alabama department health adph · attention on protecting alabamians from bioter-rorist events. to...
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ALABAMA
DEPARTMENT
OF PUBLIC
HEALTH
adph
Annual
report
2002
adph
State
Committee
of Public
Health
Pictured Below:
Front Row Seated L to R:Marsha D. Raulerson, MDGeorge C. Smith, MDDonald E. Williamson, MD
Middle Row Standing L to R:Ashley C. Cousins, PEJorge A. Alsip, MDJennie RhinehartGlen Malone, DVM A. Ray Hudson, MDSteven P. Furr, MDPamela D. Varner, MD
Back Row Standing L to R:Kenneth W. Aldridge, MDLarry Browder, DMDAllan R. Goldstein, MDArthur F. Toole, III, MDJ. Allen Meadows, MDJames G. Chambers, III, MDCraig H. Christopher, MD
George C. Smith, MD..........................................Chair, Lineville Marsha D. Raulerson, MD...........................Vice Chair, BrewtonDonald E. Williamson, MD ....................Secretary, Montgomery
Kenneth W. Aldridge, MD ....................................................TuscaloosaJorge A. Alsip, MD .....................................................................DaphneJames G. Chambers, III, MD ................................................HuntsvilleCraig H. Christopher, MD .................................................BirminghamSteven P. Furr, MD .....................................................................JacksonAllan R. Goldstein, MD .....................................................BirminghamA. Ray Hudson, MD ......................................................................JasperJ. Allen Meadows, MD ......................................................MontgomeryArthur F. Toole, III, MD ..........................................................AnnistonPamela D. Varner, MD .......................................................Birmingham
Council on Animal and Environmental HealthGlen Malone, DVM ...........................................................Montgomery
Council on Dental HealthLarry Browder, DMD, Montgomery
Council on Health Costs, Administration and OrganizationJennie Rhinehart.......................................................................Tallassee
Council on Prevention of Disease and Medical CareAshley C. Cousins, PE .......................................................Montgomery
1Photograph by Mark L. Wright
It is my pleasure to present to you the 2002Annual Report of the Alabama Department ofPublic Health. While the Department remainsdedicated to addressing the health concerns ofAlabama’s citizens, it has also focused increasedattention on protecting Alabamians from bioter-rorist events.
To ensure a more coordinated response topotential emergency events, the Department cre-ated the Center for Emergency Preparedness. TheDepartment has established response plans whichwill enable the vaccination of all Alabama citi-zens against smallpox should it be used as aweapon of mass destruction. In addition, workingwith our partners in the private sector, we haveworked to enhance hospital preparedness andhave developed the capacity for mass distributionof pharmaceuticals to our citizens should thatbecome necessary.
In addition to this enhanced focus on terror-ism, the Department continues to strive to pro-vide services that will help our citizens livehealthier and more productive lives. To addressthe problem of cardiovascular disease in the state,the Department has worked with local farmers’markets and communities to enhance physicalactivity and promote heart healthy diets. Theseactivities will result in the reduction of strokeand heart disease. The Breast and Cervical CancerEarly Detection Program has now assisted 25,000women by providing free screenings to womenbetween the ages of 40 and 64. As a result of thisactivity, over 350 breast cancers have been detect-ed and treated.
Today, over 57,000 children are enrolled inALL Kids, a program which provides free or low-cost health insurance to the children of low-income, working parents in our state. Throughthe partnership between ALL Kids, Medicaid, andthe Alabama Child Caring Foundation, we havebeen able to reduce the level of uninsuranceamong Alabama children to below the nationalaverage.
In addition to the progress in insuring chil-dren, progress has also been made in reducing thelikelihood of death and disability due to motor
vehicle accidents. In 2002, Alabama’s childrestraint usage rate increased to 89 percent. Inaddition, safety belt usage for adults remained at79 percent, exceeding the national average. Theimproved use of child restraints and safety beltsin motor vehicles will have long-term conse-quences in reducing death and disability due tomotor vehicle accidents.
While infant mortality remains far too high inour state, progress continues to be made as 2001revealed the fewest infant deaths in our state’shistory. In addition, we saw the lowest percentageof births to teenagers ever reported. Unfortunate-ly, challenges such as maternal smoking, lowbirth weight babies, and pregnant women withoutinsurance persist. Working with partners in thepublic and private sector, we remain committedto reducing Alabama’s infant mortality rate.
As we continue to enhance our ability torespond to terrorist threats, we remain commit-ted to services and programs that will reduce pre-ventable death and disability for our fellow citi-zens. In the coming year, we look forward toworking with our public and private partners toimprove the health status of Alabama.
Sincerely,
Donald E. Williamson, M.D.State Health Officer
The Honorable Bob RileyGovernor of AlabamaState CapitolMontgomery, Alabama 36130
Dear Governor Riley:
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Staff AssistantMelvin Maraman, BS
General CounselJohn R. Wible, JD
Personnel OfficeSandra Wood, MBA
Office ofRadiation ControlKirksey Whatley, MS
Staff AssistantKathy Vincent, MSW, LCSW
Office of ProgramIntegrityDirector
Debra Thrash, CPA
Office of Professional & Support Services
DirectorFrances Kennamer, MPA
• Management Support• Nursing
• Nutrition & Physical Activity• Office of Women’s Health
• Pharmacy• Social Work
Office of FacilitiesManagement
William J. Coleman, BS
• Technical Services
Bureau ofEnvironmental Services
DirectorWilliam P. Allinder, PE, PLS
• Community EnvironmentalProtection
• Food/Milk/Lodging• Training & Program
Development
STATE GOVERNMENT
STATE BOARD OF HEALTH
STATE COMMITTEE OF PUBLIC HEALTH
STATE HEALTH OFFICERDonald E. Williamson, MD
Office of Children’sHealth Insurance
DirectorGayle Lees Sandlin,
MSW, LCSW
Bureau of Home &Community Services
DirectorGrover Wedgeworth,
RN, MPH• Community Services• Home Health Care• Program Support
• Professional Development
Office ofPrimary Care
& Rural HealthDevelopment
DirectorClyde Barganier,
DrPH• Minority Health• Primary Care• Rural Health
AssistantState HealthOfficer forDisease
Control &PreventionCharles H.Woernle, MD, MPH
Bureau of FamilyHealth Services
DirectorThomas M. Miller,
MD, MPH• Administration
• CommunityDevelopment/
Professional Support• WIC
• Women’s & Children’s Health
Center forEmergency
PreparednessActing Medical
DirectorCharles H.Woernle, MD, MPH
Director ofOperations
Ray Sherer, MBA
Bureau of Health Provider Standards
DirectorRick Harris, JD
• Emergency Medical Services• Health Care Facilities
• Provider Services• Managed Care Compliance
Bureau ofInformation
ServicesDirector
Leon Barwick, MS
Bureau ofFinancialServices
Chief Accountant & DirectorThomas L.
White, Jr., CPA
Public Health AreasArea HealthOfficer/Area
Administrator
CountyHealth
Departments
Bureau of Clinical Laboratories
Director William J. Callan, PhD• Administrative Support
Services• Clerical
• Clinical Chemistry• Metabolic
• Microbiology• Quality Assurance
• Respiratory Disease• Sanitary Bacteriology/
Media• Serology
• Birmingham Microbiology• Birmingham Serology• Decatur • Dothan
• Mobile
Bureau ofCommunicable
DiseaseDirector
Charles H. Woernle,MD, MPH
• Epidemiology• HIV/AIDS Prevention
& Control• Immunization
• Infection Control • STD Control • Tuberculosis
Control
Bureau of HealthPromotion &
Chronic DiseaseDirector
Jim McVay, Dr PA• Chronic Disease
Prevention• Communications &
Social Marketing• Injury Prevention
• Public Information • Video Communications
• Worksite Wellness
Center for HealthStatistics
Director Dorothy S.
Harshbarger, MS• Quality Assurance• Record Services
• Registration• Statistical Analysis
Computer Systems Center
DirectorJohn Heitman, MS
• InformationTechnology Operations
• SystemsDevelopment
• Technical Support
Public HealthAdministrative
OfficerReuben E.
Davidson, III, MPA• Operations Support
Organization of the Alabama Department of Public Health
September 30, 2002 3
MISSIONTo serve the people of Alabama by assuring conditions inwhich they can be healthy.
VALUE STATEMENTThe purpose of the Alabama Department of Public
Health is to provide caring, high quality and professionalservices for the improvement and protection of the public’shealth through disease prevention and the assurance ofpublic health services to resident and transient populationsof the state regardless of social circumstances or the abilityto pay.
The Department of Public Health works closely withthe community to preserve and protect the public’s healthand to provide caring, quality services.
AUTHORITYAlabama law designates the State Board of Health as an
advisory board to the state in all medical matters, matters ofsanitation and public health. The Medical Association,which meets annually, is the State Board of Health. TheState Committee of Public Health meets monthly betweenthe annual meetings and is authorized to act on behalf ofthe State Board of Health. The State Health Officer isempowered to act on behalf of the State Committee ofPublic Health when the Committee is not in session.
More than 125 years ago medical leaders in Alabamaadvocated constitutional authority to oversee matters ofpublic health. The purpose of the authority was to preserveand prolong life; to plan an educational program for allpeople on the rules which govern a healthful existence; and to determine a way for enforcing health laws for thewelfare of all people.
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Table of Contents
Bureau of Communicable Disease..................................6
Bureau of Health Promotion
and Chronic Disease......................................................13
Bureau of Clinical Laboratories ....................................21
Bureau of Family Health Services.................................25
Bureau of Home and Community Services..................32
Bureau of Health Provider Standards............................34
Office of Radiation Control...........................................36
Bureau of Environmental Services................................37
Office of Professional and Support Services.................40
Office of Children’s Health Insurance..........................44
Office of Primary Care
and Rural Health Development ....................................46
Bureau of Information Services.............................................49
Office of Financial Services...........................................53
Office of Personnel and Staff Development .................55
Office of Program Integrity ...........................................57
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Cases of Notifiable Diseases, by Year, 1996-2002NOTIFIABLE DISEASES 1996 1997 1998 1999 2000 2001 2002Campylobacteriosis 264 244 186 182 163 175 228Cryptosporidiosis * * * 16 12 18 43E. coli O157:H7 15 15 23 28 11 15 20Ehrlichiosis (Human Monocytic) * * * 2 2 0 2Giardiasis 299 364 289 341 224 228 206H. influenzae invasive disease 13 19 12 18 14 26 17Hepatitis A 217 91 87 52 58 79 39Hepatitis B 78 88 73 80 65 84 102Histoplasmosis 19 14 28 24 10 1 9Legionellosis 5 3 9 6 3 13 8Listeriosis 12 8 8 9 4 8 4Lyme Disease 9 12 27 16 6 10 11Malaria 8 10 6 7 15 6 7Measles 0 0 1 0 0 0 12Meningococcal invasive disease 95 87 51 39 34 33 23Mumps 6 9 9 12 3 0 3Pertussis 26 35 28 19 21 38 41Rocky Mountain Spotted Fever 15 8 13 17 10 19 16Rubella 2 0 0 2 4 0 0Salmonellosis 507 481 696 602 664 718 861Shigellosis 144 283 453 110 106 199 839
Vibrio vulnificus infection 4 4 4 4 4 6 4
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BUREAU OFCOMMUNICABLEDISEASE
The mission of the Bureau of
Communicable Disease is to
prevent and control designated
communicable diseases and
illnesses in Alabama. The
bureau consists of the follow-
ing divisions: Epidemiology,
HIV/AIDS Prevention and
Control, Immunization,
Infection Control, Sexually
Transmitted Diseases and
Tuberculosis Control.
EPIDEMIOLOGYThe Division of Epidemiology
is directed by the state epidemiol-ogist. He and the environmentaltoxicologist share responsibilityfor the overall coordination ofconsultation and investigation ofinfectious and toxicological prob-lems. The division contains sever-al branches: General Communi-cable Disease, Zoonotic Disease,Public Health Assessments andHazardous Substances EmergencyEvents Surveillance System.
COMMUNICABLE DISEASEThe Communicable Disease
Surveillance Branch is responsiblefor tracking the occurrence ofreportable diseases and conditionsand investigating disease out-breaks and trends. Infections gen-erally associated with foodbornetransmission continued toaccount for the vast majority of
disease reported to the division in2002, including 861 cases of sal-monellosis, 839 cases of shigel-losis, 228 cases of campylobacte-riosis, 206 cases of giardiasis and39 cases of hepatitis A.
Shigellosis case reports weresignificantly higher than the num-ber of cases reported in 2001. Thiswas primarily the result of a largecommunity-wide daycare-associ-ated outbreak in Mobile County.Mobile County accounted for over57 percent of reported shigellosiscases in 2002.
Cases of meningococcal dis-ease declined again in 2002, con-tinuing a six-year trend. Therewere 12 cases of measles in 2002resulting from an outbreak in adaycare center in Lee County. Thelast reported case of measles inAlabama prior to the outbreakoccurred in 1998.
ZOONOTIC DISEASEThe Zoonoses program is
charged with monitoring, control-ling and preventing diseases trans-mitted from animals to humans.The number of cumulative casesof animal rabies in 2002 was 76.Usually raccoons account for two-thirds of the rabid animals found,but because of a canine distemperenzootic over the past three years,the population of raccoons hasgreatly decreased. As a conse-quence, only 27 percent of therabid animals detected were rac-coons.
Disturbingly, five cats and onedog, all strays, were laboratory-confirmed to have rabies. Areview of records over the past 10years reveals that of 41 dogs andcats found with rabies, 35 of themwere strays. The lack of effectiveanimal control programs in manyrural areas of the state presents apublic health risk because ofrabies. Although those were theonly domestic animals foundwith rabies, domestic animalsstill accounted for two-thirds ofthe almost 3,400 laboratory exam-inations.
The Division of Epidemiologyfurther cooperated in a nationalprogram to begin establishing abarrier of wildlife rabies fromLake Erie to the Gulf of Mexicovia oral rabies vaccination. Thebarrier in Alabama is expected tofollow the Coosa-Alabama Riversystem and baiting with the vac-cine will probably start in 2003.
Lyme disease was reported in11 patients, according to the casedefinition. Other anthropod-bornediseases included 16 cases ofRocky Mountain spotted fever,three cases of Ehrlichiosis andfive imported cases of malaria intravelers. Alabama had 48 humancases of West Nile virus in 2002,with three fatalities. One fatalcase of eastern equine encephali-tis occurred in Mobile County inlate summer.
For the third year, theZoonosis Branch collaboratedwith CDC and 24 cooperators inAlabama in a West Nile virus sur-veillance project. Following themovement of the novel encephali-tis virus into the state in 2001, itwas expected that West Nile viruswould become well establishedthe next year. Surveillance wasvery successful and allowed forearly public alerts and a massiveeducation promotion. West Nilevirus activity was detected in allof the state’s 67 counties, and 607of 1,133 dead birds tested werepositive for the virus, indicativeof the high level of virus circulat-ing among mosquitoes and birds.In addition, 193 horses and 63mosquito pools were found withWest Nile virus.
Although media reports dur-ing the year again highlightedrecalls of delicatessen meatsbecause of Listeria contamina-tion, reports in the state werelimited to four cases, which wasabout half of that expected. Thestate reported 43 cases of cryp-tosporidiosis, by far the largestnumber since protozoan diseasebecame reportable in 1999. Otherfoodborne or waterborne zoonosesincluded 20 cases of E. coli0157:H7 and 13 cases of vibriosis.Nine cases of histoplasmosis werereported, but only one case oftularemia and tetanus. No posi-tive reports were received for bru-cellosis, anthrax, leprosy, lep-tospirosis, psittacosis or trichi-nosis in 2000.
PUBLIC HEALTHASSESSMENTS PROGRAM
The Public HealthAssessments program evaluateshazardous waste sites in Alabamato identify actual or potentialpublic health hazards, determinethe extent of risk and populationsat risk, and to communicate thehazards to the public and otheragencies. This includes
recommended ways for individu-als to avoid or minimize the riskof exposure. Hazardous wastesites are usually industrial facili-ties, landfills or other locationswhere hazardous substances, orcontaminants, have been acciden-tally or intentionally released intothe environment.
In 2002, the program conduct-ed health evaluations, communityinvolvement, and environmentalhealth education activities at 10hazardous waste sites and numer-ous environmental healthinquiries not related to actualsites. Two health assessors werehired in 2002.
HAZARDOUS SUBSTANCESEMERGENCY EVENTSSURVEILLANCE (HSEES)SYSTEM
The Hazardous SubstancesEmergency Events Surveillanceprogram compiles data on theacute health effects experiencedby responders, employees and thegeneral public during accidentaland intentional emergency releas-es of hazardous substances. In thenine-year period between Jan. 1,1993, and Dec. 31, 2001, 1,599events involving 1,730 differentsubstances were found to meetthe criteria for inclusion in thesurveillance system. One hundredninety-eight of these eventsresulted in injury to a total of 522individuals. There was injury in33.3 percent of the events wherechlorine was present, 15.3 percentwhere ammonia was present and13.2 percent where acids werepresent. Evacuations were calledfor in 181 of these events, with atotal of over 23,800 peopleevacuated.
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CENTER FOR EMERGENCYPREPAREDNESS
The department’s Center forEmergency Preparedness was cre-ated in June 2002. The mission ofthe center is to provide overalldirection and management of thedepartment’s assessment, plan-ning and response to acts ofbioterrorism, other outbreaks ofinfectious disease, and other pub-lic health threats and emergen-cies, such as meteorological, geo-logical, chemical, radiological andindustrial disasters.
The center ensures a coordi-nated and integrated process formonitoring progress, allocatingresources, developing work plans,and coordinating activities withunits within the AlabamaDepartment of Public Healthresponsible for various activitiesrelated to disaster preparednessand response.
Since its creation, the centerhas been planning for bioterror-ism by working with other statesto coordinate the department’sbioterrorism response activities;assisting in the hiring of staff inpublic health areas; participatingwith department staff to prepareplans to vaccinate health careworkers and public health
response teams in Alabama toprotect them in the event of abioterrorist release of smallpox;preparing and currently tabulatingthe results of a survey researchingthe capacity of hospitals torespond to bioterrorism to use theinformation to fund hospitals torespond to attacks more effective-ly; and assisting other units with-in the department in their prepa-rations for a bioterrorist attack.
In 2002, emergency staff dutyofficers received and responded to19 emergency calls. Seven ofthose calls were referred to theBureau of Environmental Servicesfor action.
The Chemical StockpileEmergency Preparedness Program,once part of the Bureau of HealthProvider Standards, was relocatedto the center. In the past year,activities of the program included:� Participation in exercises with
the Alabama EmergencyManagement Agency and theAnniston Army Depot.
� Completion of response plansfor nine hospitals, county emer-gency medical services agencies,and the medical emergencyoperations centers.
� 100 percent completion of themedical emergency operations
centers in Calhoun, Etowah,Talladega and St. Clair counties.
� Providing each of the nineChemical Stockpile EmergencyPreparedness Program hospitalswith chemical agent detectorkits.
HIV/AIDS PREVENTIONAND CONTROL
The goal of the Division ofHIV/AIDS Prevention andControl is to reduce the spread ofHIV infection among the citizensof Alabama, while increasing sur-vival time and quality of life forthose citizens who are currentlyliving with HIV or AIDS. Duringthe past year the division contin-ued its AIDS awareness campaignby increasing the length of timethe advertisements will be dis-played on 18-wheeler trucks thatare moving across the state. TheAIDS Awareness Campaign wasawarded the Lantern Certificateof Achievement presented by theSouthern Public RelationsCampaign in July 2002.
In 2002, the HIV/AIDS DirectCare Branch made a commitmentto promote collaboration, cooper-ation and coordination amongdirect care, prevention and STDactivities, as well as helping to
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Number of substances released in all events and events with victims, by substance category, 1993-2001
SUBSTANCE CATEGORY EVENT EVENTS WITH VICTIMS PERCENT OF THIS SUBSTANCENUMBER PERCENT NUMBER PERCENT EVENTS WITH VICTIMS
Acids 197 11.4 26 13.1 13.2Ammonia 111 6.4 17 8.6 15.3Bases 111 6.4 9 4.5 8.1Chlorine 69 4.0 23 11.6 33.3Mixture of Categories 47 2.7 6 3.0 12.8Other Inorganics 284 16.4 40 20.2 14.1Paint and Dyes 54 3.1 6 3.0 11.1Pesticides 102 5.9 9 4.5 8.8PCBs 34 2.0 0 0.0 0Volatile Organics 280 16.2 15 7.6 5.4Other 440 25.4 47 23.7 10.7Total 1,729 100.0 198 100.0 11.5
increase participation of con-sumers of HIV care and preven-tion services in the planningprocess. On Nov. 18, approxi-mately 75 people representingHIV/AIDS service organizations,community planning and preven-tion, HIV/AIDS surveillance, STDand consumers of HIV servicesattended a collaborative and net-working event sponsored by theHIV/AIDS Direct Care Branch.The special guest speaker for thisyear’s event was Alabama’s RyanWhite Title II Project Officer withthe Health Resources andServices Administration RegionalOffice in Atlanta, Georgia. Theevent also provided an opportuni-ty for participants to have inputin the development of Alabama’sStatewide Coordinated Statementof Need for 2003. The meetingprovided a venue for the partici-pants to work together to identifystrategies in overcoming specificbarriers to HIV care and services.The Direct Care Branch willbegin to sponsor this meetingannually.
