due to chronic lower respiratory diseases (a title change from
ICD-9 title chronic obstructive pulmonary disease) ranked third, with
2,530 resident deaths reported (6
percent of all deaths). Deaths due
to cerebrovascular disease (including stroke) moved up from fifth
place in 2001 to fourth in 2002,
with 2,448 deaths reported.
Dropping to the fifth leading cause
was accidents (unintentional
injuries), accounted for 2,416 or
5.7 percent of total deaths.
Together, these five causes
accounted for 64.0 percent of total
deaths in 2002.

Based on Percent of
Deaths Occurring
Prematurely
Selected causes of death are
ranked according to the proportion
of deaths occurring before the
decedent reaches 77.2 years of age
(the life expectancy at birth in the
US in 2001). This approach highlights diseases and injuries that
cause persons to die at young
ages. The leading cause of
premature death is HIV infection,
followed by homicide, suicide,
accidents, cancer, and diabetes.
Additional information about
Arizona’s death statistics in 2002
can be found on the vital statistics
website: www.hs.state.az.us/
plan/ohpes.htm.
4

Prevention Bulletin

November/December 2003

Arizona Department of Health Services
Public Health Directory
ADHS Web Site: www.hs.state.az.us
Office of the
Assistant Director

Hepatitis C
Ph. 602.364.3658
Fax 602.364.3267

Ph. 602.542.1023
Fax 602.364.3445

Ph. 602.364.3289
Fax 602.364.3264

HIV/AIDS

Native American Liasion
Ph. 602.364.1041
Fax 602.364.3445

Public Information Office
Ph. 602.364.1201
Fax 602.364.3268

Ph. 602.364.3610
Fax 602.364.3268

Sexually Transmitted
Diseases
Ph. 602.364.4666
Fax 602.364.3267
————————————

State Epidemiologist
Ph. 602.364.3582
Fax 602.364.3445

Environmental
Health/Lead Poisoning

Healthy Arizona 2010
Healthy Aging 2010

Ph. 602.364.3118
Fax 602.364.3146

Ph. 602.364.0526
Fax 602.542.1265

Food Safety
Ph. 602.364.3122
Fax 602.364.3146
———————————––

Infectious Disease
Epidemiology/
Communicable
Disease Reporting

Arizona Immunization
Program

Ph. 602.364.3676
Fax 602.364.3199

Ph. 602.364.3630
Fax 602.364.3285

Vaccines For Children
(VFC)

Rabies and
Other Vector-Borne/
Zoonotic Diseases

Ph. 602.364.3642
Fax 602.364.3276

Ph. 602.364.3676
Fax 602.364.3198

ASIIS Registry Helpline

Tuberculosis Control
Ph. 602.364.4750
Fax 602.364.3267

Medical Director, Bureau
of Epidemiology and
Disease Control
Ph. 602.364.3856
Fax 602.364.3267

Epidemic Detection and
Response (Bioterrorism)

Maricopa County
602.364.3899
Other Areas Toll-Free
877.491.5741
Fax 602.364.3285
————————————

Office of Border Health
Ph. 520.770.3110
Fax 520.770.3307

State Health Laboratory
Ph. 602.542.1188
Fax 602.542.1169
————————————

Tobacco Education and
Prevention Program
Ph. 602.364.0824
Fax 602.364.0844
————————————

Arizona Smokers’
Helpline
www.ashline.org
Ph. 1.800.55.66.222
————————————

Vital Records
Ph. 602.364.1300
Fax 602.364.1257
————————————

General Public
Health Statistics

Child Fatality
Review Program
Ph. 602.542.1875
Fax 602.542.1843

Children With Special
Health Care Needs
Ph. 602.542.1860
Fax 602.542.2589

Women and Children’s
Health
Ph. 602.364.1400
Fax 602.364.1494

Nutrition & Chronic
Disease Prevention
Services
Ph. 602.542.1886
Fax 602.542.1890
————————————

Oral Health
Ph. 602.542.1866
Fax 602.542.2936
————————————

Behavioral Health
Services
Ph. 602.364.4558
Fax 602.364.4570

Ph. 602.542.2955
Fax 602.542.2940
————————————

Arizona State Hospital

Health Registries (Cancer,
Birth Defects and CNS
injury)

Ph. 602.244.1331
Fax 602.220.6355
————————————

Ph. 602.542.7308
Fax 602.364.0296
————————————

Poison Control
Phoenix 602.253.3334
Tucson 520.626.6016

Emergency Medical
Services
Ph. 602.364.3150
Fax 602.861.9812
————————————

COUNTY HEALTH DEPARTMENTS - (Main Numbers)
Apache
Ph. 928.337.4364
Fax 928.337.2062

Gila
Ph. 928.425.3189
Fax 928.425.0794

La Paz
Ph. 928.669.1100
Fax 928.669.6703

Navajo
Ph. 928.524.4750
Fax 928.524.4754

Santa Cruz
Ph. 520.375.7900
Fax 520.761.4813

Cochise
Ph. 520.432.9472
Fax 520.432.9480

Graham
Ph. 928.428.0110
Fax 928.428.8074

Pima
Ph. 520.740.8261
Fax 520.623.1432

Yavapai
Ph. 928.771.3122
Fax 928.771.3369

Coconino
Ph. 928.522.7800
Fax 928.522.7808

Greenlee
Ph. 928.865.2601
Fax 928.865.1929

Maricopa
Ph. 602.506.6900
Fax 602.506.0272
Mohave
Ph. 928.753.0743
Fax 928.718.5547

Pinal
Ph. 520.866.7241
Fax 520.866.7358

Yuma
Ph. 928.317.4550
Fax 928.317.4591

November/December 2003

Prevention Bulletin

5

SUMMARY OF SELECTED REPORTABLE DISEASES
Year to Date (January - September, 2003)1, 2
Jan - Sept
2003

Jan - Sept
2002

5 Year Median
Jan - Sept

6 (3)
1
0
79 (50)
0 (0)

4 (2)
0
1
47 (32)
0 (0)

4 (3)
0
2
59 (36)
1 (0)

650
25
9
522
398

549
34
14
493
322

452
34
11
569
356

216
241
771
7
6,826 (2,551)

253
185
861
5
7,809 (3,948)

355
148
804
10
4,707 (1,667)

457
143
19
14

610
236
16
25

610
154
25
25

10,246
2,824
148 (18)

11,151
2,738
148 (11)

9,738
3,035
148 (21)

4 (1)
650

9 (0)
779

8 (1)
720

0
0
57

1
0
117

2
0
77

1,954
158
390
347
226 (202)

2,210
156
363
297
223 (200)

1,343
157
363
367
223 (184)

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
VIRAL HEPATITIDES:
Hepatitis A
Hepatitis B
Hepatitis B: non-acute3
Hepatitis C
Hepatitis C: non-acute3
INVASIVE DISEASES:
Streptococcus pneumoniae
Streptococcus Group A
Streptococcus Group B in infants <30 days of age
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:
Hantavirus Pulmonary Syndrome
Plague
Animals with Rabies4
ALSO OF INTEREST IN ARIZONA:
Coccidioidomycosis
Tuberculosis
HIV
AIDS
Lead Poisoning (<16 years of age)
1
2
3
4

6

Data are provisional and reflect case reports during this period except Lead Poisoning which is by date of diagnosis.
These counts reflect the year reported or tested and not the date infected.
Case counts for non-acute Hepatitis B and C are not available before 1998.
Based on animals submitted for rabies testing.

Prevention Bulletin

November/December 2003

Tularemia and Rocky Mountain Spotted Fever
By Craig Levy

Tularemia
The first case of tularemia reported in 2003 occurred in
late summer when an adult male from Coconino County
presented to a physician with fever, diarrhea, right axillary
lymphadenopathy, and soreness in the right forearm. He
reported being bitten by an insect (presumably a deerfly)
on the right forearm a couple of days prior to onset of
symptoms. The lymph node aspirate tested positive for
Francisella tularensis.
Although deerfly activity has waned in northern
Arizona, there is still some risk of acquiring this zoonotic
disease through hunting or skinning rabbits, etc.
Historically, most cases of tularemia in the summer are
associated with arthropod bites, and those in the winter
tend to be associated with exposure to infected rabbit carcasses. There was one case reported in Arizona in 2000
and one in 2001, but none in 2002. More information is
available at www.bt.cdc.gov/agent/
tularemia/index.asp.

Rocky Mountain Spotted Fever (RMSF)
Rickettsia rickettsii infection was confirmed as the
cause of illness and death of a young child in Navajo
County. The child had onset of illness in mid-August.
Symptoms included fever and maculopapular rash. History
of a tick exposure could not be confirmed. Laboratory findings included leukopenia, thrombocytopenia and elevated
liver enzymes. This is the first case of RMSF reported in

Arizona in 2003. There was one case reported in 2002 (in
the same area) and none in 2000 and 2001. Ninety percent of the cases nationwide tend to occur from April
through September.
Diagnosis and treatment of RMSF pose specific challenges due to its low frequency, non-specific symptoms in
the early stages, and rapid progression of disease. Delayed
diagnosis and initiation of specific antirickettsial therapy
(>= 5 days) is associated with a greater risk for a fatal outcome. This underscores the need for clinicians to consider
RMSF in children with rash and fever, particularly those
with an history of tick bite; however, lack of a known tick
exposure should not rule out RMSF since less than 20% of
RMSF patients present with rash, fever, and a history of tick
exposure on their first visit. For more information, please
visit www.cdc.gov/ncidod/dvrd/rmsf.
If you need assistance in determining if a tick that is
attached to a patient is a potential vector for RMSF, please
submit the tick(s) in 70% isopropyl alcohol to the:
Arizona Dept of Health Services
Vector-Borne Diseases Program
150 North 18th Avenue, Ste. 140
Phoenix, Arizona 85007
602.364.4562
Craig Levy is the Program Manager for the Vector-Borne Diseases
Program and can be reached at 602.364.3581 or clevy@hs.state.az.us.