Several other activities weredesigned to focus on the goal ofimproving dialogue between RyanWhite HIV/AIDS providers, con-sumers, and the AIDS Divisionstaff. Each member of the sevenstatewide area Ryan White CareConsortia was provided an oppor-tunity to complete a consortiummember satisfaction survey.Several voluntary focus groupswere convened across the state tosolicit the required information.The group makeup included con-sumers and HIV prevention andcare providers. The focus groupswere led by staff members fromDirect Care, HIV PreventionPlanning and Communicationbranches. The suggestions andcomments will be used to create,develop and further enhancedirect care activities for 2003.
Collaboration and cooperationbetween the HIV/AIDS Special
Projects and the Limestone andJulia Tutwiler CorrectionalFacilities’ HIV Units have resultedin the successful implementationof the HIV care discharge plan.The plan has ensured that personsreceiving medication and treat-ment in prison do not discontinueupon their release. Each prisonerhas been successfully referred tophysicians, clinics, housing andother support services.
The Alabama DrugReimbursement Program ispresently serving 1,242, with 180patients on the waiting list. Theprogram’s drug formulary present-ly includes 27 HIV medications.The plan is to increase the num-ber of available medications in2003.
The HIV/AIDS SurveillanceBranch has been collaboratingwith other health departmentdivisions to investigate HIV/AIDScases which have been reportedwithout risk factor. This collabo-ration will ultimately provideaccurate data for HIV/AIDS pre-vention programs to target specif-ic populations at risk for HIVinfection. The staff is also in theprocess of completing the HIVEnhanced Perinatal Study for1999 - 2000. This study is fundedby the Centers for DiseaseControl and Prevention and isdesigned to investigate potentialand actual perinatal HIV trans-mission as well as preventivemeasures taken by the physicianand mother to reduce the risk ofHIV transmission. In 2003, theHIV/AIDS Surveillance Branchwill implement the HIV inci-dence study using the serologicaltesting algorithms for recent HIVseroconversion, STARHS. TheHIV Incidence Study will allowthe surveillance staff to deter-mine HIV infections within thepast 140 days as well as providecurrent assessment of recentexposure. In conclusion theSurveillance Branch is continuing
to utilize the health department’sWeb site by providing moredetailed statistical data whichmay be accessed by communityservice providers for purposes thatinclude writing grants, proposals,prevention programs, direct careinitiatives and more.
In 2002, the HIV PreventionCommunity Planning Programadded three new HIV coordina-tors. Program activities are nowcovered in all 11 public healthareas. The youth FOCUS programimplemented at Jacksonville HighSchool in Jacksonville continuesto be successful. Interactive learn-ing activities in the classroomand community engage studentsin risk reduction and programdevelopment skills. The programis led by one part-time employee,a former school teacher and cur-rent Board of Education member.Students receive class and com-munity service credit as well asopportunities for travel to nation-al conferences and other similarmeetings. The Cheaha CoosaValley HIV PreventionCommunity Planning Group inPublic Health Area 6 laid thefoundation to gain the support oftwo additional local school sys-tems to implement this modelcommunity planning process.
As a result of the programsuccess, other school systemsacross the state are either replicat-ing the program or expressinginterest in hearing more about it.In Public Health Area 5, theregional community planninggroup has engaged the leadershipof Litchfield High School inGadsden to implement theFOCUS Program model. Thedirector of the HIV/AIDSPrevention Planning Branch proj-ects a total of five more schoolsystems to be added to theFOCUS Program in 2003.
In 2002, a prevention projectevaluator was hired by the AIDSDivision. This employee works
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closely with division-funded proj-ects by providing technical assis-tance and monitoring of the fund-ed activities. In September, atraining was sponsored in whichfunded project representativesreceived computer training on theWeb-based reporting system forproject activities.
The support and dedication ofthe regional staff members in car-rying out the mandated HIV pre-vention planning directives areessential to the success of theHIV Prevention Planning Branch,planning and program activities.
In December of 2002 theAIDS Division ended the yearwith staff participation and sup-port in World AIDS Day activitiesacross the state. The theme forthis year was “AIDS Does NotDiscriminate...People Do.” Forthe first time the AIDS Divisiondirectly managed the 15th AnnualAIDS Symposium in December.The conference was evaluated bythe attendees as successful andinvigorating considering 2002 isthe 21st year of the epidemic.
Immunization
During 2002, theImmunization Division distrib-uted $15,613,400 in vaccine to537 public and private providersstatewide. This represents a 19percent decrease in vaccine distri-bution caused by vaccine short-ages for many vaccines. Most ofthe vaccine shortages have beenresolved as the year comes to aclose.
The division continues towork toward establishing itsimmunization registry, known asImmPRINT. Enrollment andtraining activities are being devel-oped in cooperation with BlueCross Blue Shield of Alabama andthe Alabama Medicaid Agency forprivate vaccine providers.ImmPRINT is already in use in anumber of federally qualifiedhealth centers and in all countyhealth departments.
INFECTION CONTROLThe Infection Control Section
of the Bureau of CommunicableDiseases has as its mission to pro-vide infection control and infec-tious disease training and consul-tation. These services are struc-tured to meet the needs of theAlabama Department of PublicHealth, the medical communityand the general public.
During 2002, inservice train-ing was provided statewide at var-ious locales, and via satellite tele-conference to other states, to atotal of 5,552 participants. Theseindividuals included health careproviders from the AlabamaDepartment of Public Health,hospitals, extended care facilities,hospices, home health agencies,physician and dental offices aswell as other sectors (teachers,day care providers, body artistsand various industries).
Alabama’s Infected HealthCare Worker Management Act of1995 mandates that health careworkers who are chronicallyinfected with the hepatitis B virus
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Total Dollar value ofvaccine distributedthrough all vaccine
programs
FY 2000: $10,414,320
FY 2001: $19,341,992
FY 2002: $15,613,400
Immunization: Cases of Vaccine Preventable Diseases
DISEASE 2000 2001 2002
Measles 0 0 12
Mumps 0 0 0
Rubella 4 0 0
Diphtheria 0 0 0
Tetanus 2 0 1
Pertussis 18 41 37
Polio 0 0 0
Hib1 0 0 12
Hepatitis B3 64 4 4
Varicella Not Reportable Not Reportable Not Reportable
1 Hib reported in children 5 years of age or younger.2 Child was 3 weeks old therefore Hib was not vaccine-preventable.2 Hepatitis B vaccine is given to children 0-18 years of age. Hepaatitis B for 2001 and 2002 include only those cases occurring in this age group.
or the human immunodeficiencyvirus report themselves to thestate health officer. The purposeof this law is to prevent transmis-sion of these viruses from infect-ed health care workers who per-form invasive procedures to theirpatients. Infection Control per-sonnel provided consultation, ini-tiated investigations, and con-ducted appropriate followup ofthese reported individuals.
The Alabama Department ofPublic Health Refugee HealthScreening Program ensures newlyarriving refugees into Alabamaare properly provided healthscreenings. Infection control staffcoordinate this program to ensurecommunicable and infectious dis-eases are not being introducedinto the state. Sixty-six refugeesfrom Afghanistan, Bosnia, China,Cuba, the Philippines, theUkraine and Vietnam settled inAlabama in 2002. The counties inwhich they settled were Autauga,Etowah, Houston, Jefferson,Mobile and Shelby.
In 2002 the state health offi-cer appointed the Alabama TaskForce on Antibiotic-resistantOrganisms. This task force ismade up of statewide infectiousdisease physicians, infection con-trol practitioners, representativesfrom the Alabama Nursing HomeAssociation, the Home HealthAssociation, and public healthemployees with expertise ininfectious diseases and infectioncontrol. The task force reviewedand revised the AlabamaDepartment of Public Health’s1991 Position Paper onMethicillin ResistantStaphylococcus aureus. A newdocument has been completedand will be distributed in 2003 toall health care facilities inAlabama. The purpose of the newdocument is to update and expandinformation on the infection andto include infection control rec-ommendations concerning
Vancomycin ResistantEnterococcus resistance inAlabama health care facilities/settings.
SEXUALLY TRANSMITTEDDISEASES
During calendar year 2002,the Sexually Transmitted DiseaseControl Division documented anincrease in the total number ofearly syphilis cases reported, witha marked increase in reportedinfectious syphilis, as comparedwith 2001. Alabama reported atotal of 335 cases of early syphilisin 2001, and 365 cases in 2002.This represents an increase of 8percent in early cases. Statewideprimary syphilis cases decreasedfrom 42 cases in 2001 to 30 in2002, which is a 29 percent reduc-tion. Reported cases of secondarysyphilis have increased from 100in 2001 to 120 in 2002, or by 17percent.
Secondary and early latentcases of syphilis have increased in2002 as a result of syphilis out-breaks in three of the state’s larg-er counties: Montgomery,Tuscaloosa and Jefferson. Thenumber of early cases has contin-ued to increase in MontgomeryCounty. In 2001, a total of 101early cases were reported and 198cases were reported in 2002.There was an increase in primarysyphilis cases from 15 in 2001 to20 in 2002. Secondary syphilisincreased from 39 in 2001 to 76 in2002. Early latent cases increasedfrom 47 in 2001 to 102 in 2002.The STD staff assigned toMontgomery County and STDprogram staff members are work-ing with community-based organ-izations, religious directors, pro-fessional organizations, commu-nity leaders and other programswithin and outside of the healthdepartment to stop the outbreakof syphilis in MontgomeryCounty.
Tuscaloosa County had a 50percent increase in early syphilisfrom 2001 to 2002. The syphilisoutbreak in Tuscaloosa Countyhas been contained. No primarycases of syphilis were reported in2001 or 2002. In 2001, only onecase of secondary syphilis wasreported and three cases werereported in 2002. A total of fourearly latent cases were reported in2001 and seven were reported in2002.
Jefferson County’s STDProgram reported 47 early syphiliscases in 2001 and 36 in 2002. Anincrease in syphilis cases occurredbetween the first and second halfof 2002. The county reported anincrease in early syphilis from 14cases in the first half of 2002 to19 cases in the second half of theyear, and this increase is nowcontained.
There were five congenitalsyphilis cases reported in 2001; allwere presumptive cases. In 2002there were eight congenital casesreported; all of these were pre-sumptive cases as defined byCenters for Disease Control andPrevention’s congenital syphiliscase definition.
Chlamydia reported anincrease in positive cases from14,524 in 2001 to 15,636 in 2002.Among women of childbearingage, between 15 - 44 years of age,there was a reported increasefrom 12,868 cases in 2001 to13,439 cases in 2002. Theincrease in cases reported isbelieved to be a result of the pro-motion of more consistent report-ing by the Infertility PreventionProject. There was a slight declinein the number of reported cases ofgonorrhea during this same peri-od: from 11,182 in 2001 to 10,119in 2002. This decline is alsoreflected in the cases of gonorrheareported among women of child-bearing age: from 5,433 in 2001 to4,756 in 2002.
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TUBERCULOSIS CONTROLThe Division of Tuberculosis
Control strives to eliminatetuberculosis in Alabama. Untilthat goal is attained, the depart-ment’s goal is to prevent thetransmission of TB to Alabama’spublic, and to provide any med-ications and services necessary todiagnose and treat active TB dis-ease as well as provide treatmentfor latent TB infection.
In 2002, the TuberculosisControl Division verified 233reported cases of TB for the state.This is 32 fewer cases than in2001 representing an 11.9 percentdecrease. This continues an
established trend of annualdeclines in the rate of TB diseasein Alabama. To maintain and con-tinue the momentum for thistrend, medications will continueto be delivered to at least 90 per-cent of the TB patients throughthe directly observed therapy pro-gram. Under this program, atuberculosis control staff mem-ber, or other responsible personobserves and records the patienttaking the anti-TB drugs. Thispractice ensures that patientsreceive an adequate and completecourse of therapy to cure activedisease and prevent the transmis-sion of the tuberculosis bacteria
to others. Other field staff activi-ties include contact investigation,training of health departmentstaff and consultation services toother facilities and state agencies.
Alabama’s TB control programhas consistently met or exceededall Centers for Disease Controland Prevention program guide-lines in areas such as completionof recommended therapy, investi-gation and examination of con-tacts, and completion of preven-tive therapy. Alabama is recog-nized nationwide as having one ofthe premier TB control programs.
Historical Trend of Tuberculosis Cases in Alabama
1,500
1,000
500
01962
1,266
1972
918
1982
631
1992
418
2002
233
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BUREAU OFHEALTHPROMOTION ANDCHRONIC DISEASE
The Bureau of Health
Promotion and Chronic Disease
manages programs related to
chronic disease prevention,
tobacco use prevention,
cancer prevention, disability
prevention, communications
and social marketing, health
education, public information,
risk surveillance, worksite
wellness and video
communications.
CHRONIC DISEASEPREVENTION DIVISION
The goal of this division is topromote healthful lifestyles andbehaviors; to educate Alabamiansabout the benefits of a healthylifestyle; to provide informationon disease prevention related toosteoporosis, cardiovascular dis-ease, asthma, arthritis, diabetesand other risk reduction pro-grams; to disseminate health-related information toAlabamians; to conduct astatewide screening program forunderserved women; and to con-duct a statewide program provid-ing free anti-hypertensive medica-tions to low-income persons withhypertension who have noresources to obtain medication.
DIABETESIn 2002, statistics were
released that showed Alabamaleading all 50 states in the rate ofdiabetes. Almost 1 in 10 adults inthe state report having been diag-nosed with the disease, anincrease of 71 percent since 1990.Approximately 439,000 individu-als know that they have diabetesand it is estimated that 200,000more have it, but do not knowthat they have it. Diabetes direct-ly contributes to the incidence ofheart disease and stroke, amongthe leading causes of death in thestate, and is the leading cause ofkidney failure, nontrauma-relatedlimb amputations and adult onsetblindness.
Staff of the Diabetes Branchpartner with many other agenciesto prevent diabetes and to helppeople with diabetes live longer,healthier lives by reducing com-plications linked to the disease.Based on national objectives, thebranch works to increase the per-centage of persons with diabeteswho receive the recommendedinfluenza and pneumococcal vac-cines, foot exams, eye exams andA1C tests. Results of surveys
conducted during the past yearshowed improvement in thoseindicators. The program also pro-motes good nutrition, physicalactivity, weight loss and smokingcessation as key factors in pre-venting and managing diabetesand works to reduce health caredisparities.
Health department activitiesduring 2002 included thefollowing: � Participation in a national dia-
betes awareness campaign topromote monitoring and controlof blood glucose, blood pressureand cholesterol levels amongpersons with diabetes;
� Involvement as sponsor orcosponsor in education andtraining conferences, includingsatellite video conferences formultiple organizations andagencies involved in diabetes-related activities;
� Provision of educational andtraining sessions, technicalassistance, and printed materialsabout diabetes and relatedissues for health care profession-als, community organizations,and people living with or at riskfor diabetes;
� Coordination of communitycoalitions through countyhealth departments at five sites;
� Initiation of a pilot project topromote improved preventionand self-management strategiesin two rural areas of the state.
HYPERTENSIONThe mission of the
Hypertension Branch is to reducethe morbidity and mortality relat-ed to uncontrolled hypertension.Hypertension is linked to heartattacks, congestive heart failure,stroke and kidney disease. TheAmerican Heart Association esti-mates that the direct and indirectcost of these diseases to Alabamais more than $5 billion a year.Yet, a hypertension patient can betreated in the local health
13
adph
departments for less than $200 ayear.
In the 2002 fiscal year, theprogram served 15,000 low-income patients whose incomewas less than 150 percent of thepoverty level. After they had beenreferred by private physicians, thepatients were served through thelocal health department clinics.The clinics provide medication,monitoring and education to thepatients and provide progressreports back to the referringphysicians. The number of coun-ties with contracted physicianswill be significantly reduced.Partnerships are being developedwith a number of communityhealth centers, local pharmaciesand private physicians that willresult in reduced costs for thedepartment.
The program continues toemphasize the value of lifestylemodification; proper nutrition,proper body weight, smoking ces-sation and limited alcohol use, aspreventive measures to the onsetof hypertension, and as effectivemeasures to help control the highblood pressure of diagnosedhypertension patients.
TOBACCO PREVENTIONAND CONTROL DIVISION
The Tobacco Prevention andControl Division provides techni-cal assistance and limited fundingto the Coalition for a TobaccoFree Alabama and 19 local coali-tions across the state through thesupport of central office staff and11 area tobacco control coordina-tors with funding from the stateand the Centers for DiseaseControl and Prevention. The mis-sion of the division is to imple-ment the Alabama Tobacco UsePrevention and Control StatePlan, thereby eliminating expo-sure to secondhand smoke, pre-venting youth from starting touse tobacco and assisting thosewho use tobacco to stop. The
division also houses the YouthTobacco Prevention Program thatprovides minigrants to 17 com-munities statewide.
2002 Accomplishments� The Department of Education’s
2001 Youth Risk BehaviorSurvey revealed a 37 percentdecrease in smoking among 9th - 12th graders from the 1999survey. The Tobacco Division’s2002 Youth Tobacco Surveyconfirmed this decrease noting aprevalence rate among 9th -12th graders of approximately25 percent, dropping Alabamabelow the national average forthis age group.
� The Tobacco Use Preventionand Control Evaluation Planwas presented as a model planat the Centers for DiseaseControl’s “Surveillance andEvaluation Workshop.” Theevaluation plan underwent peerreview and was adopted by theAlabama Tobacco UsePrevention and Control TaskForce for inclusion in therevised State Plan at itsNovember 2002 meeting hostedby the division.
� The Youth Tobacco PreventionProgram funded 17 communi-ties statewide to conduct pre-vention and empowerment pro-grams, reaching more than10,500 4th - 12th graders. Inaddition, 16 school systemsreceived drug testing strips toimplement programs thatencourage youth not to usetobacco and 8,822 3rd - 8thgraders in 41 schools weretaught the Life Skills Trainingcurricula.
� The division utilized theAmerican Cancer Society’s“Communities of Excellence inTobacco Control CommunityAssessment Guide” to assess 15communities with tobacco con-trol coalitions. The division’sevaluation team compiled the
results and disseminated reportson the assessments at fourregional strategic planning ses-sions. The strategic planningmeetings enabled local coali-tions to develop annual actionplans to address identified needsin tobacco control in theircommunities.
� Surveillance activities included:opinion polls of residents andkey opinion leaders in Gadsdenand Selma regarding theirknowledge; behaviors andbeliefs about tobacco topics;health care provider practicessurvey to determine their proto-col for assessing and treatingtheir patients’ tobacco use; astatewide sample survey ofhomes with children to assessthe number of children exposedto tobacco smoke in the home;compilation of the 2002 YouthTobacco Survey summaryreports; and a statewide sampleof adults’ attitudes, beliefs,behaviors and knowledge oftobacco with questions from thenational Adult Tobacco Survey.
� The Mobile County HealthDepartment added tobacco usepolicy questions on its foodservice inspection form result-ing in the identification of 321smoke-free restaurants. Almost50 percent of Mobile area restau-rants are smoke free, althoughthe city ordinance only requiresthat 75 percent of all restaurantseating be smoke free.
CANCER PREVENTIONThe Cancer Prevention
Branch is responsible for imple-menting the Alabama Breast andCervical Cancer Early DetectionProgram and the Alabama CancerPrevention and Control Program.The program provides no costbreast and cervical cancer screen-ing services to women betweenthe ages of 40 and 64, who are ator below 200 percent of thefederal poverty level, and are
14
uninsured or underinsured.Services include a Pap test, pelvicexam, clinical breast exam,screening mammogram, and diag-nostic services if indicated.
The statewide screening pro-gram continues to expand and hasprovided services to over 25,000women since its inception inOctober 1996, diagnosed over 350breast cancers, 10 invasive cervi-cal cancers, and detected 90 pre-cancerous cervical lesions.Approximately 51 percent ofpatients served are Caucasiansand 49 percent are AfricanAmerican and other minorities.
As of October 2001, womendiagnosed with breast or cervicalcancer through the AlabamaBreast and Cervical Cancer EarlyDetection Program may be eligi-ble for Alabama Medicaid bene-fits. To be eligible for treatmentcoverage women must be diag-nosed through the program, haveno other credible insurance cover-age, be a U.S. citizen or docu-mented resident, and reside inAlabama. To date, approximately212 applications have beenreferred to Medicaid and over 191have been approved.
The Alabama CancerPrevention and Control Plan pro-vides the infrastructure for facili-tating implementation of theAlabama Comprehensive CancerControl Plan. This comprehensiveapproach to coordinating cancerprevention and control initiativesinvolves partnerships between theAlabama Department of PublicHealth and other health careproviders, research and academicinstitutions, and community-based private and volunteerorganizations to effect change inbehavioral risk practices, increaseusage of early detection and fol-low-up examinations, provideaccess to state-of-the-art treat-ment services and promote atoxic-free environment. TheAlabama Comprehensive Cancer
Control Coalition is responsiblefor developing, updating, imple-menting and evaluating the plan.
This diverse network usessurveillance data and scientificresearch to develop educationalmessages for priority populationsand health care providers, linkcancer prevention and controlactivities with communities, andimprove the accessibility, avail-ability and quality of cancer treat-ment services and programs inAlabama. Currently, special proj-ects focus on colorectal, ovarian,prostate and skin cancers.
CANCER REGISTRYThe purpose of a population-
based cancer registry is to providecancer data and cancer risk factorinformation to public health andmedical professionals, volunteeragencies, community groups, andothers who are interested in can-cer prevention and control.Cancer is the second leadingcause of death for Alabamians andapproximately one out of everythree people will be diagnosedwith cancer at some point in hisor her lifetime. In Alabama, therewill be approximately 22,600 newcancer cases diagnosed during2002, 62 people diagnosed eachday somewhere in the state.There are expected to be approxi-mately 9,800 cancer deaths inAlabama during 2002, or 27 peo-ple dying every day as a result ofcancer.
Effective prevention measuresexist to substantially reduce thenumber of new cancer cases eachyear and to prevent many cancerdeaths. Cancer surveillance servesas the foundation for a compre-hensive strategy to reduce illnessand death from cancer, andenables health professionals tobetter understand and tackle thecancer burden.
During 2002, the AlabamaStatewide Cancer Registry begancollaborating with the American
Cancer Society to publish the firstAlabama’s Cancer Facts andFigures. The goal of this publica-tion is to illustrate a variety offactors that affect prevention,detection and quality of life byproviding not only data, but alsointerpretation of how these fac-tors affect one another.
The registry is also participat-ing in an American CancerSociety study evaluating cancersurvivors’ quality of life. Thisstudy will examine the behav-ioral, psychosocial, treatment,and support factors that influencethe quality of life and survival ofcancer survivors in the UnitedStates.
In addition to the partnershipwith the American CancerSociety, the Alabama StatewideCancer Registry also began work-ing on a national cancer outcomesresearch project, in collaborationwith University of Alabama atBirmingham, funded by theNational Cancer Institute. Thepurpose of this study, CanCORS,is to prospectively study cancercare processes and patient cen-tered outcomes, in a population-based sample of newly diagnosedlung and colorectal cancerpatients.
As part of this project, theregistry is analyzing demographicand treatment associations inpatients diagnosed with lung can-cer without tissue confirmation.This review will evaluate poten-tial disparities in patients diag-nosed without tissue confirma-tion based on race and/or locationwithin the State of Alabama, andin cancer care treatment.
Initial analysis shows the rateof patients diagnosed with lungcancer without tissue confirma-tion was higher in patients overthe age of 70 and in those thoughtto have distant metastases. Therewas a trend toward a higher rateamong blacks than whites.
The rate varied significantly
15
based on county of residence andthe use of chemotherapy, andradiation was less frequent inthese patients.
This preliminary reviewshows (a) age, but not race/sex,was significantly associated withthe group of individuals diagnosedwithout tissue confirmation sug-gesting a role of functional statusand/or comorbidities; (b) marked
disparities correlated with geo-graphic location within Alabamasuggesting that access to special-ized medical care modulated bothdiagnosis and treatment; and (c)patients diagnosed without tissueconfirmation receive less therapyfor lung cancer compared withthose patients having tissueconfirmation of the diagnosis.
CARDIOVASCULAR HEALTHIn Alabama, heart disease has
been the leading cause of deathfor more than 70 years. In 2002,major cardiovascular diseases,which include heart disease andstroke, accounted for almost 40percent of all deaths in Alabama.Over the past ten years, cardio-vascular disease has claimed thelives of more than 170,000Alabamians. In addition, thefinancial burden of cardiovasculardisease to the state is staggering.The cost to Alabama has beenestimated at more than 4.5 billiondollars. This figures includeshealth expenditures and lost pro-ductivity resulting from illnessand death. As the number of peo-ple living with cardiovascular dis-ease continues to rise and thestate’s population continues toage, the health and economic bur-den of cardiovascular disease willgreatly impact the health statusof this state.
The mission of the Cardio-vascular Health Branch is toimprove the cardiovascular healthof all Alabamians through supportfor heart healthy policies andcommunity settings that promotecardiovascular health. In 2002,the branch released the 2002Alabama Stroke Report, profilingthe burden of stroke in Alabama.Stroke is the third leading causeof death in Alabama. Althoughstroke mortality rates havedeclined over the past twodecades, Alabama’s stroke mortal-ity rate is approximately 15 per-cent higher than the national rate.
In 2002, the branch conducteda pilot project to address risk fac-tors related to heart disease andstroke. Working with communitypartners and community healthadvisors in Wilcox County, theCardiovascular Health Branchfacilitated the development oflocal farmers’ markets in PineApple, Camden and Alberta toencourage consumption of fresh
16
Alabama Cancer Incidence Rates, by Site and Sex, 1996-2000*
MALE FEMALE MALE AND FEMALERATE COUNT RATE COUNT RATE COUNT
All types 486.1 45,926 349.5 43,302 403.4 89,228Bladder 28.8 2,587 6.4 829 15.4 3,416Brain & CNS 7.8 783 5.5 660 6.6 1,443Breast (Female) 113.8 13,791Cervix 10 1,161Colorectal 57.8 5,322 41.2 5,289 48.2 10,611Esophagus 8 775 1.9 238 4.6 1,013Kidney 13.9 1,342 7.1 884 10.1 2,226Larynx 9.3 908 1.9 230 5.1 1,138Leukemia 10.9 1,034 6.8 834 8.5 1,868Liver 4.8 447 1.8 235 3.1 682Lung 108.7 10,292 45.1 5,716 71.6 16,008Hodgkin Disease 2.6 270 1.9 221 2.2 491Non-Hodgkin-Lymphoma 18.1 1,719 12.6 1,587 15 3,306Melanoma 14.6 1,403 8.6 1,025 11.1 2,428Myeloma 6.1 567 3.7 471 4.7 1,038Oral Cavity 18.1 1,747 6.2 780 11.5 2,527Ovary 14.2 1,751Pancreas 12 1,096 8.7 1,129 10.1 2,225Prostate 121.5 11,586Stomach 9.1 821 4.6 596 6.5 1,417Testis 3.9 414Thyroid 2.6 257 6.7 780 4.8 1,037Uterus 17.7 2,197
*Rates are per 100,000 and age-adjusted to the 2000 U.S. (5-year groups) standard.
produce and a heart healthy diet.Walking trails in the communi-ties of Pine Apple, Rosebud andSnowhill were also established toprovide opportunities for physicalactivity in those local areas.Through support for heart healthycommunities and targeted effortsat reduction of major risk factorsthat lead to cardiovascular dis-ease, significant strides can bemade in reducing the burden ofheart disease and stroke inAlabama.
ARTHRITIS PREVENTION Arthritis is not a single dis-
ease that affects individuals in thesame manner, but it includesmore than 100 diseases and condi-tions. The 2001 Behavioral RiskFactor Surveillance System indi-cates that 41 percent ofAlabamians have some form ofarthritis. Persons aged 65 andolder are the fastest growing seg-ment of Alabama’s populationand the impact of arthritis isexpected to increase dramaticallyby the year 2020, as the “babyboomers” age.
In Alabama, the arthritis prob-lem is magnified by a high levelof obesity and lack of leisure timephysical activity. There is also ashortage of facilities and properlytrained professionals in arthritistreatment, care, education andrehabilitation programs.
To address these issues, theAlabama Arthritis Prevention andTreatment Coalition was estab-lished with individuals andgroups dedicated to decreasing theburden of arthritis. Four annualmeetings have taken place.
The coalition has implement-ed a comprehensive state ofarthritis control plan. This planfocuses on the following: promot-ing self-management programsoffered by the Alabama Chapterof the Arthritis Foundation; com-municating through the newsmedia the benefits of physical
activity, weight management, andavoidance of occupational orsports-related injuries; utilizingcurrent technologies such as theWeb site, video, and satellite con-ferences; enhancing the under-standing of the frequency, distri-bution and potential risk factorsfor arthritis in the state ofAlabama; improving access torheumatology care in certaingeographic locations; and integrat-ing evaluation measures intoactivities.
Workgroups have completedto date: a case-based trainingmodule with continuing educa-tion units attached, access to arheumatologist in three rurallocations with more than 200patients being evaluated, aPreventive Education for Arthritisin the Work Place Task Force, aneducational video for distributionto 14,000 seniors at nutritionsites, a public service announce-ment, arthritis surveys (chil-dren/high risk elderly), and anevaluation plan.
The Arthritis Self-HelpCourse has been established in arural, low income, low literate,and medically under-served areain East Wilcox County. Ten peo-ple from the community weretrained as lay-health instructors.Ten classes, each consisting of sixsessions with a total of 106 partic-ipants, have been provided bythese instructors.
To sustain these efforts inWilcox County, two PACE(People with Arthritis CanExercise) instructors have beentrained and classes are provided inPine Apple. In addition, plans for2003 have been established for ahealth communications campaignwith the theme “PhysicalActivity: the Arthritis PainReliever.”
INJURY PREVENTIONThe Injury Prevention
Division endeavors to reducedeath and disability from inten-tional and unintentional injuriesthrough data collection and thecoordination and implementationof health promotion and educa-tion programs. Current fundedprograms include injury surveil-lance, fire safety, motor vehiclesafety, and violence againstwomen.
Trauma surveillance is animportant tool that is fundamen-tal in assessing the true impactthat traumatic injuries have onpublic health. Trauma injury sur-veillance in Alabama is accom-plished through the AlabamaTrauma Registry which is operat-ed by the Injury PreventionDivision. The registry is a central-ized database for the collection,storage and analysis of statewidetrauma data, and there are approx-imately 25,000 records in it atthis point. Head and spinal cordcases must be reported to theAlabama Trauma Registry by allacute care hospitals according toAlabama Law 97-611, enacted onMay 6, 1998. After case identifica-tion and data acquisition, moder-ate to severe head injury andspinal cord injury cases arereferred to the AlabamaDepartment of RehabilitationServices for follow-up. This sub-set of Alabama Trauma Registrydata is called the Alabama Headand Spinal Cord Registry. To date,approximately one half of allAlabama acute care hospitalshave submitted data to the reg-istry. The data collected can beutilized to monitor trends in theincidence of traumatic injuries, todetermine the need for the devel-opment and implementation ofeducational awareness programs,and to monitor the effectivenessof interventions aimed at reduc-ing these injuries.
17
The Alabama State CapacityBuilding Injury SurveillanceProgram, funded by the Centersfor Disease Control andPrevention, seeks to reduce unin-tentional and intentional injuriesby establishing a focal point forinjury collaboration and surveil-lance within the InjuryPrevention Division. An injuryadvisory council has been formedto collaborate with organizationsacross the state. The council hasoffered expertise with the devel-opment of a statewide injury pre-vention plan which addressesmotor vehicle crashes, bicycle-related injuries, falls in the elder-ly, residential fires, youth vio-lence, sexual assault, and domes-tic violence. This plan will assistin developing and supporting pub-lic policy and decision-makingefforts for injury prevention.
The division is also commit-ted to reducing violence againstwomen, specifically sexualassault and domestic violence.Through the Rape Prevention andEducation Program, the AlabamaCoalition Against Rape receivesfunding and support for its 15member rape crisis centers. Thecenters provide a 24-hour rapehotline, and provide educationalinformation to schools, organiza-tions and communities regardingrape prevention. Through theViolence Against WomenProgram, a partnership with lead-ers throughout Alabama resultedin the establishment of astatewide plan to address violenceagainst women. The comprehen-sive plan addresses every aspect ofour society from health careproviders to law enforcement tothe judicial system to victimsthemselves. Efforts to prioritizeand implement portions of theplan are underway.
Alabama has ranked amongthe top 10 nationally for fire-relat-ed deaths and injuries for severalyears. The best proven protection
against fire-related deaths is aworking smoke alarm. Throughthe Alabama Smoke AlarmInitiative, smoke alarms can beprovided and installed in commu-nities with high fire fatality rates.The community-based projectinvolves local fire departmentsand community volunteers and isdesigned to ensure that areas inAlabama with high rates haveaccess to home smoke alarms andreceive information regarding fireprevention, smoke alarm installa-tion and maintenance, and homeevacuation plans. Smoke alarmshave been provided in 10 commu-nities in Bibb, Perry, Sumter andWilcox counties. The program iscurrently underway in four com-munities in Bullock and Maconcounties.
The use of seat belts and childrestraints has been shown toreduce fatalities. In 2002, 79 per-cent of Alabamians buckled uptheir seatbelts and 89 percent puttheir children in car seats. Theseare dramatic increases from yearspast. Through the OccupantRestraint Program, ADPH willcontinue to increase awarenessand provide education toAlabamians regarding the impor-tance of appropriate occupantrestraints. In addition to conduct-ing observational surveys todetermine Alabama’s usage rates,educational activities include astatewide poster contest for ele-mentary school children and atraffic safety essay contest for jun-ior high students.
The division also serves onthe Alabama Suicide Task Force,a collaboration with several stateagencies with the goal of publish-ing a state plan to address suicideand obtain funding for preventionactivities. Additional effortsinclude the promotion of bicycleand playground safety and theestablishment of funding toaddress youth violence.
COMMUNICATIONS ANDSOCIAL MARKETING
The Communications andSocial Marketing Division estab-lished a Social Marketing Branchin 2002 to provide programs withsubject and audience data to helpthem refine their communica-tions goals, better target theirmessages and select mediums,and create evaluation tools.
To achieve this, the newSocial Marketing Branch offeredthe following services to healthdepartment offices and partneringorganizations:� Community health assess-
ments, including targeting spe-cific communities from broad(statewide) to specific (down tosub-zip code, census tract level),improving outreach andprogramming
� Baseline information to setappropriate, realistic andeffective objectives
� Benchmark data to evaluateprogram efficacy
� Community-specific multime-dia analysis to decrease cost-per-contact through bettertargeting of messages andmediums
� Ability to improve quality andcompetitiveness of proposals,presentations and reports tofunding sources by quantifyingneed through data-basedtargeting and evaluation ofcommunications
� Training on social marketingand its application to healthbehavior change and improve-ment of public health practice,employee performances anddepartment services
Communications Development,Production and Delivery
The division continued to pro-vide development, production anddelivery of communications forthe agency. Development of anew section of the division wasbegun to help offices plan the
18
design and delivery of internaland external communications uti-lizing social marketing, educa-tional, management, professionalmedia and community-basedresearch and tools. Researchincluded public and professionalinformation access issues andsolutions, the design of a func-tionality and usability study ofthe department’s Web site, andWeb site marketing.
An average of 877,000 pageviews a month were recorded onwww.adph.org in 2002. Havingcompleted the transition from theagency’s Web site being based onproprietary software to open-source, active server pages in2001, the division not onlymigrated the existing 30 programsections to the new site but alsoadded 41 more sections.Individual files included a total of1,518 HTML and 685 PDF.
Media activities includedplacing over 8,652 television spotsand 15,543 radio spots for depart-ment programs. Approximately11,000 pages of forms, reports,manuals, scripts, presentations,posters, brochures, fact sheets,flyers, displays, incentives, cards,letterhead, identification badges,and other items were designedand typeset through the division.The division requested 157 mil-lion pages of administrative andeducational materials to be repro-duced at outside printers, and theDocument Imaging Branch print-ed over 12.5 million black-and-white pages and 560,000 colorpages in-house.
PUBLIC INFORMATIONThe goal of the Public
Information Division is toimprove public health by provid-ing information through the massmedia and through departmentalpublications.
The division provides healthinformation to the news mediaand agency staff about
departmental objectives and activ-ities. In 2002 the division pre-pared and distributed more than50 news releases; assisted withnews media campaigns for severalprograms; edited the monthlypublication, Alabama’s Health;assisted with other newsletters;distributed newspaper clippingsand video monitoring reports; andcoordinated regular appearanceson a television talk show.
The division sent notices andnews releases to the news mediaelectronically and through facsim-iles based on the media outlet’sexpressed preference. More than150 news organizations receivedelectronic mail from the depart-ment as did area and county pub-lic health offices. More than13,500 faxes were transmitted tothe news media, and news releas-es continued to be published onthe department’s Internet Website. To improve internal commu-nications, news releases also weresent to all public health employ-ees through e-mail for the firsttime.
The department’s official pub-lication, Alabama’s Health, con-tinues to be printed in-house andmade available on the agency’sWeb site.
In order to communicateagency objectives and plans to thepublic and to special target audi-ences, division staff also com-posed and edited a variety of pub-lications and worked on numer-ous projects and promotions.These included reports, open let-ters, fliers, address/telephone ros-ters, news conferences, proclama-tions, public service announce-ments and fact sheets. Initiativesincluded promoting community-wide health fairs and assistingwith numerous media and in-house releases on public healthconcerns such as West Nile virus,smallpox immunization andbioterrorism. Staff also participat-ed by serving as a panelist for a
satellite conference on crisis andemergency risk communication.
RISK SURVEILLANCEThe purpose of the Risk
Surveillance Unit is to identifyand measure the health practices,attitudes and conditions thatplace adults in Alabama at riskfor chronic diseases, injuries andpreventable infectious diseases.More than half the deaths thatoccur each year can be attributedto modifiable health risk factors.The Alabama Behavioral RiskFactor Surveillance System orBRFSS is an annual telephone sur-vey which monitors the health-related risk behaviors among theadult population in Alabama. Theinformation gathered in these sur-veys is used by public health offi-cials to determine health areasthat need to be addressed, to elim-inate health disparities and toevaluate success in reducing theprevalence of health behaviorsthat endanger public health. Byproviding this information, publichealth officials can strive forchange through programs whichpromote healthy lifestyles andimproved health status for allAlabamians.
In 2001, 2,795 Alabama adultsparticipated in the AlabamaBehavioral Risk Factor Survey andreported the following concerningtheir health practices and dailyliving habits:� 23.8 percent classified them-
selves as current smokers.� 9.6 percent reported being told
by a doctor that they havediabetes.
� 31.2 percent reported no leisuretime physical activity orexercise.
� 37.2 percent classified them-selves as overweight, based onbody mass index.
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The Risk Surveillance Unitresponds to numerous datarequests from within thedepartment, from outside agen-cies and news media. Also, thedata serve as an effective tool inplanning for future public healthactivities and evaluation.
VIDEO COMMUNICATIONSThe Video Communications
Division produced the first satel-lite conference for departmentemployees 10 years ago and theAlabama Department of PublicHealth continues to lead thenation in the utilization of thistechnology to educate the publichealth workforce. During the pastyear, the department was able tocapitalize on the ability to utilizesatellite technology to broadcastemergency communications forboth staff and the news mediaconcerning the public healthmandate to prepare for a nationalsmallpox vaccination program bycoordinating several emergencyprograms regarding smallpox.
The Alabama Department ofPublic Health is the only statepublic health agency in the coun-try to have both the equipmentand staff to produce live satelliteconferences for continuing educa-tion, inservice training and newsconferences for the media. Theinfrastructure includes a Ku-bandsatellite uplink vehicle, purchasedin 1995, which is specificallydesigned for interactive deliveryof educational programs via satel-lite and an office and productionsuite which includes an editroom, a master control room anda studio. In addition, the depart-ment now has 62 county healthdepartment facilities that haveinstalled satellite downlinkantennas that provide convenientand efficient access for employeesto participate in satellite confer-ence training and educationalprograms.
The Video CommunicationsDivision initiated national satel-lite conference activities and thesubsequent development of thePublic Health Training Networkby working in collaboration withthe Centers for Disease Controland Prevention in 1992. Todaythe training network is thenationally recognized provider ofpublic health training and educa-tion programs, with the AlabamaDepartment of Public Health pro-ducing more programs than anyother state or federal agency. In2002, the department producedover 30 continuing educationsatellite conferences for the train-ing network and the national pub-lic health workforce.