Saving Lives for Cheap: Intervention of Hepatitis C
By Dr. Bob England, State Epidemiologist

The Arizona Department of Health
Services (ADHS) has overhauled its
hepatitis C virus (HCV) activities to
make a real difference in preventing
illness. If we do this right, we think
we’ll have one of the most cost-effective secondary prevention activities in
all of public health.
An estimated 1.8% of the general
population has been infected with
HCV (approximately 100,000
Arizonans). Of these, approximately
80% have chronic infection (80,000
Arizonans). Up to 20% of these will
progress to cirrhosis and life threatening liver disease. Importantly, we
know who many of these persons are.
Last year, we received 10,280 reports
of HCV infection.
On average, serious liver disease
appears some 20 years following initial HCV infection. Since the epidemic
November/December 2003

peaked less than 20 years ago (in the
late 1980s), we have yet to see the
peak of those presenting for medical

Given the large numbers
of candidates for treatment
and the current cost of care,
significant societal costs lie
just over the horizon.
care. Despite this, HCV is already the
leading cause of liver transplantation
and reported HCV infection surged by
more than 50% last year in Arizona.
Although much research is underway,
medical treatment remains effective in
only about half of individuals and the
cost for a year’s treatment can easily
exceed $10,000 per patient. Given the
large numbers of candidates for treat-

ment and the current cost of care, significant societal costs lie just over the
horizon.
Yet there is a simple intervention
that costs nothing and would prevent
many persons from progressing to serious liver disease – simply avoiding
alcohol. We have known for some
time that alcohol is the most significant synergistic factor for developing
cirrhosis in those with HCV infection.
Risk is increased even in moderate
drinkers. We also know that many
patients either never receive or never
hear the message about this risk from
alcohol. What we didn’t know until
recently was how best to reach and
educate HCV-infected persons in
Arizona, and how much of a difference such education might make.
Now we know.
continued on page 8
Prevention Bulletin

7

❍ Change of Address/Name
❍ Delete my name from your mailing list
❍ I received more than one copy
Please include your mailing label with all requests
for changes. Fax changes to 602.542.1265

PRSRT STD
US Postage
PAID
Phoenix, AZ
Permit No. 957

Arizona Department of Health Services
Public Information Office
150 North 18th Avenue
Phoenix, AZ 85007
602.364.1201
Janet Napolitano, Governor
Catherine R. Eden, Ph.D., Director ADHS
Rose Conner, Assistant Director, Public Health Services
Editorial Board
Bob England, M.D., M.P.H., State Epidemiologist
Victorio Vaz, D.V.M., Ph.D.
Tim Flood, M.D.
Kathy Fredrickson, M.P.H.
Will Humble, M.P.H.
Karen Lewis, M.D.
Ken Komatsu, M.P.H.
Cheryl McRill, M.D.
Wesley Press, M.S.
Lisa Shumaker, M.A.
Emma N. Viera, M.P.H.
Managing Editor: Courtney Casillas
e-mail: ccasill@hs.state.az.us
Contributors: Bob England, Tim Flood, Craig Levy
Lisa Shumaker, Emma N. Viera
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).

Hepatitis C

continued from page 7

Programs elsewhere have demonstrated efficient mechanisms for contacting and educating persons reported with
HCV infection. Despite this, many have been skeptical of
the effect such education might have on alcohol consumption. Data from one follow-up study elsewhere, of persons
provided only brief public health education, showed that
the effect was much more significant and prolonged than
anticipated. An astounding 77% had decreased their alcohol consumption when interviewed an average of more
than a year later, and fully half had stopped drinking altogether. Apparently, hearing that one is at special, personal
risk makes a real difference.
We are using our own and others’ experiences to
develop a more efficient HCV program. Basically, we’re
trimming down the data we’re collecting, trimming down
the time we can spend with particular individuals, and
focusing on talking to as many as possible with the most
important messages. We believe we can greatly increase
the number of persons we reach and educate, most specifically regarding the risk posed by alcohol.
We’ve hired a new program coordinator and three new
health educators so far. Each of these educators will be
contacting persons reported with hepatitis C infection to
assure their understanding of the risk posed by alcohol, as
well as the need for hepatitis A and B vaccines if they’ve
8

Prevention Bulletin

never had the diseases. We may add a few other basic
messages. In the meantime, we’ll be working with provider
groups and institutions to facilitate ways that they can educate their own patients. In this way, you’ll still be the primary source of information to your patients and we’ll be
the safety net for the most important messages – catching
those who slipped through the cracks or didn’t hear your
education the first time around.
We’ve done some quick calculations and we think that
once this activity is fully functioning, if we get results seen
elsewhere, we can prevent up to 300 cases of future cirrhosis, make an enormous difference in the lives of each of
those persons, prevent tens of millions of dollars in health
care costs, and result in thousands of years of life extended
with each year of the program. Our program budget is
$350,000 per year. Not a bad investment.
We’re only beginning (just in time for hepatitis C
awareness month in November). Those of you who are
involved in hepatitis C screening and treatment will no
doubt hear more from us in the future. For more
information, contact Judy Norton, Hepatitis C Program
Manager, at 602.364.4698.
Bob England, M.D., is the State Epidemiologist and can be reached at
602.364.3582 or benglan@hs.state.az.us.
November/December 2003