The department also providesvideo production and satelliteconferencing services to otherAlabama agencies and nationalorganizations. The VideoCommunications Division wasawarded a contract by theAmerican Public HealthAssociation to uplink portions ofthe Annual Meeting in Chicago in1999, Boston in November 2000,Atlanta in October 2001, andPhiladelphia in November 2002.Plans are now being made for thedivision to travel to San Franciscoto provide a satellite uplink forthe upcoming APHA AnnualMeeting in November 2003. Inaddition the division producedprograms for the Alabama Boardof Nursing, the Association ofState and Territorial Directors ofHealth Promotion and PublicHealth Education, the AlabamaConsortium of Health Educators,the Retirement Systems ofAlabama, the Alabama AlcoholicBeverage Control Board, theMarch of Dimes – AlabamaChapter, and the Centers forDisease Control and Prevention.
The division continues tomaximize the growth of Internettechnology for marketingprograms, processing electronic
registration for program partici-pants and as a vehicle to dissemi-nate conference packet/handoutmaterials. This past year, the divi-sion designed a new Web site,known as a learning managementsystem. Participant enrollment incourses can be electronicallymonitored as well as all adminis-trative functions, such as report-ing and marketing. The site alsohas the capability to include otherfunctions such as video and audiostreaming.
The Video CommunicationsDivision also produces other proj-ects such as video educationalprograms, news conferences, andtelevision and radio public serviceannouncements. Thousands ofvideotapes are reproduced anddistributed in Alabama andnationally each year.
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CLINICAL CHEMISTRYDIVISION
The Lead Branch of theClinical Chemistry Divisionprovided both clinical blood leadtesting and environmental leadtesting. Increased testing volumesoccurred in both areas. TheBureau of Clinical Laboratories isone of four laboratories in thestate accredited by the AmericanIndustrial Hygiene Association,AIHA, to perform lead testing onpaint, soil and wipe samples. OnSept. 25, 2002, the EnvironmentalSection of the Lead Branch hadanother AIHA site inspection toensure compliance with a newISO 17025 standard.
The Clinical Services Branchof the division increased viral loadtesting capabilities through grantparticipation with the HIV/STDDivision. This branch also worksclosely with the state Tuberculo-sis program. Additional servicesinclude routine chemistry testing,hematology, therapeutic drugmonitoring, and flow cytometryfor CD4 counts.
METABOLIC DIVISIONThe Metabolic Division pro-
vides newborn screening testingfor five disorders: hypothyroidism,phenylketonuria, congenital adre-nal hyperplasia, galactosemia andsickle cell anemia (includingother abnormal hemoglo-binopathies). During fiscal year2002, the division tested approxi-mately 63,000 newborns withinthe first 48 hours of life as well asa second test at 2-6 weeks of life.Thirty-eight infants were identi-fied as positive for sickle cell ane-mia, 18 were positive for hypothy-roidism, seven were potential pos-itives for galactosemia, two werepositive for phenylketonuria, andno positives were detected forcongenital adrenal hyperplasia.
This year, the division imple-mented an automated test forPKU. This system can test
specimens in several hours asopposed to a manual test whichrequires an overnight incubationtime. It also gives a more quanti-tative result which is helpful forphysicians monitoring the diet ofpatients with phenylketonuria.
The adult hemoglobin testingsection tested 10,626 specimens.
MICROBIOLOGY DIVISIONThe Microbiology Division
received funding for its Bioter-rorism Program for the fourthyear as well as supplementalfunding that totaled $4,381,284.Additionally, the division receiveda total of $87,959 continuedfunding for the EpidemiologyLaboratory Capacity Grant. Fundsfrom the bioterrorism awardallowed renovation plans to beginupgrading the overall laboratoryand specifically for the enhance-ment of a Biosafety Level 3+facility.
The Emerging InfectionDisease Surveillance Sectionexperienced an unprecedentedsurge of specimens at the begin-ning of the 2002 fiscal year. TheBioterrorism Program within thesection was inundated with speci-mens to rule out Bacillusanthracis, the causative agent ofanthrax, during the national 2001anthrax outbreak. The first clini-cal specimen for ruling outanthrax was received on Oct. 8,2001. The first environmentalsample for bioterrorism wasreceived on Oct. 10, 2001.
In all, there were 318 eventsinvestigated; 30 clinical speci-mens processed; 436 environmen-tal samples examined and ofthese, 389 were tested to rule outthe presence of Bacillus anthracis.Approximately 50 of the environ-mental samples submitted weredue to assistance given to theUnited States Postal Service inconducting clean-sweep testing ofthe Alabama U.S. Postal Proces-sing Center in Birmingham.
BUREAU OFCLINICALLABORATORIES
The goal of the Bureau of
Clinical Laboratories is to
provide testing for diseases of
public health significance;
offer diagnostic capabilities
unavailable to the private
sector; provide private labora-
tories with reference services;
administer regulations, provide
educational services; institute
new testing procedures; and
provide data to agencies.
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No evidence of Bacillus anthraciswas found in any of the environ-mental or clinical samples sub-mitted for testing.
The bioterrorism staff suc-cessfully participated in theCenters for Disease Control andPrevention BioterrorismProficiency Testing Program forYersinia pestis, the causativeagent of plague. Some personnelreceived training in the rapidresponse methods (real-time poly-merase chain reaction and time-resolved fluorescence assays) torule out suspect bioterrorismagents. Other training includedattendance at an EmergencyFoodborne Response Counter-Terrorism Workshop sponsored bythe Food and Drug Administra-tion to address the possibility ofterrorist attacks on the nation’sfood supply.
The Epidemiology LaboratoryCapacity Program within the sec-tion implemented an algorithm totest for the West Nile virus dur-ing the national 2002 outbreak.Within two weeks of the request,personnel had implemented thetest and began receiving serumand cerebrospinal fluid for WestNile virus testing on Aug. 26,2002. The IgM capture antibodyassay was used to test the 134specimens received during thisperiod, of which, 18 were posi-tive. These positives were for-warded to the CDC in Ft. Collins,Colo., for confirmation.
The Reference BacteriologySection had a 32 percent increasein the number of specimensreceived this fiscal year periodover the past fiscal year. Therewas an approximate 41 percentdecrease in the number of posi-tive Bordetella pertussis speci-mens received. The number ofpositive Escherichia coli O157:H7cultures remained about the sameas the past fiscal year. There wasa 200 percent increase in thenumber of specimens submitted
for Bacillus species identification;however, none was Bacillusanthracis. Twenty-five percentidentified were Bacillus cereus.There was one Listeria monocyto-genes and two Vibrio choleraenon 01/0139 isolates submitted.There were two foodborne inves-tigations in Jefferson County, oneinvolved Bacillus cereus and theother involved Clostridiumperfringens.
The Parasitology Section hadthree malaria specimens whichwere identified as Plasmodiumfalciparum, and one Cryptospori-dium species. There was a smalldecline in specimens tested andan equivalent decline in the num-ber of specimens with the pres-ence of parasites.
The Enteric Section had an11.5 percent increase in the num-ber of specimens submitted, witha 2 percent increase in the num-ber of Salmonella species identi-fied and a 28 percent increase inthe number of Shigella speciesidentified. There was a Shigellaoutbreak in Mobile County whichmay have attributed to theincrease in Shigella isolates.
The Gonorrhea Section had adecline in the total number ofGonostat for this fiscal year. Thisdecline was due partially to thetemporary transfer of specimensto the regional labs duringrenovation.
The Rabies Section had adecline in the number of speci-mens tested as compared to theprevious fiscal year. The numberof positive specimens alsodeclined from 40 in the previousyear to 21 for this reporting peri-od. There were five domestic ani-mals infected with rabies. Anemployee was sent to the nationaltraining for Laboratory Methodsfor Detection of Rabies in January2002.
QUALITY ASSURANCEThe Quality Assurance
Division provided training eventsto both private sector and publichealth personnel in 2002. RapidPlasma Reagin and DarkfieldMicroscopy training was present-ed to personnel at the MobileCounty Health Department inJanuary. Newborn screeningseminars were presented tonursing personnel at hospitals inTuscaloosa and Birmingham.PHASES I and II were offered toall bureau personnel by QualityAssurance personnel at all fivelaboratories throughout thespring.
Responding to requirementsof the Bioterrorism grant, QualityAssurance personnel participatedin developing and presentingLevel A training to hospital labo-ratory personnel throughout thestate. In a related note, theQuality Assurance Divisionaccepted the responsibility ofsafety officer for the bureau.
The Quality AssuranceDivision has been involved inwriting requirements for andchoosing a Laboratory Informa-tion System. Division personnelhave also been involved in gather-ing information for HIPAAcompliance.
Microscope and Wet Preptraining was provided to nursingpersonnel in Blount, Butler andMontgomery county healthdepartments. One QualityAssurance employee traveled toAugusta, Ga., to present DarkfieldMicroscopy training to diseaseintervention specialist and nurs-ing personnel.
Finally, an antibiotic resist-ance workshop was offered tohospital personnel in October2002.
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RESPIRATORY DISEASEDIVISION
The Respiratory DiseaseDivision received 13,966specimens to identify formycobacteria and actinomycetes.The Mycobacteriology sectionperformed 1,347 DNA probes,1,652 high performance liquidchromatographies, and 500 drugsusceptibilities for the identifica-tion and drug susceptibility pat-tern of M. tuberculosis and othernontuberculous mycobacteria.The Mycology section receivedapproximately 4,608 specimensfor fungal identification and iden-tified over 1,306 dermatophytes,353 yeasts and 911 other fungi,including 15 Histoplasma capsu-latum and five Blastomyces der-matitidis.
The division continues partic-ipation in the TuberculosisCooperative Agreement Grant,CDC Tuberculosis Multi-DrugResistant Susceptibility Study,and the National Genotyping andSurveillance Network Grant. Incooperation with the Universityof Alabama at Birmingham, thedivision continues to genotypestrains of tuberculosis in theongoing establishment of a DNAfingerprinting library of tubercu-losis isolates in Alabama.
The Mycology Section is alsocontinuing participation in thestudy of significant systemicmycosis conducted by theMedical Mycological Society ofthe Americas through theDepartment of Microbiology andImmunology at the University ofCalifornia in San Francisco.
SEROLOGY DIVISIONThe Syphilis Section screened
specimens using the VDRL test(Venereal Disease ResearchLaboratory) on 44,782 patients.Confirmatory testing for allresults other than nonreactive(1,692 patients) was performedusing the TP-PA test (Treponema
pallidum Particle Agglutination).The rate of reactive syphilis speci-mens increased to 3.4 percentfrom 3.0 percent the previousyear. TP-PA testing revealed a 76percent reactivity rate for fiscalyear 2002 which coincides withprevious confirmatory results.
The Maternal and ChildHealth section performed Rh,ABO, antibody testing on 6,504specimens. From these speci-mens, 189 antibodies were detect-ed in the screening process with30 antibodies found to be signifi-cant in potentially causingHemolytic Disease of theNewborn. Predominant signifi-cant antibodies detected were theanti-D with the next most com-mon being anti-M and anti-C,respectively. Total specimensdecreased slightly; however, sig-nificant antibodies increased from21 to 30.
The Measles Section per-formed 5,613 EIA tests forRubella IgG and 108 EIA tests orRubeola IgG. IgM testing is alsoavailable for both Rubella andRubeola, however, due to thedecrease in the prevalence of bothRubella and Rubeola the numbersfor IgM testing are relativelysmall. The Rubella IgG testingrevealed 91 percent of patientsimmune and no specimens reac-tive with the IgM testing. Themajority of active measles casesare from patients born outside theUnited States.
The EIA Section changed itschlamydia testing from an EIAmethodology to a more sensitivedirect-DNA probe. By using thisformat, other capabilities presentthemselves for future use.
BIRMINGHAMMICROBIOLOGY DIVISION
The Sanitary BacteriologySection provided proficiency testspecimens for seven industrydairy laboratories and one statelaboratory. The laboratory
evaluation officer inspected fourindustry dairy laboratories andfive public water utility laborato-ries for compliance with state andfederal regulations.
The Microbiology Sectioncontinued its participation in theCDC Gonococcal IsolationSurveillance Program, providing300 isolates of N. gonorrhoeae forsurveillance of drug resistancepatterns.
BIRMINGHAM SEROLOGYDIVISION
The Birmingham SerologyDivision performs the followingtests: VDRL/TPPA, HIV,Chlamydia, rabies and influenza.There was a 10 percent increasein the total number of specimenstested in fiscal year 2002 as com-pared to fiscal year 2001. All testsexcept rabies showed an increase.The increase in the number ofpositive specimens was a reflec-tion of this change.
All employees are presentlygoing through training for theGen Probe method of testingchlamydia. Several clinics madeadjustments in how the swabswere taken and submitted. Theadjustment period has ended andvery few specimens were lost.
Influenza season was verymild. All of the early isolateswere identified as InfluenzaA/H2N3. The CDC further char-acterized these as InfluenzaA/Panama/99-Like H2N3. At theend of the testing season,Influenza B/Hong Kong wasisolated.
DECATUR DIVISIONDuring the first two months
of the fiscal year, the publicexpressed concern about anthraxand a white powder they found atthe bottom of containers the divi-sion laboratory or health depart-ments had provided to collectwater samples.
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Compared to fiscal year 2001,there was some increase in thetotal number of specimensreceived for testing. This increasecan be attributed to the N. gonor-rhoeae tests. There was a slightdecrease in the number of speci-mens submitted for rabies andbacteriological testing on watersamples. The total number of pos-itive tests for HIV and syphilisserology decreased as well.
MOBILE DIVISIONThe Mobile Division, partner-
ing with the AlabamaDepartment of EnvironmentalManagement and Baldwin CountyHealth Department, receivedEnvironmental Protection Agencygrant money to develop a BEACHAct and to expand monitoring ofAlabama swimming areas alongthe Gulf of Mexico and MobileBay. In another partnership withthe State Health Department,Department of NaturalResources, ADEM, and theDauphin Island Sea LabConsortium, the Mobile Divisionreceived funding for additionalharmful algal bloom monitoringincluding samples for offshoresurveillance. Mobile staffersdeveloped a database and digitizedseven years of monitoring results.This effort is part of a larger Gulfof Mexico program known as theHarmful Algal Bloom Sensing/Observation System. Researchersare using the data to develop pre-dictive models based on theKarenia brevis blooms of 1996and 2000. A staff member wasselected to participate in a nation-al workshop to develop theUnited States component of theGlobal Ocean Observing System,Ocean. US. The laboratory pro-vided support for a study of postharvest treated oysters. Specimenvolume remained steady in thispast year with a slight increase inpositive rabies specimens.
DOTHAN DIVISION Fiscal year 2002 was busy for
the Dothan Laboratory, due toperforming Gonostat and rabiesspecimens for the MontgomeryLaboratory during its renovation.The overall test volume for thelaboratory was up nearly 12 per-cent. This was the first year inwhich no dairy specimens of anytype were run by the DothanLaboratory.
The total number of rabiesspecimens, as well as the numberof positives, continued to decline.For the first time the highestnumber of positives was found inbats instead of raccoons.
In the upcoming year theDothan Laboratory will undergorenovation.
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PROFESSIONAL SUPPORTDIVISIONCommunity Development
The goal of the CommunityDevelopment Branch is to buildthe capacity of the county healthdepartments to meet the chal-lenges of the changing maternaland child health care environ-ment. The branch has worked tochange the paradigm in whichmaternal and child health servicesare conceived and operationalizedat the state, area and county lev-els. The bureau has for the pastfive years emphasized its para-digm shift for how maternal andchild health services are deliveredat the county local staff level. Thecooperative agreement serves asthe catalyst for broader participa-tion by the county staff to imple-ment local initiatives focusing on“community development.” Theparadigm shift augments the pro-vision of direct personal care serv-ices while emphasizing the essen-tial maternal and child healthservices as well. The branchdefines community developmentas a “shift in thinking or mind-set” of direct personal health careservices only to conclude a moreglobal “community capacity-building” perspective, and fromstate domination of the maternaland child health care systems tomuch greater reliance on collabo-ration, community coalitions andactive partnerships at the countylevel.
2002 Service Activities� The Bureau of Family Health
Services Community SystemsDevelopment grant programprovides support for counties todevelop and implement commu-nity-based initiatives. Technicalassistance and training are pro-vided in the areas of programdevelopment and evaluation.
� A cooperative agreementbetween the public health areasand the bureau was modified to
better define community-basedactivities at the local level. Sitevisits were made to the 11 pub-lic health area teams to identifyopportunities for enhancementof the agreement and to gatherinput by the area staff.
� Nine prepared presentationswere circulated to county healthdepartments to increase com-munity outreach and publicawareness. Program specific pre-sentations include theChildren’s Health InsuranceProgram or ALL Kids,Hypertension and Plan firstFamily Planning MedicaidWaiver Programs. Preventivehealth presentations includedtobacco, folic acid, infant mor-tality, osteoporosis, SuddenInfant Death Syndrome andShaken Baby Syndrome.
Professional SupportThe Professional Support
Branch provides consultation, pro-gram and policy development,training and technical assistanceprimarily in the areas of clinicalpractice.
2002 Activities� A contract was negotiated with
the Department of HumanResources to provide care coor-dination services to teens whocome to local health depart-ments for family planning serv-ices. Approximately 168 socialwork and nurse care coordina-tors worked either full or parttime in the Teen FamilyPlanning Care Coordinationprogram in 2002. Training at theCentral Office was provided fornew workers on a quarterlybasis during 2002. Sixty-fivecare coordinators attended train-ing, which included psycho-social, contraceptive, sexuallytransmitted diseases and HIVinformation. Public health carecoordinators working in theteen care coordination program
BUREAU OF FAMILYHEALTH SERVICES
The Bureau of Family Health
Services protects and promotes
the health and safety of women,
infants, children, youth and
their families in Alabama
through assessment of
community health status,
development of health policy
and assurance that quality
health services are available.
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also provide abstinence-basedsex education in public schoolsand other sites and facilitatesupport groups for teens at localhealth departments. The absti-nence-based sex education cur-riculums have been wellreceived in local public schoolsystems in the state.
� The Medically at Risk Programwas approved by the AlabamaMedicaid Agency to provide tar-geted case management servicesunder Title XIX effective Jan. 1,1999. The Operational ProtocolManual developed by thebureau’s social work consultantwas updated in 2002. Twenty-four full-time public healthsocial workers and nurses pro-vided services to Medically atRisk families in all counties inAlabama during fiscal year2002. Training was conductedon a quarterly basis for all newworkers during fiscal year 2003.Eighty-seven case managersreceived training in fiscal year2002.
� The 1115 Family PlanningWaiver (Plan first) was imple-mented on Oct. 1, 2000. Thebureau’s social work and nurseconsultants worked with theAlabama Medicaid Agency todevelop the OperationalProtocol Manual and supportmaterials for the waiver. Forty-two social workers and nursesprovided Plan first care coordi-nation during 2002 in all 67counties. Training was conduct-ed on a quarterly basis for newworkers in the Plan first pro-gram. Fifty-six care coordinatorsreceived training. Sexuallytransmitted diseases and HIVinformation was added in the2001 fiscal year to the psycho-social and contraceptive infor-mation provided in the training.
� Maternity care coordinationwas provided by licensed publichealth social workers and nurs-es through subcontracts with
Medicaid’s primary contractorsin 28 counties, down from 40counties in 2001. The programdecreased due to several factors,the major being the low reim-bursement rate offered by theprimary contractors for carecoordination. Training was pro-vided on a quarterly basis fornew maternity care coordina-tors. In 2002, 26 case managersreceived training.
� Targeted case management con-tinued to be provided bylicensed public health socialworkers for specific diagnoses(HIV, sickle cell disease, elevat-ed lead in children and newbornscreening diagnosis). Publichealth social workers staffedfour sickle cell clinics in 2002,however, due to the lack ofstaff, two of the clinics weredropped. Targeted case manage-ment training was providedquarterly. Sixty-one case man-agers received training in fiscalyear 2002.
� There were 295 case managersand care coordinators trained.
WOMEN’S AND CHILDREN’S HEALTHWomen’s Health Branch
The Women’s Health Branchprovides administrative and sys-tems’ development support andtechnical assistance to countiesand areas on women’s health clin-ical programs and special projects.Women’s health programs andprojects in 2002 included FamilyPlanning, Maternity, Perinatal,the Alabama Smoking CessationReduction in Pregnancy Trial(SCRIPT), the Alabama TobaccoFree Families Program, theAlabama Unwed Pregnancy Pre-vention Program and the Uncom-pensated Maternity Care Project.
The overall goals of the branchare:■1 Reduce the incidence of
pregnancy related mortality
and morbidity by ensuringstatewide access to qualitywomen’s health care services,and
■2 Reduce the incidence ofunintended pregnancy.
MaternityWith the health department
no longer being a major providerof maternity services for Medicaidand uninsured women, concernwas raised regarding the lack of asafety net for these women.Because of this concern, theUncompensated Maternity CareProject was initiated to betterunderstand and better serve theneeds of those among Alabama’smaternity population without pri-vate insurance or Medicaid. Thegoals of the project have been todetermine the number and demo-graphics of this vulnerable popu-lation; study the level of healthcare services available to them;and as needed, help put in placeappropriate and accessible sys-tems of care. Annual data showthat over 1,400 women wereuncompensated maternitypatients in 2001, that a growingpercentage of this number isHispanic, that these womenaccess care later and less fre-quently, and that their birth out-comes are poorer than their coun-terparts’ with insurance. The proj-ect has encouraged developmentthrough community-based coali-tions of local health care net-works. In addition, the bureau hasredirected some Maternal andChild Health Block Grant fundsto help pay for prenatal care inthese new systems. Projects werefunded in 20 counties in 2002.
Family PlanningDirect patient services were
provided to more than 99,000family planning clients during the2002 fiscal year. The number ofclients served has increased by 4 percent from the previous year.
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Plan first, a 115(A) MedicaidResearch and DemonstrationWaiver implemented in October2000, accounted for 60 percent ofthose served. Plan first expandedMedicaid eligibility for familyplanning services to women age19-44 at or below 133 percent ofthe federal poverty level. Sinceimplementation of the program,approximately 97,308 womenhave been enrolled.
Plan first is a joint effortbetween the Alabama MedicaidAgency and the AlabamaDepartment of Public Health.Each month the Medicaid agencysent more than 1,000 letters towomen automatically eligible forthe Plan first Program. Thedepartment continues to operate acomputer based toll-free informa-tion hotline, which helped over8,000 women choose a familyplanning provider and schedule anappointment for services. Thisagency continues to distributespecifically designed brochuresand posters to market the pro-gram. The brochure has beentranslated into Spanish, and thesematerials were given to privateproviders and health departmentsto be distributed in communitiesstatewide. A Plan first televisioncommercial was produced andrun for four weeks throughout thestate. Calls to the toll-free hotlinetripled during that time.
The Plan first program,through the Alabama Departmentof Public Health, continued pro-viding psychosocial assessmentsto those enrolled to determineone’s risk potential for anunplanned pregnancy. Those iden-tified by the assessment as highrisk are then offered care coordi-nation counseling and educationfrom a trained nurse or socialworkers. The care coordinationservice and accompanying litera-ture are specifically designed tomeet the literacy needs of the eli-gible women. To facilitate the
care coordination service, the cen-tral office continues to providetraining on a quarterly basis, forthose workers new to the pro-gram. These care coordinatorsrisk assessed more than 32,000women and determined that 41.5percent were at high risk for hav-ing an unintended pregnancy.
The Family Planning TeenCare Coordination Program con-tinues in its effort to reduce teenpregnancy. This program is fund-ed through a partnership with theAlabama Department of HumanResources and provides care coor-dination for all family planningteens age 18 and under. Servicesconsist of individual counseling,case plan development and fol-low-up, preventive health educa-tion classes and teen supportgroups. Over 9,000 teens wereserved in 2002.
Alabama Smoking Cessation-Reduction in Pregnancy Trial(SCRIPT) and the AlabamaTobacco Free Families (ATOFF)Program
SCRIPT was a five-year col-laborative project between theUniversity of Alabama atBirmingham and the AlabamaDepartment of Public Health thatlasted from 1997 to 2000. Basedon 10 years of previous studiesinvolving approximately 2,000public health patients, theSCRIPT methods were found tobe effective in increasing smokingcessation or reduction ratesamong pregnant Medicaid smok-ers. The Bureau of Family HealthServices, in collaboration withUAB, developed a disseminationplan to train all public healthmaternity care services staff todeliver the SCRIPT methods aspart of routine care. In late 2001,public health area nursing andsocial work directors selected pro-fessional staff as SCRIPT trainers.Free basic tobacco interventionskills training for SCRIPT took
place in Montgomery in May2002 with nine public healthareas represented. Participantssuccessfully completing thecourse will be certified as basictobacco intervention skillsinstructors and qualified to trainpublic health staff who providematernity care or care coordina-tion services to deliver theSCRIPT model in their own coun-ty health department clinics.Instructor certification and stafftraining are presently underway.As of Sept. 30, 2002, there are 11county health department profes-sional staff who were trained todeliver SCRIPT. The training issponsored by the AlabamaTobacco Free Families Program.
The ATOFF Program is a four-year community-based programthat started in 2000 and will con-tinue to 2004. The program uses acampaign of media and policychange and a professional practiceeducation component to reducethe smoking prevalence rate ofpregnant females whose materni-ty care is supported by Medicaid,and all females of childbearingage (14-44) in the eight SCRIPTcounties (Calhoun, Covington,Cullman, Houston, Jefferson, Lee,St. Clair and Walker). The pro-gram also focuses on male part-ners and families of these womenwith the purpose of creating asocial environment supportive ofa tobacco-free family home.Training for private providers alsobegan in early 2002. As of Sept. 30, 2002, more than 800health care and other interestedprofessionals have received a four-hour basic tobacco interventionskills course of a one to two houroverview of the U.S. PublicHealth Service/DHHS clinicalpractice guideline: TreatingTobacco Use and Dependence.ATOFF’s first TV/radio campaign,which focused on a better qualityof life for the mother as a result ofnot smoking when pregnant, has
27
won three major national/interna-tional media awards. The secondcampaign focuses on the healthhazards of secondhand smoke andthe importance of not smokingwhen children are in the car. As aresult of the two campaigns, theATOFF Quitline has receivedmore than 6,300 calls andrequests for smoking cessationmaterials.
Perinatal Program (State andRegional Perinatal AdvisoryCommittees)
The Alabama State PerinatalAdvisory Council was formed toadvise the state health officer inplanning, organization and evalu-ation of the perinatal program.Five perinatal regions, based onregional neonatal referred hospi-tals, compose the regional perina-tal health care system of thestate. Regional Perinatal AdvisoryCouncils provide representationfrom each county to advise andinform about regional perinatalissues.
During 2002, the state perina-tal program capacity wasenhanced by creating five full-time positions to provide a staffnurse for each perinatal region.The regional nurse positions havea primary role of coordinatingcouncil activities for the purposeof strengthening the perinatalhealth care system in each region.Additional responsibilities of theregional staff include: conductinga regional needs assessment toidentify gaps and barriers in peri-natal services, providing assis-tance to the High Risk InfantFollow-up and Tracking clinics ineach perinatal region and foster-ing collaboration between clinicsand the Early Intervention pro-gram, partnering with perinatalissues and coordinating fetal andinfant mortality review processesin each region.
The perinatal program contin-ued to fund community-based
projects focusing on perinatal con-cerns in each of the five perinatalregions. Seventeen of these proj-ects were funded in 2002.
Alabama Unwed PregnancyPrevention
The Alabama UnwedPregnancy Prevention Programwas established and funded in1999 through a partnership withthe Alabama Department ofHuman Resources to address theissue of unwed pregnancy amongwomen of childbearing age. Since2000, a media campaign has beenimplemented to encourage parent-teen communication, whichincludes four public serviceannouncements, a 1-800 hotline,brochures and pamphlets, and aWeb site. Thirty statewide proj-ects continue to receive fundingto provide information and activi-ties to reduce non-marital preg-nancy through community-basedorganizations, churches, schools,health departments and countyagencies.
CHILD HEALTH BRANCHThe Child Health Branch pro-
grams include the NewbornScreening Program, the AlabamaChildhood Lead PreventionProject, Healthy Child CareAlabama, Child Death Reviewand the Alabama AbstinenceEducation Program. A new initia-tive is the Universal NewbornHearing Screening Program.These programs are involved dailywith protecting and promotingthe health and safety of infants,children and adolescents withinthe state.
Newborn ScreeningThe Alabama Newborn
Screening Program is a five-partpreventive health care systemdesigned to identify and treatselected heritable disorders thatotherwise would become cata-strophic health problems. Such
disorders that otherwise wouldbecome galactosemia (GAL), con-genital hypothyroidism/TSH,(T4/TSH), classical phenylken-tonuria (PKU) and congenitaladrenal hyperplasia were screenedon over 62,569 newborns.
The following disorders wereidentified and referred for treat-ment: 30 confirmed Hb, 0 galac-tosemia, there were 11 new diag-nosis of Durate Variants (DGCarriers) with ongoing monitoringand evaluation at the SparksCenter, 18 T4/TSH, 0 classicalPKU, 2 hyperphenylalaninemia,and four CAH-two born in 2002and two born in 2001, andaccounted in the year 2002 report.Follow-up services were providedfor over 900 clients.
Medical consultants at theUniversity of Alabama atBirmingham and the Universityof South Alabama, primary med-ical providers, county healthdepartments, and the seven com-munity-based sickle cell organiza-tions provided support for the pro-gram’s goals and objectives to pre-vent infant mortality, develop-mental impairment, decreasedmorbidity, delayed physicalgrowth and other catastrophic ill-nesses and conditions resulting indeath by providing testing for dis-eases of public health signifi-cance, offering diagnostic capabil-ities, providing private laborato-ries with reference services,administering regulations, provid-ing education services and provid-ing data to agencies.
Newborn Hearing ScreeningThe Alabama Department of
Public Health provided grantstotaling $70,000 to five additionalhospitals to start or enhance cur-rent hearing screening programs.These second-round grantsbrought the total number of hos-pitals that have participated inthis initiative to 55. All but oneof the 60 birthing facilities in
28
Alabama have the capability toscreen infants for hearing lossbefore discharge.
The rules and regulationsregarding “The Care andTreatment of Infants IdentifiedThrough the Newborn ScreeningProgram” were approved by theState Committee of Public Healthand became effective on Oct. 23,2002. The revisions do not makehearing screenings mandatory, butrequire the hospitals to report theresults of voluntary hearingscreenings done on infants. Therevisions allow the department torelease the hearing results tophysicians registered with theVoice Response System and allowthe department to provide coun-seling and management forinfants with hearing loss, infantswith high risk factors, and/orinfants who did not receive aninitial screening.
The Newborn ScreeningCollection Form has been revisedto obtain the hearing screeninginformation. These modificationsallow the hospitals to documentthe hearing screening results on afamiliar form and also link themetabolic and hearing programs.The tracking on a follow-up sys-tem is in place and staff are work-ing with the hospitals and healthcare providers to ensure thataccurate and timely informationis reported.
The Alabama Department ofPublic Health was successful increating the position of NewbornHearing Screening Coordinator.
Alabama Childhood LeadPoisoning Prevention Project
During the tenth year theAlabama Childhood LeadPoisoning Prevention Project,funded through the Centers forDisease Control and Prevention,collected reports of 19,260 bloodlead screenings through which358 lead cases were referred formedical and environmental casemanagement and 79 primary andsecondary homes of lead-poisonedchildren were inspected duringthe year. Follow-up inspectionswere completed on all homeswhere children’s blood lead levelsdid not improve in a six-monthperiod.
Healthy Child Care Alabama Healthy Child Care Alabama
is a collaborative effort betweenthe Alabama Department ofPublic Health and the AlabamaDepartment of Human Resources.Eight nurse consultants (regis-tered nurses) serve 45 counties byproviding developmental, healthand safety classes, coordinatingcommunity services for specialneeds children, identifying com-munity resources to promotechild health and safety andencouraging routine visits forchildren to their health careproviders.
The nurse consultants willalso work with community agen-cies and organizations to reduceinjuries and illnesses and promotequality child care. The nurse con-sultants can perform health andsafety assessments of child carefacilities and if a problem is iden-tified, assist the child careprovider in correcting theconcern.
At the end of the 2002 fiscalyear the nurse consultants docu-mented 830 health and safetytrainings and educational sessionsfor providers. There were 393 newprovider contacts and visits madewith a total of 2,569 provider con-
tacts in 2002. A major focus hasbeen placed on the importance ofevery child having a medicalhome. Collaboration between thenurse consultants and ALL Kidsinsurance staff has proven veryeffective in getting the informa-tion to parents with uninsuredchildren.
Alabama Abstinence-OnlyEducation Program
The goal of the AlabamaAbstinence-Only EducationProgram, a five-year federallyfunded grant program whichbegan in 1998, is to reduce theoccurrence of sexual activityamong adolescents 17 years of ageand younger in Alabama. The pro-gram continued funding for 13community–based projects in2002. The 13 projects providedabstinence-only education in theschool setting to approximately34,000 participants 17 years of ageand younger in 24 of Alabama’s67 counties. Project activitieswere conducted in educationalfacilities, a public health carefacility and city/county/statesocial service organizations. Theprojects used the funds to provide:1) abstinence-only-until marriageeducation, 2) direct services and3) educational, recreational andpeer/adult mentor programs. Astatewide media campaign con-sisted of news releases, radio/tele-vision public service announce-ments, outdoor media (billboards),project enhancements/incentivesand a Web site. Over the five-yearduration of the grant period, pro-gram evaluators are conducting acomprehensive, intensive, longitu-dinal evaluation of each of thecommunity-based projects and theabstinence program as a whole.
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Alabama Community-BasedAbstinence-Only EducationProgram
Federal funding to expand andenhance current community-based abstinence-only educationimplementation for fiscal year2002-2004 was received on July 6,2001. The goal of the program isto reduce the proportion of ado-lescents who have engaged in pre-marital sexual activity, includingbut not limited to sexual inter-course; and reduce the incidenceof out-of-wedlock pregnanciesamong adolescents 12-18 years ofage, with a focus on predominant-ly adult role models, as well asadolescents age 12-18. Elevencommunity-based projects werealso conducted which included:abstinence seminars/abstinencecertification training conducted in15 select locations for adult rolemodels (community leaders/par-ents, faith-based individuals,teachers/counselors/educators,health care professionals) whohave contact with adolescents 12-18 years of age; abstinence-onlyeducation for adolescents age 12-18; abstinence-only education foradult role models; and a statewidemedia campaign which included aWeb site. Over the three-yearduration of the grant period, a pre-test and post-test will be adminis-tered to all program participantsto capture the data required toreport progress toward achievinggoal/objectives.
Child Death ReviewThe Alabama Child Death
Review System is making a differ-ence in the lives of Alabama’schildren. Child Death Reviewdata shows that in 1998 and 1999there were 500 infant/childdeaths per year that met criteriafor case review. New data showthat in both 2000 and 2001 thenumber of infant and child deathsthat met criteria has decreased to385 per year. While the Alabama
Child Death Review System prob-ably cannot be credited for all ofthis decrease, the system is a sig-nificant factor in saving lives.
The data mentioned wereavailable because of the publica-tion and distribution of the sys-tem’s first annual report. Thetwo-year report was published inFebruary 2002 and distributed tothe governor and the state legisla-ture, as well as to over 300 citi-zens and agencies in Alabama andthroughout the country. Thesecond annual report is beingdeveloped and is scheduled forpublication in February 2003.
The Child Death ReviewSystem program staff hosted twomajor conferences during calendaryear 2002. The first conferencetitled “Southeast RegionalConference on Child Fatalities,”was an informative conferencethat attracted over 300 attendeesfrom over 20 different states,including Alaska. High-profilenational experts in all areas ofchild death investigation wereattracted to either attend or pres-ent at the conference.
The second conference wasthe first of a planned, continuingprogram feature that will providetraining opportunities for all localteams. In the years to come, train-ing conferences will be offered ona statewide and regional basis.
Year 2002 marked the inaugu-ration of the capability to com-plete and submit data collectionforms online. Now teams can logonto the ACDRS Web site andcomplete all data forms, then sub-mit them directly into the data-base with the push of singlebutton.
Clinical ServicesThe department saw a slight
increase in the number of childhealth patients who were provid-ed services during the 2002 fiscalyear. A total of 39,742 patientswere provided services by county
health department staff. Thesepatients made a total of 85,423visits to local clinics.
Quality Assurance BranchThe Quality Assurance
Branch audited 11 county healthdepartment sites and four privateWIC contract agencies during cal-endar year 2002. The purpose ofthe audits is to meet federal man-dates for evaluation and to meas-ure specific components of clini-cal care against practice guide-lines.
ORAL HEALTH BRANCH
The Oral Health Branch con-tinued to promote communitywater fluoridation as a majorobjective during fiscal year 2002.Board resolutions or ordinanceswere established for the followingsystems: East Brewton, Flomaton,Ridge Road and Riverview. Uponapproval, these four water sys-tems became eligible for fundingto purchase new fluoridationequipment. The new fluoridationdollars were provided through agrant from the Centers forDisease Control and Preventionand were administered throughthe Oral Health Branch.Additionally, state funds wereprovided to qualifying water sys-tems that currently fluoridate,and needed financial assistance toupgrade inadequate or substan-dard equipment.
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Initiating water fluoridationduring 2002 were the BlountCounty Water System, ExcelWater System, New BrocktonWater Department and theWedowee Water, Sewer and GasBoard. With the addition of thesenew systems, the 129 fluoridatingsystems and 14 naturally fluori-dated systems serve an estimatedpopulation of 4,137,000 statewide.Other notable successes during2002 include: � An oral health component was
added to the Targeted CaseManagement for Medically atRisk and Maternity CareCoordination certification train-ing sessions with county healthdepartment social workers andnurses. Reimbursement for casemanagement with qualifyingclients needing dental serviceswas approved by the AlabamaMedicaid Agency.
� The WIC education model toprevent early childhood cariesin WIC children was also final-ized this year and added to thefiscal year 2003 State NutritionEducation Plan. The programshould serve as a nationalmodel for other states asAlabama WIC nutritionists pro-mote good dental health prac-tices through their nutritioneducation counseling.
� The Coffee County HealthDepartment began providingdental services through the newJerry Brunson Dental Clinic. Thedoors opened in June 2002 andbegan providing services on apart-time basis three days perweek. Four local dentists andtwo dental hygienists work part-time in the clinic providing serv-ices primarily for Medicaid chil-dren. The new clinic was a col-laborative effort of many agen-cies including the Coffee CountyFamily Services Center, theCoffee County Health Depart-ment, the state health depart-ment and other local entities.
� A new Public Health DentalAdvisory Committee wasformed and met for the firsttime in June 2002. The statedental director established thecommittee to seek guidance andrecommendations for futurepublic health dental initiatives.The committee consists of pub-lic and private practicing den-tists with a broad range ofexpertise and specialty trainingincluding pediatric dentistry,geriatric dentistry, children withspecial needs, mental healthdental programs, county healthdepartment dental clinics,school-based dental clinics,community health center clin-ics and others. The Chair of theCouncil on Dental Health, StateCommittee of Public Health,also serves on the committee.
� Alabama’s oral health programshowed improvement as anorganization titled Oral HealthAmerica provided report cardson the status of state oral healthprograms. Alabama improvedfrom a C- in 2001 to a C averageduring 2002. The national aver-age also improved to a C.
Dental Services/PreventiveProgram Activity45,279 Patient encounters
occurred in Coffee,Jefferson, Mobile andTuscaloosa county health department dental clinics.
29,052 Dental sealants were provided through Coffee,Jefferson and Tuscaloosacounty health depart-ment clinics.
1,371 Patient encountersoccurred in Auburn andOpelika City Schoolsdental clinics.
193 Dental sealants wereplaced through school-based programs.
15,000 K-6 grade studentsparticipated in the
school-based fluoridemouthrinse program.
15,000 K-6 grade studentsreceived free oral hygienekits and dental healtheducation instruction.
ADMINISTRATIONEpidemiology and DataManagement
The Epidemiology and DataManagement Branch has twomain purposes.
The first is to conduct popula-tion-based studies pertaining tothe health of mothers and chil-dren in Alabama. The second is totranslate these and other studiesinto information necessary forallocating resources and forreshaping programs to better pro-mote the health of women andchildren. The branch’s activitiesduring 2002, often conducted incollaboration with other AlabamaDepartment of Public Healthstaff, included the following :� Preparation of the Maternal and
Child Health Services BlockGrant annual report andapplication, which includedupdates regarding ongoingmaternal and child health needsassessment.
� Production of State of Alabama5-Year Maternal and ChildHealth Needs Assessment, areport for general readership.Hard copies have been distrib-uted in collaboration with theAlabama Chapter of the Marchof Dimes, and an electroniccopy is posted on the AlabamaDepartment of Public Health’sWeb site.
� Implementation of an electronicdata linkage project, in order tobetter estimate the proportionof newborns who are screenedfor certain metabolic and hema-tologic conditions, such asphenylketonuria and sickle celldisease.
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BUREAU OFHOME ANDCOMMUNITYSERVICES
In 2002, the Bureau of Home
and Community Services
continued to administer the
statewide Home Care Program
in partnership with county, area
and state level staff to fulfill its
mission - to ensure the delivery
of compassionate and effective
health care services in the
home and community while
striving to be consistently
responsive and innovative in
meeting the changing health
care needs of Alabama citizens.
This mission supports themission statement of theAlabama Department of PublicHealth – to serve the people inAlabama by assuring conditionsin which they can be healthy. Inthe fulfillment of its mission, theBureau of Home and CommunityServices works with a cooperativeeffort on all levels and phases ofprogram operation while at thesame time ensuring compliancewith federal and state regulationsand laws; federal, state and privatepayor home care program require-ments; and the department’s busi-ness policies and procedures.
Changes mandated by theBalanced Budget Act of 1997 con-tinued to have a tremendousimpact on all facets of the HomeCare Program. The major impactwas the implementation of theProspective Payment Systemwhich instituted a per episodepayment rate versus a per visitpayment rate. Many home careagencies throughout the countryhave not survived these changes.The Bureau of Home andCommunity Services has not onlysurvived, but has also been able tomaintain its agency values:integrity, competence, compas-sion, innovation, excellence, effec-tiveness and commitment. TheBureau of Home and CommunityServices operates within theframework of four divisions: theDivision of Billing and Support,the Division of Home CareService, the Division ofCommunity Services and theDivision of Quality Assurance/Performance Improvement andAccreditation.
HOME HEALTH PROGRAMThe Bureau of Home and
Community Services is aMedicare-certified home healthagency with 31 subunits. Qualityand compassionate home healthcare is provided to patients withMedicare, Medicaid, private insur-
ance and no payment source.Services available through homehealth include skilled nursing,home health aide services, med-ical social services, physical thera-py, occupational therapy andspeech therapy. All disciplineswork together as a team to meetthe patient’s health needs and pro-vide quality care. The homehealth aide services of the homehealth program are fully accredit-ed through the Home CareUniversity of the NationalAssociation for Home Care.Approximately 444,051 homehealth visits were made in 2002in efforts to assist many Alabamacitizens in reaching their optimalhealth goals.
LIFE CARE PROGRAMThe Bureau of Home and
Community Services through theLife Care Program is a statewidedirect service provider of homecare services. Life care servicesare provided under specialized fed-eral and state funded programs forthe disabled, poor and elderly, aswell as contracts with other payorsources. Life care services can alsobe purchased by individualsthrough an Options program. Lifecare patients are not required tobe homebound, and physicians areinvolved in the patient’s care asneeded or as required by specificprogram guidelines.
Services offered by the LifeCare Program include: homemak-er services, personal care services,skilled respite services, unskilledrespite services, companion serv-ices, adult day health services andnursing visits.
COMMUNITY SERVICESThe Division of Community
Services within the Bureau ofHome and Community Servicesfunctions as an administeringagency for the Elderly andDisabled Medicaid Waiver. Thisprogram is designed to offer an
alternative to nursing home carefor the elderly and/or disabledMedicaid recipient. Through pro-fessional case management servic-es, the client’s needs are assessedand an individualized plan of careis initiated. The plan of care willspecify the services that are need-ed by clients to remain at homeso long as their health and safetyare ensured. The client chooses adirect service provider to providespecified services. In fiscal year2002, Elderly/Disabled Waivercase managers provided morethan 85,000 hours of case man-agement and recruitment, andprovided a total of 1,132,566.21hours of Elderly/Disabled Waiver/Lifecare service.
BILLING AND SUPPORTBilling and reimbursement
activities are pivotal operationswithin the Bureau of Home andCommunity Services. Although acentralized billing system is uti-lized, billing and reimbursementactivities still require input fromall levels of Home Care Programstaff statewide. These activitiesinclude: the collection of billingdata at the point of service deliv-ery by visiting staff, billing datareviews by supervisory staff, dataentry by support staff, billing dataprocessing, submitting claims andposting reimbursements by theDivision of Billing and Supportfor Medicare, Medicaid and pri-vately insured patients. Fiscalyear 2001 saw the transition inMedicare billing from a per visitreimbursement system to a per
episode reimbursement systembased on a 60-day episode of care.
The analysis and evaluation ofHome Care Program patient cen-sus, service delivery and billingdata are essential aspects of pro-gram support. Information issummarized and provided toadministrative and managerialstaff to assist them with settinggoals and making decisions thatpromote quality of care and effi-ciency operations in the provisionof services to Alabama citizens.Information is also provided tothe fiscal intermediary for costreporting and auditing purposes incompliance with federal Medicareprogram laws.
QUALITY ASSURANCE AND PERFORMANCEIMPROVEMENT PROGRAM
The year 2002 marked the endof the third year of operations forthe Quality Assurance andPerformance ImprovementProgram. The goal of the programis to provide an organized, sys-tematic, and continuous approachfor quality care that will result inimproved patient outcomes, cus-tomer satisfaction, communica-tion between service providersand customers, clinical perform-ance, documentation, employeejob satisfaction, management per-formance and agency performancereviews. This goal enables all staffto expeditiously identify andresolve issues that may impactupon the quality of patient care.Service satisfaction surveys andquality improvement audits arethe principal evaluation toolsused to assess the service deliveryprocesses. One addition to theprogram is the utilization of thenew government reports that areobtained from OutcomeAssessment Information System(OASIS) data. Indicators of areasfor improvement are addressedthrough education and correctiveplanning.
EDUCATIONThe Bureau of Home and
Community Services continues tobe committed to the philosophyof an education plan for allemployees. An education planincludes orientation, continuingeducation and inservice trainingmanuals that have been devel-oped over the past five years forall disciplines and most job posi-tions. The bureau plans and pro-duces 12 hours of mandated con-tinuing education for the homehealth aides and the home atten-dants each year. Orientation andtraining are conducted at the locallevel by the area continuous qual-ity improvement/education coor-dinator under the direction of andusing manuals developed by theBureau of Home and CommunityServices. This process supportsthe philosophy that qualitypatient care is promoted by train-ing home care staff to perform jobtasks and to understand the oper-ation of the work environment.
HOME CARE COMPLIANCEPROGRAM
Since 1999, the Home CareCompliance Program has contin-ued to promote the prevention,detection and resolution ofinstances of conduct that do notconform to federal and state regu-lations, rules and laws, thedepartment’s ethical businesspractices, the Home CareProgram policies, and privatepayor’s requirements governingthe home care industry. Underthe direction of the complianceofficer, complaints are respondedto by conducting audits andinvestigations where noncompli-ance is suspected. The compli-ance officer works with the Officeof the General Counsel in resolv-ing compliance issues includingapplying internal disciplinaryactions and reporting to licensureboards for further actions.
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Health Care FacilitiesThe Division of Health Care
Facilities ensures that services ofhealth care providers are consis-tent with standards of qualityhealth care. Standards to ensurethat nursing homes are in compli-ance with Medicare and Medicaidrequirements for 2002 continue tobe enforced.
The federal government hasimplemented mandatory assess-ment tools in certified long termcare facilities and home healthagencies. For the first time, man-dates have required the compre-hensive collection of health caredata in a national repository.During the calendar year 2002 thestate of Alabama processed morethan 294,000 records from nursinghomes and home health agencies.Inspection processes and Medicarereimbursement are based on thisdata.
The division investigated 242abuse and neglect complaints.There were 163 allegations of resi-dent abuse and 79 allegations ofneglect. Long Term Care surveyed287 facilities and conducted 235follow-up visits, and six initialsurveys for certification purposes.
The Clinical LaboratoryImprovement Amendment orCLIA, is administered by theLaboratory Unit. This unit wasresponsible for monitoring 3,036CLIA federal certified laborato-ries, 293 state licensed independ-ent clinical and 55 state licensedphysiological laboratories in 2002.There were 233 CLIA recertifica-tions and 47 follow-up visits, 64initial and biennial licensure sur-veys for a total of 344 surveysconducted.
The Medicare Other Unit,responsible for certification andlicensure of home health agencies,hospices, hospitals, dialysis facili-ties, ambulatory surgical centers,rural health clinics, various typesof rehabilitation facilities,portable X-ray units, abortion
centers and sleep disorder centers,conducted 184 certification sur-veys, 78 follow-up visits, 41 com-plaint investigations, six hospitalvalidations, 34 initial certificationsurveys and 22 initial licensuresurveys.
The Nurse Aide RegistryProgram tracks 222 approvedtraining programs. The registryhas a total of 69,118 nurse aides.There are 30 nurse aides that areon specific time limited sanctionsand 769 that have been placed onthe abuse register permanently.
The assisted living facilitiesindustry continues to grow. As ofDecember 2002, there were 282regular licensed facilities totaling8,457 beds and 58 specialty carefacilities totaling 1,445 beds.
PROVIDER SERVICESThis division processes initial
licensure and certification appli-cations; maintains and distributesthe Provider Services Directory;and publishes, maintains and dis-tributes licensure rules. The divi-sion also processes bed and sta-tion requests, change of owner-ship applications and providesconsultation to health careproviders and the general publicrelating to health care licensurerequirements and certificationstandards and procedures.
In 2002 the division issued1,274 annual renewal license cer-tificates, 89 initial license certifi-cates, 66 change of ownershiplicense certificates and 417license status changes. Also, therewere 1,552 facilities and providerscertified to participate in theMedicare and Medicaid programs.During this year the divisionprocessed 90 initial certifications,44 change of ownership certifica-tions and 249 certificationchanges.
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BUREAU OFHEALTHPROVIDERSTANDARDS
The mission of the Bureau of
Health Provider Standards is to
ensure that services of licensed
and certified health care
facilities are provided in a
manner consistent with
standards which ensure access
to and quality of health care.
EMERGENCY MEDICALSERVICES
During 2002 the EmergencyMedical Services Division beganimplementation of new patientcare reporting software for use inthe prehospital setting. The soft-ware will replace the scannableforms which are now used forgathering of information on thetreatment of prehospital patientsthroughout Alabama. The system,when fully implemented, willresult in the saving of a great dealof time and money associatedwith Alabama’s current patientcare reporting system. Data willbe sent directly to the EMSDivision via a secure Internetconnection.
Also during 2002, Alabama’sPatient Treatment Protocols wereextensively revised and new pre-hospital drugs and invasive proce-dures were added to the treatmentregimen now available to
Alabama’s credentialed emer-gency medical technicians. Inorder to support the implementa-tion of these new drugs and pro-cedures, appropriate training mod-ules were developed and thestate’s emergency medical techni-cian credentialing process wasmodified. Education sessions forthe training of instructors wereconducted in numerous locationsacross the state by the regionalEMS agencies and EMS Divisionstaff to make emergency medicalservices training personnel awareof changes in protocols, drugs andprocedures.
MANAGED CARE COMPLIANCE
The Division of ManagedCare Compliance jointly regulateshealth maintenance organizations(HMOs) with the AlabamaDepartment of Insurance, certifiesorganizations performing utiliza-tion review activities for Alabamacitizens, and monitors selectedactivities of organizations andHMOs offering supplementalMedicare coverage. During the2002 fiscal year, the division’sresponsibilities for the depart-ment’s emergency/disasterresponse and preparedness pro-gram and the medical portion ofthe Chemical StockpileEmergency Preparedness Programwere transferred to the depart-ment’s new Center for EmergencyPreparedness.
Service Activities � For the year ending September
2002, there were 118,391enrollees in the four licensedHMOs in Alabama. The divi-sion performed a total of fourHMO surveys. One of these wasa comprehensive statutorysurvey, and the remainder werefocus surveys of selectedfunctions important to theregulatory program.
� The division received and inves-tigated 83 HMO enrollee mem-ber complaints and 24 providercomplaints.
� The division received andreviewed 295 requests for mate-rial modifications (changes topreviously approved HMO oper-ations, processes or documents).
� A total of six organizations,including two HMOs, offeredsupplemental Medicare cover-age through Medicare Selectproducts. A total of 172,159enrolled individuals werereported for the end of the fiscalyear.
� Three HMOs contracted withthe federal Centers for Medicareand Medicaid Services to pro-vide health care services toMedicare beneficiaries. Enroll-ment at the end of the fiscalyear was reported at 45,224.
� Through a combination ofrecognition of the AmericanAccreditation HealthCareCommission’s accreditation and Alabama requirements, the division certified 11 neworganizations to performutilization review activities inAlabama. Of those new organi-zations, five were accredited.Another 90 organizations wererecertified, representing 65URAC accredited organizationsand 25 Alabama certified organ-izations. One hundred fourteenagents were recognized as certi-fied at the end of the fiscal year.
Permitted ambulances inspected 376
Licensed transport services inspected 119
Advanced Life Support services permitted 294
Individual EMT licenses processed and issued 5,278
EMT licensure exams administered 2,193
EMT training institutions accredited 30
EMT training programs approved 34
Individual continuing education records reviewed and approved 2,592
EMS continuing education courses reviewed and approved 222
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X-RAY REGISTRATION AND COMPLIANCE� Registered 409 new tubes.� Inspected 2,534 X-ray tubes.� Inspected 152 mammography facilities.� Reviewed 217 radiation shielding plans.
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OFFICE OFRADIATIONCONTROL
The Office of Radiation Control
ensures the protection of the
public from excessive exposure
to ionizing radiation through a
variety of activities, including
registration and inspection of
equipment that produces ioniz-
ing radiation including particle
accelerators, of users of radioac-
tive material, environmental
monitoring, maintaining con-
tinuous radiological emergency
response capability, and public
and professional education
activities.
2002 Service Activities
RADIOACTIVE MATERIAL COMPLIANCE� Inspected 123 licenses for compliance to standards for usage of
radioactive materials.� Inspected 22 particle accelerator facilities.� Mailed 369 information packets on radon.
RADIOACTIVE MATERIAL LICENSING� Issued 25 specific licenses, 385 specific license amendments
and 47 particle accelerator registration amendments.
EMERGENCY PLANNING AND ENVIRONMENTALMONITORING� Participated in four nuclear plant emergency planning drills.� Participated in four hospital radiological emergency response drills. � Trained 265 radiological emergency response workers.� Responded to 56 incidents involving radioactive material.
BUREAU OF environmentalservices
The Bureau of Environmental
Services completed a statewide
computerization project in
2002. County environmental
offices were equipped with
state-of-the-art computer equip-
ment and a program specific
software package designed to
advance environmental
activities and save time.
Approximately 200 desktop
computers and related hardware
were purchased to equip county
environmentalist offices to run
the specially designed programs
that compile environmental
health data (food, lodging,
onsite sewage, solid waste and
administrative data). The use of
networked data within the
counties and throughout the
state will increase consistency
among programs and make
delivery of environmental
public health services more
efficient and customer friendly.
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TRAINING ANDENVIRONMENTALPROGRAMS
This unit serves as a facilita-tor for the Bureau of Environ-mental Services by providingstructured training through work-shops, seminars and conferencesfor bureau and county personnel.Each year the Training Unit coor-dinates the mandated BasicEnvironmentalist Training Coursewhich is designed to educatenewly hired public health envi-ronmentalists with the interpreta-tion of the rules and regulations.The Training Unit assisted withthe Annual Onsite SewageTreatment and DisposalConference. The conference (withmore than 300 individuals attend-ing from throughout the U.S.) wasorganized more than 12 years agoto educate industry, business andgovernmental professionals aboutonsite treatment and disposal con-cepts and practices. Two foodseminars were presented this year:the Gulf and South AtlanticStates Shellfish Conference heldin Point Clear and the FDA FoodSafety Seminar held in Mobile.Both workshops allowed individu-als from throughout the U.S. tocome together in an educationalarena and receive the skills neces-sary to perform their job duties.
FOOD, MILK AND LODGINGThe safety of food sold at
retail in Alabama and of foodprocessed in Alabama, other thanred meat and poultry, is theresponsibility of the environmen-tal staff of the county healthdepartments and of the Divisionof Food, Milk and Lodging at thecentral office. This division prom-ulgates rules and regulationsaffecting safety and sanitation offood, sanitation of lodging facili-ties in the state, and issues guide-lines for the inspection of prisonsand jails. The division also admin-isters and enforces sanitation
rules for milk and seafood. Thecounty health departments’ envi-ronmentalists enforce the rulesfor establishments such as restau-rants, grocery stores, conveniencestores, food manufacturing plants,tattoo facilities, hotels and camps.The division consists of threebranches: Food and Lodging, Milkand Seafood.
Food and Lodging BranchState law requires any facility
selling food to have a permit fromthe county health department.The Rules for Food EstablishmentSanitation require food facilitiesto be inspected up to four times ayear on a routine basis, dependingon the type of food being preparedand the amount of food prepara-tion steps involved. Hotels, campsand tattoo facilities are inspectedtwo times a year.
In 2002, county health depart-ments conducted 55,862 inspec-tions at these establishments; inaddition, 3,504 inspections weremade at temporary food establish-ments such as food booths at fairsand festivals and 5,294 inspec-tions were made at other loca-tions. County health departmentsinvestigated 3,855 complaintsfrom the public concerning foodor food establishments and issued8,395 notices.
“Body art” includes tattooing,body piercing and branding. In2002, county health departmentscompleted the first full year ofregulatory activities for this pro-gram, established in 2001. Underthe requirements for licensing thebody art facilities and issuing per-mits to the operators, 96 facilitieswere licensed and over 200 opera-tors were permitted. The countyhealth departments conducted158 inspections at body art facili-ties, issued 39 legal notices andinvestigated 50 complaints.
Milk Branch
Milk is the basic food for boththe general public and schoolchildren in Alabama. Milk prod-ucts such as ice cream and cheeseare also important dietary compo-nents for Alabamians. To helpensure the safety of milk andmilk products, sanitation inspec-tions are routinely conducted atdairy farms, milk processingplants, bulk milk haulers andbulk milk tankers. Milk is rou-tinely sampled and tested forcompliance with bacterial andchemical standards from the timeit leaves the cow until it is on thegrocery store shelf. When out-of-state plants ship dairy productsinto Alabama they are issued per-mits and their products are alsotested for compliance with bacter-ial and chemical standards.
In 2002, the Milk Branch con-ducted 43 pasteurization equip-ment tests; 478 dairy farm inspec-tions, 101 milk, frozen dessertand cheese plant inspections; and134 bulk milk hauler and tankerinspections.
The branch collected 1,923raw (before pasteurization) milksamples, 2,576 pasteurized milksamples, 354 milk samples to testfor aflatoxin, a carcinogenic mold,and collected 14 dairy products totest for the presence of Listeriamonocytegenes, a pathogenicmicroorganism.
A total of 24 milk tankerscontaining 1,460,070 pounds ofmilk (or 169,775 gallons) weredisposed of due to antibiotic con-tamination.
Seafood BranchWith high nutritional value,
seafood is increasingly featured asa component of a healthy diet.The seafood industry of Alabamaplays a vital role in the state andcoastal economies of Alabama.The Seafood Branch ensures thatseafood processing establishmentsmeet food safety standards andthat shellfish are harvested fromclean waters.
The seafood program isadministered by state health offi-cials and has five main functions:� Classification and sampling of
Alabama shellfish growingwaters;
� Shellfish processing plant per-mitting, inspection and sam-pling;
� Blue crab processing plant per-mitting, inspection and sam-pling;
� Shrimp, fish and specialty prod-ucts processing plant permit-ting, inspection and sampling;
� Special studies program for thebacterium Vibrio vulnificus andfor dinoflagellate organisms.
During 2002, 113 processingplants (shellfish, blue crab andother seafood) were issued per-mits, 286 inspections were con-ducted and 457 field visits toplants were made.
Eight bay oyster samples, 150bay water samples and 170 watersamples from processing estab-lishments were collected for bac-terial analysis. Mobile Bay wasordered closed to oyster harvest-ing three times for a total of 19days.
2002 Special Activities� The U.S. Food and Drug
Administration completed amandatory review of theSeafood Branch’s operations,which is done on a periodicbasis in order to ensure thatAlabama’s shellfish sanitationprogram meets federal stan-
dards. All program elementswere found in satisfactory com-pliance.
� The Seafood Branch provideddepartment representation onseveral committees, includingthe Interstate ShellfishSanitation Conference, theTechnical InteragencyCommittee, the EnvironmentalProtection Agency’s Gulf ofMexico Public Health Program,the Gulf of Mexico HarmfulAlgal Bloom Program and theMobile Bay National EstuaryProgram.
� The branch continued theHarmful Algal Bloom Programin which water samples fromMobile Bay are collected andanalyzed for the presence ofdinoflagellates; an additional 10sampling sites in the Gulf ofMexico have been established tobetter ensure early detection inboth recreational and shellfishharvesting waters.
� Special studies were conductedfor Vibrio vulnificus in which12 samples were collected andfor dinoflagellates in which 62samples were collected.
� The State Board of Healthadopted the Hazard AnalysisCritical Control Point require-ments of the U.S. Food andDrug Administration intoAlabama’s Shellfish SanitationRules effective May 6, 2002.
COMMUNITYENVIRONMENTALPROTECTIONSoil and Onsite Sewage
The division and branch car-ried out programs to protect thepublic health and water resourcesfrom onsite sewage disposal sys-tem pollution. These included themeetings of the Alabama OnsiteSewage Management Committee,a consortium of representatives ofgovernment, business and highereducation, chartered under theAlabama Non Point Source
38
Management Program, and itssub-committees; continued sup-port for training at the AlabamaOnsite Wastewater TrainingCenter at the University of WestAlabama; provided statewidetraining with system manufactur-ers at 12 seminars across Alabamafor county environmentalists andengineers on three approvedadvanced treatment systems;developed and printed a new sep-tic tank brochure for homeownereducation; and made progresstoward the drafting of new onsitesewage rules to replace the cur-rent Chapter 420-3-1, with severalmeetings attended by industryand regulatory personnel.
The department continued toprovide assistance in a number oftraining programs to includetraining conducted at theAlabama Onsite WastewaterTraining Center at the Universityof West Alabama and trainingaround the state for licensing ofseptic tank installers, manufac-turers and pumpers in coordina-tion with the Alabama OnsiteWastewater Board and AlabamaOnsite Wastewater Association.
Permits to install for onsite sewage systems 18,728Onsite sewage systems installed 18,320Training participants 828
Solid WasteThe Solid Waste Branch pro-
vides technical assistance tocounty environmentalists whowork in the solid waste, septagemanagement and vector controlprograms. Local activities includethe investigation of vector controlcomplaints and unauthorizeddumps, the permitting/inspectionof transfer stations, processingfacilities, garbage collection vehi-cles and the permitting andinspection of septage/grease landapplication sites. Many counties
also enforce local mandatorygarbage collection programs andreview applications for certifi-cates of exception for suchprograms.
Unauthorized dumps inspected 2,658Transfer/processing facilities inspected 91Septage management facility inspections 29Collection vehicles inspected 904Certificates of exceptionreviewed/issued 2,990Vector complaints investigated 733
Indoor Air Quality/Lead BranchThis branch provides informa-
tion on issues related to indoor airquality, lead-based paint and otherhazards. Regarding the lead haz-ard program, the primary focus ofthe branch is to enforce the regu-lations promulgated under theAlabama Lead Reduction Act of1997. These rules require thetraining and certification of indi-viduals and firms engaged in leadidentification, risk assessmentand remediation activities in pre-1978 housing and child-occupiedfacilities. Branch personnel alsoprovide support for the “AlabamaChildhood Lead PoisoningPrevention Project.” The projectidentifies children with elevatedblood levels through screening bylocal health departments and pri-vate physicians, provides environ-mental surveys to identifysources of lead hazards and rec-ommends methods to eradicatethe hazard. This program ensuresthat responsible authority under-takes proper medical treatment orcase management and that thereis prevention of lead poisoning inhomes containing lead hazards.
The Indoor Air Quality/LeadBranch has suspended onsite
investigations of indoor air quali-ty problems because of insuffi-cient funds. However, the IndoorAir Quality/Lead Branch remainsas the EPA designated stateindoor air contact providingadvisory service and printedmaterials for those who requestit, and providing indoor air quali-ty and asbestos information.
LEAD CONTRACTOR CERTIFICATION PROGRAM ACTIVITIES:Certification of firms to conduct lead-based paint activities 47Inspection of lead abatement project sites 50Visits to housing authorities for compliance assistance 53
CHILDHOOD LEAD POISONPREVENTION PROGRAM ACTIVITIES:Lead outreach (inspections andawareness) workshops 50Inspection of homes with confirmedcases of children with high blood lead levels 116Environmental lead sampling of dust,soil, water and paint chips (approximately) 2,500
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The Office of Professional andSupport Services supported anumber of important departmentinitiatives during 2002. Staffworked with Health Administra-tion and various other departmentunits in developing and imple-menting new programs and initia-tives such as the Center forEmergency Preparedness and aplan for compliance with theHealth Insurance Portability andAccountability Act (HIPAA).
Staff continued to providemanagerial support to the CDC-funded project, “Public HealthPreparedness and Response toBioterrorism,” coordinating meet-ings of the department’s bioterror-ism task force and administeringthe contract with the Universityof Alabama at Birmingham. Staffparticipated in the intense plan-ning and coordination necessitat-ed by the 9/11 attack and theanthrax scare. Further senioroffice staff worked with the assis-tant state health officer for diseasecontrol and prevention to developthe state’s expanded public healthpreparedness and response planmade possible through a largeincrease in CDC grant funds.
Several other units in theOffice of Professional and SupportServices continued to provideleadership in the WorkforceDevelopment project calledPHASES (Public Health ofAlabama Staff Enrichment).PHASES encompasses a variety ofopportunities for public healthworkers, not only through train-ing but through internal andexternal internships and job shad-owing experiences. TheManagement Support Unit con-tinued to facilitate the depart-ment’s Workforce DevelopmentCommittee, and worked closelywith other department units suchas Health Administration, VideoCommunications andCommunications and SocialMarketing as well as schools of
public health at Tulane Univer-sity and the University ofAlabama at Birmingham and thestate health departments inArkansas, Louisiana andMississippi. Highlights of accom-plishments during 2002 includedpresentation of the first two train-ing videos in the series, “Orienta-tion to the Essentials of PublicHealth” and “CommunityPartnerships and Perspectives,” toover 1,500 department staff and ofthe first two levels in a web-basedmanagement course series.
MANAGEMENT SUPPORTUNIT
The Management SupportUnit supported the departmentthrough management of theRecords Disposition Authority,the fee manual, grant resourcedevelopment and grant review,and the Policy Clearinghouse.Staff also participated in theadministration of the depart-ment’s Institutional ReviewBoard. In addition, staff participat-ed in development of the depart-ment’s HIPAA privacy policy aswell as development of trainingfor the HIPAA regulations. Staff ofthe Management Support Unitworked closely with the TrainingUnit to coordinate trainingactivities.
TRAINING UNITEven though the department
training coordinator positionremained vacant for most of 2002following the retirement of theincumbent, collaborative workcontinued with interdepartmentaland intradepartmental groups toprovide quality education for allemployees. Staff in the Nursingand Management Support unitsenabled training services to con-tinue in the absence of a dedicat-ed coordinator. Workshops wereorganized and managed throughAuburn University atMontgomery, Alabama State
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OFFICE OFPROFESSIONALAND SUPPORTSERVICES
University, Emory University,UAB, the State PersonnelDepartment, and theTechnaCenter, as well as privatecompanies. Eighteen live work-shops were produced and present-ed and 20 distance-based/satellitelearning conferences were organ-ized. Distance learning opportuni-ties were provided through satel-lite each month and continuingeducation credits awarded toappropriate professionals. TheAlabama Department of PublicHealth training calendar contin-ued to be published as an efficientmarketing tool for keeping staffaware of training opportunities.Training and nursing staffassumed statewide responsibilityfor cardiopulmonary resuscitationtraining for home health andclinic staff.
PHARMACY UNIT The Public Health Pharmacy
director participates on thedepartment’s bioterrorism taskforce and coordinates develop-ment of Alabama’s procedures forordering and processing theNational PharmaceuticalStockpile, a special stockpile ofdrugs and supplies which wouldbe shipped by the federal govern-ment to the state if indicated fol-lowing any terrorism event. Over700 pharmacists across the statehave volunteered to help during acrisis and approximately 120 ofthem received training in 2002.CDC completed two site visits in2002 and has given Alabama’sNational PharmaceuticalStockpile program approval.
The Pharmacy Unit coordi-nates state agencies accessing theMinnesota Multi-StateContracting Alliance. Thealliance is a voluntary group pur-chasing organization operated bythe State of Minnesota servinggovernment-based health carefacilities. Currently the allianceserves 39 states. This alliance
allows the State of Alabama topurchase medications and clinicsupplies at substantially reducedprices over what can normally beobtained by a state government.
Consultation and assistanceare provided in the areas of osteo-porosis, cardiovascular disease,bioterrorism, diabetes, arthritisand home health. Assistance isalso provided in the reschedulingof drugs and the ControlledSubstances List.
The unit continues to consultand coordinate with all publichealth units, including countyhealth departments and otheragencies on medication-relatedand pharmacy-related activities.These activities include, but werenot limited to distribution issues,clinical information, drug sched-uling, purchasing and legal issues.
The Pharmacy Unit coordi-nates obtaining drugs for indigentpatients. Assistance is also pro-vided in coordinating professionaleducation satellite programs fornurses, pharmacists and physi-cians. The unit also providesmedication reviews for stateemployees which enhance theirknowledge about their medica-tions.
In addition the unit providesinternship experiences to pharma-cy students, hosting two to threestudents each year from AuburnUniversity and SamfordUniversity.
NUTRITION AND PHYSICALACTIVITY UNIT
The mission of the Nutritionand Physical Activity Unit is toimplement nutrition and physicalactivity interventions and pro-mote policy and environmental
initiatives to increase the numberof Alabamians who maintain ahealthy weight and eat a balanceddiet. To fulfill the mission theunit works with various groups.
In collaboration with theOsteoporosis Task Force, educa-tional materials were developed,limited screenings were provided,and the state plan was coordinat-ed and implemented. Screeningswere done at health fairs and con-ferences, and an intra-agency proj-ect between the health depart-ment and mental health agencyscreening residents at each men-tal health facility resulted inpatients’ medicines and physicalactivity levels being reviewed.
Educational presentations onosteoporosis prevention were alsoprovided to students, adults,health professionals, and seniorcitizens. Prevention messageswere also provided on televisiontalk shows and through radiospots. Two presentations weredone at Auburn University atMontgomery, Camp Seale Harris,and various schools and healthfairs.
Participation in the StateDiabetes Council resulted in coor-dinating the group’s annual plan.Diabetes educational presenta-tions were given at various sitesand 1,600 Plate Planner educa-tional handouts were distributedto assist in diabetes managementand weight loss.
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Planning, coordinating andimplementing environmentalnutrition and physical activityinitiatives for the AlabamaCardiovascular Health Programresulted in completing a survey ofrestaurants in rural West Alabamafor availability of heart healthyitems; implementing the“Physical Activity EnhancementProject” in five schools with theDepartment of Education; coordi-nating screening of school chil-dren to identify rates of over-weight youth among ages 9through 14 in five schools; facili-tating and participating in a satel-lite program: ReducingCardiovascular Disease RiskFactors in Youth: PhysicalActivity in Schools; and imple-menting intervention for the car-diovascular health secondary pre-vention project with AlabamaQuality Assurance Foundation.
The Food Stamps’ NutritionEducation Plan grant permitteddietitians to work with patientsat the Limestone County HealthDepartment, schools meeting theincome criteria, local and statemedia outlets, and with commu-nity nutrition related programs,such as farmers’ markets special-izing in benefits for senior citi-zens and elementary school chil-dren. As the state 5-A-Day coordi-nator, assistance was given tocommunities in three areas ofWilcox County to establish farm-ers’ markets, with the purpose ofincreasing citizen consumption offruits and vegetables and provid-ing local growers with sales out-lets. Nutrition brochures andposters, food safety literature, andan information sheet on variousstatewide food pantries and soupkitchens were distributed.Working with the AlabamaCoalition Against Hunger, variouscoalitions and community proj-ects provided an avenue to pro-mote healthy eating and physicalactivity.
To promote physical activityfor all ages, exercise videotapeswere shared with area agencies onaging, serving 23 counties.Brochures, bookmarks and pam-phlets were provided to farmers’markets in Montgomery,Huntsville and Tuscaloosa. Workwith other agencies includingwith the National Park ServiceRivers and Trails, AlabamaDepartment of Transportation’sWalk to School Program andWalking School Bus, Governor’sCommission on Physical Fitness,and various community healthprograms has afforded opportuni-ties to increase activity.Motivational signage for walkingtrails has been implemented inseveral sites.
The unit serves as a resourcefor other health professionals,educators and students, and thegeneral public. Planning andassisting in activities with theHealthy Alabama Nutrition andFitness Coalition; developing andimplementing the AlabamaIntegrated Nutrition Programwith partners across AlabamaUSDA food and nutrition pro-grams; collaboration with theAlabama Pediatric Association’sNutrition and Fitness subcommit-tee; and serving as a preceptor fordietetic interns are examples.
The Food and Fitness programcontinues to promote sound guid-ance to employees on strategiesfor achieving and maintaining ahealthy weight and lifestyle, suchas walking competitions. Thisyear members walked miles thatequaled walking the circumfer-ence of Alabama and walked fromMontgomery to Texas.
NURSING UNITIn 2002, the Nursing Unit
continued to work with state,area and local health departmentsto assure the provision of highquality nursing services toAlabama citizens. The unit per-
forms as a liaison to the AlabamaBoard of Nursing to ensure com-pliance with nursing licensurerequirements, and works in col-laboration with the department’sClinic Protocol Committee tomaintain program and profession-al nursing standards through peri-odic updates and clarification ofnursing protocols. The unit pro-vides representatives to workwith other departmental pro-grams and committees to main-tain professional standards ofnursing care. The unit is availableto offer guidance and support forpublic health nursing as the roleof public health evolves andchanges to meet the needs of thepublic. The unit works with othergovernment agencies, professionalorganizations and academic insti-tutions to provide informationand resources for the promotionof public health in Alabama.
The CardiopulmonaryResuscitation Program, previouslymaintained by Public Health Area1, is now housed in this unit.This program provides a valuablesource for certification for CPR asneeded by health care profession-als. The program provided train-ing for 1,507 CPR providers andrecertified 90 instructors.
The unit serves as a providerof continuing education, withapproval through the AlabamaBoard of Nursing and theAlabama State Nurses’Association, for public healthnurses by reviewing and approv-ing workshops, teleconferencesand other programs for continuingeducation credit. In 2002, 37 con-tinuing education activities wereapproved through this unit.
The unit has served as aresource for the nursing compo-nent in the development ofdepartmental bioterrorism planssuch as the smallpox initiativeplan and National PharmaceuticalStockpile plan.
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SOCIAL WORK UNITThe Social Work Unit worked
to promote and support soundprofessional practice. Working inconjunction with all public healthdisciplines, the unit participatedin Bioterrorism Response plan-ning, and spearheaded the StateSuicide Prevention Plan. Withcollaborative efforts of programconsultants, area social workdirectors, managers and countystaff, case management/care coor-dination services were provided tocitizens of all ages. Servicesincluded Plan first and TeenFamily Planning, Medically atRisk Case Management, Childrenwith Special Health Care Needs,Elderly and Disabled Waiver CaseManagement, Home DeliveredMeals, Home Health MedicalSocial Services, as well as someHIV/AIDS Case Management, theBreast and Cervical Cancer CaseManagement Service, andMaternity Case Management.
Responsible for assuring thata system of professional publichealth social work practice wasavailable across the state, the unitworked in conjunction with othersupervisory staff and the AlabamaBoard of Social Work Examinersto ensure that professional stan-dards of practice were main-tained. Inservice training for pro-fessional development was consis-tently offered with contact hoursprovided to assist staff in main-taining licensure and upgradingprofessional practice skills. Theunit also actively participated innational, state and local organiza-tions, such as the Association ofState and Territorial PublicHealth Social Workers, and theSuicide Prevention AdvocacyNetwork. The development ofpublic health social work initia-tives and collaboration buildingenhances state and local publichealth social work standards aswell as effecting the nation’s pub-lic health.
The Care CoordinationElectronic Computer System wasimplemented to capture all PublicHealth Social Work program doc-umentation and reimbursementrequests. This new system pro-vides an opportunity for increasedaccuracy and complies withHIPAA standards, thus providingefficiency for public health socialwork staff across the state. ThePublic Health Social Work webpage was designed to increase thegeneral public’s understanding ofPublic Health Social Work servic-es and to enhance efforts torecruit new staff. Prospectiveemployees are able to obtain anapplication for employmentonline. The site continues to offervisitors an opportunity to reviewthe Public Health Social WorkGoals and Methods, PublicHealth Social Work program serv-ice options, and to contact areasocial work directors and centraloffice staff regarding questionsand employment opportunities.Staff members visit ClinicalSocial Work Examiner-accreditedschools of social work throughoutthe state to recruit quality staff.
OFFICE OF WOMEN’SHEALTH
The Alabama Legislaturepassed Act 2002-141, which wassigned into law on May 12, 2002,creating the Office of Women’sHealth within the AlabamaDepartment of Public Health. Theoffice was created to be an advo-cate for women’s health issues.Purposes of the office as describedin the legislation are as follows:� To educate the public and be an
advocate for women’s health byestablishing appropriate forumsto educate the public regardingwomen’s health, with anemphasis on preventive healthand healthy lifestyles.
� To assist the state health officerin identifying, coordinating andestablishing priorities for
programs, services andresources which the stateshould provide for women’shealth issues and concerns.
� To serve as a clearinghouse andresource for information regard-ing women’s health data, servic-es and programs that addresswomen’s health issues.
� To provide an annual report onthe status of women’s healthand activities of the office to thegovernor and the legislature.
The law provides for anadvisory committee for the office.This steering committee consistsof three physicians appointed bythe Medical Association of theState of Alabama; three nursesappointed by the Alabama StateNurses’ Association; three phar-macists appointed by the AlabamaPharmaceutical Association; threeemployers appointed by theBusiness Council of Alabama;three consumers, one appointedby the governor, one appointed bythe lieutenant governor, and oneappointed by the speaker of thehouse; three members appointedby the Alabama HospitalAssociation; and three registereddietitians appointed by theAlabama Dietetic Association.The state health officerannounced the director for theoffice in August. The SteeringCommittee held its inauguralmeeting on Dec. 13, 2002.
The Office of Women’s Healthnow serves as the department’spoint of contact for the U.S.Department of Health andHuman Services, Region IV Officeof Women’s Health, relieving theNursing Unit of this responsibili-ty. The activities of the YoungWomen’s Health Project, whichbegan under the Nursing Unit,will be continued as the Office ofWomen’s Health continues to par-ticipate in new and ongoing ini-tiatives to promote women’shealth.
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At the end of fiscal year2002, 52,495 children wereenrolled in ALL Kids, whichreflected a net increase of 13,255(33 percent) children from theend of the last fiscal year. Inaddition to surpassing its enroll-ment goal, the program madeseveral important changes in itsenrollment unit, eligibility rulesand benefit structure. Furtheraccomplishments were also real-ized in the areas of outreach andgeneral program administration.
One of the most importantchanges to the enrollment unitwas the addition of threeMedicaid workers (two enroll-ment workers and a secretary) toprocess Medicaid applicationsreferred from ALL Kids for chil-dren in 25 counties in Alabama.
During fiscal year 2002, thethree-month waiting periodbefore enrollment was droppedfor children within the followinggroups:■1 Children whose current
individual coverage wasterminated voluntarily;
■2 Children whose currentCOBRA coverage wasterminated voluntarily; and
■3 Children whose currentAlabama Child CaringFoundation coverage wasterminated voluntarily.
These changes were made eitherdue to the extremely high cost ofthe coverage or the limited bene-fits provided by the coverage.Also during the past year achange was made in the eligibili-ty rules to allow for enrollmentin ALL Kids for children whohave exhausted the lifetime ben-efits for their current coverageand meet the other ALL Kids eli-gibility criteria.
The program continued torefine outreach efforts that hadproven successful in the past andto structure new endeavors.Outreach continued statewidethrough the public schools
utilizing partnerships withschool nurses. The program alsocontinued to partner with coun-ty health departments, theCovering Alabama Kids project,and all interested civic organiza-tions in a variety of activities.An enormous media campaignwas held across the state utiliz-ing paid television and radiospots. Regional consultantswithin each public health areawere employed and efforts werefocused on hard-to-reach or spe-cialized populations.Applications and other materialswere translated into Spanish andthe program continued toemploy bilingual staff.
During fiscal year 2002,CHIP was awarded two specialgrants; one from the RobertWood Johnson Foundation(Supporting Families afterWelfare Reform grant) and onefrom the federal HealthResources and ServicesAdministration (a State Planninggrant). Supporting Families afterWelfare Reform is a two-yeargrant which will support betterautomated communicationbetween the AlabamaDepartment of Public Healthand the Alabama MedicaidAgency as well as assist with thetransition of the Medicaid ForLow Income Families programfrom the Department of HumanResources to the AlabamaMedicaid Agency. The StatePlanning grant will allow thestate to determine the size anddemographics of the uninsuredpopulation in Alabama on bothstate and sub-state levels, as wellas promote the study of healthinsurance coverage options forthe uninsured.
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OFFICE OFCHILDREN’SHEALTH INSURANCE
The Office of Children’s Health
Insurance was designed to
decrease the number of children
in the state who are without
health insurance.
To better monitor the pro-gram, CHIP continued to contractwith the University of Alabamaat Birmingham to conduct threesurveys: ■1 New Enrollee Survey, ■2 Continuing Enrollee Survey,
and■3 Disenrollee Survey. UAB analyzed the results of allthree surveys. The results indicat-ed that ALL Kids was successfulin each of the areas surveyed:high degree of family satisfaction,improved access to health careand improved child health status.
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MINORITY HEALTHA comprehensive description
on the health status of Alabama’smulti-cultural population was themajor focus of the MinorityHealth Section in 2002. Alabama’sdiverse population is one of itsgreatest strengths and resources.The decade from 1990 to 2000 pro-duced significant changes in thecultural diversity of Alabama’spopulation. In January 2002, theMinority Health Section produceda brochure, “Our Multi-CulturalPopulation: A Resource and AHealthcare Challenge,” to provideAlabamians with a document thatdescribes the state’s four racial andethnic groups and their healthconcerns, behaviors and attitudesabout health care.
In collaboration with theAlabama Department of PublicHealth Center for HealthStatistics, the Minority HealthSection contributed to the publica-tion of a report demonstrating thedisparities in health outcomes ofAlabama’s racial and ethnic popu-lations. This report, “Atlas ofRacial Disparities in Mortality,”was produced in June 2002, by theCenter for Health Statistics and isthe first publication analyzing themortality disparities for Alabama.
Over 2,000 copies of this docu-ment were distributed to commu-nity-based organizations, medicalfacilities, health care providers,academic institutions, faith organ-izations and concerned citizens.Elimination of disparities inhealth outcomes is a major goal ofthe federal planning document,“Healthy People 2010,” and theAlabama Department of PublicHealth. The atlas publication wasproduced to increase awareness ofracial disparities in mortality andwas designed for a variety ofaudiences.
The Minority Health Sectioncontinues partnering with com-munity-based organizations andacademic institutions in securinggrant funds for activities toachieve parity in health outcomesamong Alabamians. During 2002several proposals were funded toaddress disparities in cancer,teenage pregnancy, syphilis, andlanguage interpretation for limitedEnglish proficiency residents. Theaddition of an employee to theMinority Health staff provides aresource to community organiza-tions in developing effective out-reach in health care activities tothe state’s growing Latinopopulation.
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OFFICE OFPRIMARY CAREAND RURALHEALTH
The Office of Primary Care and
Rural Health Development
facilitates and participates in
activities to improve accessibili-
ty of primary care and promotes
the health status and attain-
ment of stable health care
services for rural residents with
special concern for minority
and other medically
underserved populations.
PRIMARY CAREThe Primary Care section
received a $125,000 grant for theState Loan Repayment Programfrom the National Health ServiceCorps. This program providesgrants ranging from $20,000 to$70,000 to offset educationalloans for primary care physiciansand general or pediatric dentistswho will commit to practicing incritical health care shortage areasof the state. Participating localhealth care organizations hire theprofessionals and provide 50 per-cent of the award, with theremaining 50 percent comingfrom the federal grant allocation.
The Primary Care Section col-lected and analyzed data to desig-nate as Health ProfessionalShortage Areas, or HPSAs, thosecommunities satisfying federalcriteria. Assessments are per-formed in designating a shortageof primary care physicians, den-tists and mental health workers.A HPSA designation qualifies thecommunity for several grants andprograms to increase health careaccess. Sixty-two of Alabama’s 67counties are now designated asprimary care physician HPSAswith information on 22 of thesecounties being updated during theyear. Elimination of these HPSAdesignations would require anadditional 238 physiciansstrategically placed in Alabamacommunities for an estimated 1.8million underserved residents. All67 counties are designated as den-tal health HPSAs for the low-income population. Essentially,the entire state has been consid-ered deficient in mental healthcare workers through designationof 22 Mental Health CatchmentAreas. Data were collected earlierthis year to update these 22 catch-ment areas as Mental HealthHPSAs and will be submitted forupdated designations to theFederal Division of ShortageDesignation.
Applications for assistancefrom the National Health ServiceCorps to recruit health profes-sionals to Alabama communitiesresulted in 88 approvals this year.Efforts to recruit and fill theseapproved slots are underwaythrough joint activities with thePrimary Care Section and recruit-ing communities. Historically,only 15 percent of approved slotshave been filled, primarilybecause of limited financial assis-tance available from the Corps.However, significant fundingincreases for this federal programbring encouragement that thispercentage will be higher thisyear.
A demonstration programdeveloped through Primary Careand funded by the Southern RuralAccess Project provides a modelfor aggressively recruiting healthprofessionals to live and work inAlabama’s rural communities.The program is administeredthrough the state’s Area HealthEducation Centers with technicalsupport from the Primary CareSection. Activities include organ-izing a community’s civic leadersand its health institution leadersin collaborative activities to bothrecruit and retain health workersin the community.
RURAL HEALTHThe J-1 Physician Waiver
Program remains the principalsource of recruitment of primarycare and mental health workersfor many Alabama communities.Presently, 81 waiver physiciansare practicing in the state with 27applications being received during2002. Approximately 1,250 con-sultations were provided on theprogram to community level lead-ers, health care employers, physi-cian recruiters, and immigrationofficials. Alabama’s rural healthWeb site received over 9,000transactions on the program. Thestate-administered J-1 Program’s
guidelines are continuouslyreviewed for appropriate changes.Recent federal legislation hasincreased the number of allottedplacements in the state programfrom 20 per year to 30. While theprogram’s priority is placement ofprimary care physicians, its guide-lines were amended during theyear to include allowing each yearup to 10 physician placements toprovide sub-specialty care.
Work continued on buildinghealth technology “bridges”between tertiary/specialty healthcare resources in urban areas andmedically underserved residentsin rural, remote areas. Successfulinitiatives included a projectdemonstrating the use of remotesurveillance technology to pro-vide around-the-clock monitoringcapability for elderly, homeboundpatients, and delivering mentalhealth services through tele-health psychiatric consultations.Rural Health is functioning as aninformation clearinghouse forapplication of emerging healthcare technologies and their poten-tial for serving rural Alabamians.A ListServe has been establishedto provide communication linkswith organizations and individu-als in the state interested inmaintaining current informationon this topic.
Two federal grant applicationswere submitted and approved dur-ing the year to strengthen small,rural hospitals and improvehealth care in their communities.A continuation application wassubmitted for the Medicare RuralHospital Flexibility Program incollaboration with the AlabamaHospital Association and awarded$430,000. This grant programfocuses on the smaller, rural hos-pitals. Grant funds can be used toexplore the feasibility of convert-ing to a federally designatedCritical Access Hospital, conduct-ing community needs assess-ments, developing health care
47
networks, integrating EmergencyMedical Services in communities,and improving the quality of carebeing delivered. Eighteen hospi-tals were approved for fundingthis year by the Alabama RuralHospital Flex Grant Committeewhich evaluates and approvesfunding proposals from prospec-tive hospital grantees.
The other federal grant appli-cation submitted was for therecently enacted Small HospitalImprovement Program. Federalgrant funds are made availablethrough this program for all ruralhospitals in a state having lessthan 50 beds operational. Theapplication process was conduct-ed in a joint educational process
with the Alabama HospitalAssociation and identified 27 eli-gible hospitals in the state. Theapplication resulted in an awardto the state of $276,830. Eligiblehospitals may use these grantfunds to update financial opera-tions for Prospective PaymentSystems, plan and implementHIPAA requirements, reducemedical errors, and improve qual-ity of care.
Grant opportunities andhealth related community dataare continuously being requestedfrom staff. A grant notificationprocess has been operationalthrough mail and fax. In conjunc-tion with the Alabama RuralHealth Association, a ListServe is
now under development and pro-vides notices on grant opportuni-ties of interest to community-based organizations in rural com-munities. More extensive supportis being planned for those appli-cants interested in applying forfunding through the federal RuralHealth Outreach Program. Thiswill include a statewide confer-ence call hosted by Rural Healthto offer technical assistance forapplicants and identify potentialcollaborators for outreach grantapplications. During the year 160organizations and individualsreceived routine communicationsof notices for 233 grantopportunities.
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Center For HealthStatistics
The Center for HealthStatistics operates the vitalrecords system and collects andtabulates health-related statisticaldata for the state of Alabama. Thecenter files, stores and issues cer-tified copies of vital recordsincluding birth, death, marriageand divorce certificates for eventsthat occur in Alabama. An auto-mated vital records system calledViSION or Vital Statistics ImageOriented Network allows vitalrecords to be issued through all 67county health departments.Customers can obtain most vitalrecords from the Center forHealth Statistics through theircounty health department in 30minutes or less. Records may alsobe obtained through the mail inabout 10 to 14 days.
The Statistical AnalysisDivision in the center conductsstudies and provides analysis ofhealth data for public health poli-cy and surveillance. Staff preparevarious statistical analyses ofnatality, pregnancy, general mor-tality, infant mortality, causes ofdeath, marriage, divorce, andother demographic and health-related data for the state and itsgeographic subdivisions. Thisinformation is distributed throughnumerous publications, reports,presentations, special tabulations,the department’s Web site and bytelephone to the public, newsmedia, researchers, government orprivate agencies, and various unitswithin the department.
2002 Service Activities� Issued more than 415,000 certi-
fied copies of vital records withmore than 271,000 of theserecords requested through localhealth departments.
� Coded, keyed and scanned morethan 175,000 new vital recordsinto the vital records database.
� Prepared 2,300 new birth
certificates after adoption and3,300 after paternity determina-tion; filed over 325 delayed birthcertificates; amended more than4,500 birth certificates and over1,400 death certificates.
� Processed more than 500requests for copies of informa-tion from sealed files due to achange in the law which allowsadult adoptees to obtain copies oftheir original birth certificates.
� Filed more than 8,900 paternityaffidavit forms which fatherssigned to acknowledge theirlegal responsibilities when theywere not married to the motherof the child.
� Received more than 99 percentof birth certificate data throughelectronic transmission usingthe Electronic Birth Certificatesoftware installed in 67 hospi-tals throughout the state.
� Made more than 500 visits tocounty health departments andvital record providers such asfuneral directors, hospital andnursing home staff, county coro-ners, medical examiners, physi-cians and probate judges.
� Provided training to more than850 vital records providers at 11locations across the state.
� Keyed electronic index recordsfor 130,000 death records and113,000 marriage records.
� Received more than 81,000phone calls through the auto-mated telephone system fromcustomers requesting vitalrecords information aboutobtaining Alabama birth, death,marriage and divorce certifi-cates. The system providesrecorded information 24 hours aday.
� Conducted studies and analyzedvital events data for geographicareas throughout the state.
� Produced four volumes of statewidedata, tables, figures and graphs onpregnancy, birth, infant mortality,causes of death, marriage anddivorce trends.
BUREAU OF informationservices
The Bureau of Information
Services provides vital record
functions and statistical analy-
sis of health data through the
Center for Health Statistics. It
also includes the Computer
Systems Center, which houses
data operations, systems and
programming, technical support
and the support desk.
49
adph
� Provided health-related vitalstatistics information andexpertise to the public; thenews media; governmental, edu-cational and private agencies;and other offices in the healthdepartment.
� Surveyed new mothers for thePregnancy Risk AssessmentMonitoring System (PRAMS) (agrant from the Centers forDisease Control and Preventionto study factors related to preg-nancy and infant health inAlabama).
� Presented professional papers atthe PRAMS National Meeting,the Maternal and Child HealthEpidemiology Annual Meeting,and the Southern DemographicAssociation Annual Meeting.
� Produced the special reports“Homicide: Higher Risk for
Black and Other Races,”“Diabetes in Alabama,” and the“Alabama Maternal and ChildHealth Chart Book.” Producedthe monograph Alabama Atlasof Racial Disparities inMortality in cooperation withthe Minority Health Section ofthe ADPH Office of PrimaryCare and Rural HealthDevelopment. Produced the“Alabama Health Data Sheet”and the monograph Dying inAlabama: Leading Causes andFactors in cooperation with theCenter for DemographicResearch of Auburn Universityat Montgomery.
� Presented data at the AlabamaTeen Pregnancy PreventionConference and the AlabamaCooperative Extension Systems’Diabetes Workshop.
� Maintained a Center for HealthStatistics Web site to provideInternet access to statisticalreports, tables, maps and graphs,and to provide information forobtaining vital records inAlabama. Vital records formsand instructions are available tobe downloaded.
� Responded to more than 1,000requests for statistical informa-tion and analytical assistance.
� Provided Alabama vital eventsdata to the National Center forHealth Statistics for inclusionin national statistics.
� Provided computerized birthcertificate data to the SocialSecurity Administration to ini-tiate Social Security numbersfor over 59,000 newborns.
4,486,580 RATE/PERCENT60,295 13.4 (Per 1,000 population)8,993 28.3 (Per 1,000 females aged 10-19 years)5,815 9.6 (Percent of all live births)
20,739 34.4 (Percent of all live births)45,196 10.1 (Per 1,000 population)45,052 10.0 (Per 1,000 population)24,159 5.4 (Per 1,000 population)11,852 12.2 (Per 1,000 females aged 15-44 years)
567 9.4 (Per 1,000 live births)355 5.8 (Per 1,000 live births)212 3.5 (Per 1,000 live births)
ESTIMATED POPULATIONBirths
Births to TeenagersLow Weight Births
Births to Unmarried WomenDeaths
MarriagesDivorces
Induced Terminations of PregnanciesInfant Deaths
Neonatal DeathsPost Neonatal Deaths
VITAL STATISTICS RECORDS 2001
2001RANK NUMBER RATE1
45,1961 13,117 293.72 9,783 218.13 2,983 66.54 2,196 48.9
5 2,187 48.76 1,339 29.87 1,100 24.58 1,095 24.4
9 978 21.810 770 17.2
9,648
CAUSE OF DEATHTotal All CausesDiseases of the HeartMalignant NeoplasmsCerebrovascular DiseasesChronic Lower
Respiratory DiseasesAccidentsDiabetes MellitusAlzheimer’s DiseaseInfluenza and PneumoniaNephritis, Nephrotic Syndrome
& NephrosisSepticemiaAll Other Causes, Residual
ALABAMA’S LEADING CAUSES OF DEATH – 2001 AND 20001
1 Rate is per 100,000 population.
CAUSE OF DEATHTotal All CausesDiseases of the HeartMalignant NeoplasmsCerebrovascular DiseasesChronic Lower
Respiratory DiseasesAccidentsDiabetes MellitusAlzheimer’s DiseaseInfluenza and PneumoniaNephritis, Nephrotic Syndrome
& NephrosisSepticemiaAll Other Causes, Residual
2000RANK NUMBER RATE1
44,9671 13,354 300.32 9,772 219.73 3,177 71.45 2,043 45.9
4 2,097 47.26 1,315 29.69 891 20.07 1,130 25.48 933 21.0
10 778 17.59,477
50
COMPUTER SYSTEMSCENTER
In 2002, the ComputerSystems Center added a divisionto support the Bureau of FinancialServices. The new division con-solidated the responsibility forperforming third party billings, aswell as providing analysis andprogramming for the systems sup-porting finance, personnel, proper-ty and budgeting. With the forma-tion of this division, the depart-ment has increased the recoveryof costs for services, improved theaccuracy of financial reports, andstreamlined the development ofnew financial managementinitiatives.
In preparation for compliancewith the new Health InsurancePortability and AccountabilityAct, HIPAA, and bioterrorismsecurity intiatives, the ComputerSystems Center completed ananalysis of the current methods offormatting and transmitting datawith the new requirements. Aftercompleting the analysis, the cen-ter developed a work plan for fullcompliance and transition to thenew standards. After evaluating anumber of alternatives, it wasdetermined that it would be mostcost effective to purchase a trans-lator to read data from the exist-ing clinical systems, translate thedata into the acceptable formatand send the new transaction tothe receiving party such asMedicaid or an insurance payor.The center developed the specifi-cations in preparation for releaseof an Invitation to Bid for aHIPAA/Security Translator.
To better manage the growingcase management workload, thecenter developed the CareCoordination System in coordina-tion with the project manager inthe Office of Professional andSupport Services. This new sys-tem uses Lotus Notes to auto-mate the collection of time-keep-ing data and all the forms used for
tracking patient activities. Thenew application was installedthroughout all counties in 2002.The center ordered, installed andconfigured over 315 new comput-ers for case managers in 66counties.
The Bureau of EnvironmentalServices sponsored a new data-base application to track environ-mental activities and generateforms and letters in the counties.The system was developed by oneof the area environmentalists andtested in several counties by otherenvironmentalists. CSC installedover 260 new computersstatewide configured with thenew environmental system.
In response to a need for bet-ter homeland security andresponse in case of a bioterroristattack, the Alabama Departmentof Public Health began buildingits capability for emergencyresponse. The center is supportingthe department’s initiatives,which are funded by federalgrants from the ComputerSystems Center, by purchasing aLaboratory Information System,increasing information technolo-gy security, and implementing aproject to integrate several diseasemanagement information sys-tems. Several employees areassigned to these projects andeach project is in the early stagesof development and implementa-tion.
To increase service to citizensof Alabama, several new enhance-ments were added to the systemssupporting Vital Records. On thedepartment’s Internet Web sitethe ability for citizens to submitqueries and receive reports regard-ing Alabama’s mortality andnatality statistics was added, andthe fax machines used in thecounties to request and print vitalrecords were replaced.Additionally, a new death certifi-cate tracking system was devel-oped and tested to assist the
county registrars with theirduties.
The center added three newfeatures to the Public Health ofAlabama County OperationsNetwork to improve productivityof staff and services to patients.The first feature, installed inJanuary, allows the network toissue benefits to WIC participantsfor three months at a time.Midyear a second improvementwas added that automated print-ing of the infant growth charts.And finally, the center added thecapabilility of automated printingof health forms, allowing fasterservice to all clients.
During 2002, the ComputerSystems Center and the Bureau ofHome and Community Servicesfinalized the purchase of a com-mercial Home Health automatedsystem. The contract for the newsystem was finalized and installa-tion will begin in 2003.
Several critical networkupgrades were completed in 2002,at the central office and theClinical Laboratories. The net-work connection to the Internetwas upgraded to provide increasedspeed and response to employees.The center purchased andinstalled Voice over InternetProtocol to improve theChildren’s Health InsuranceProgram office’s telephone serv-ice. Additionally, the centerimplemented SameTime, a sys-tem which allows workers in pub-lic health areas to work remotelyand communicate instantly witheach other via the network. Thisnew capability will be expandedfor further use to save time andtravel costs.
51
CSC SUPPORT SYSTEMSCATEGORY QUANTITIES
Help Desk Calls 9,329
Personal Computers Supported 3,000
Personal Computers Installed 816
County Support Trips 1,373
PROGRAM DATE NAME PURPOSE SUPPORTED INSTALLED
PHALCON (Public Health Clinic System WIC, Family Health, 1999of Alabama County Disease ControlOperations Network)
Lotus Notes E-mail, Calendaring All 1996
OnlineCare Coordination System Capture data for case Case Management 2002management patients
HCIS (Home Care In Home Patient Care System Home Health 1991Information System)
Community Based Elderly and Disabled Community Based Waiver 1994Waiver System Care Support System
IRIS (now ImmPRINT) Internet based immunization Immunization 1996registry system
ARTEMIS Hepatitis B Case Management System Immunization 2000
HRS (Human Resource System) Maintain personnel information Personnel 1990
Vital Records Information Collect, maintain and Health Statistics 1994System issue vital records
AFNS (Advantage Maintain financial information Finance 1988Financial System)
Cost Accounting Reimbursement justification Finance 1990
Billing Medicaid billing for ADPH services Family Health, 1988Case Management
CHIP (Children’s Health Enrollment System for the ALL KIDS Children’s Health 2000Insurance Program) Children’s Health Insurance Program Insurance Program
Death Tracking System Track death certificates Health Statistics 2001
Reports Databases Distribute electronic reports All 2000
Health Provider Standards Digitally store and retrieve surveys Health Provider Standards 2001Imaging Project
Environmental System Manage County Environmental Environmental 2002Activities
Portfolio of Current Information Systems
52
The Bureau of FinancialServices provides accounting,accounts receivable, payroll, thirdparty collections, purchasing,budgeting, production planningand administrative support toaccomplish its goals in financialaccounting, reporting and man-agement.
In addition, financial manage-ment services were provided forthe Alabama Public Health CareAuthority’s $47 million buildingprogram. The State Committee ofPublic Health authorized thedepartment to establish theauthority in 1995 which enabledthe selling of bonds in 1996 forconstruction or renovation ofinadequate facilities.
From 1997 through 2002, land was acquired by counties
identified with the greatest need.Groundbreaking ceremonies wereheld and facilities were designedfor construction. Twenty-eightfacilities were constructed/ renovated and occupied in Bibb,Blount, Bullock, Calhoun,Chambers, Chilton, Choctaw,Clay, Cleburne, Cullman, Dallas,DeKalb, Elmore, Jackson, Lamar,Lawrence, Macon, Marengo,Marion, Monroe, Montgomery,Morgan, Perry, Russell, St. Clair,Shelby, Sumter, Talladega andTallapoosa counties.
Economic financial manage-ment and cooperation by localgovernments and the departmenthave enabled the majority ofcounties identified to renovateinadequate facilities or constructnew ones.
BUREAU OF financialservices
53
adph Excludes Children’s Health Insurance Program & Children First Fund.State funds include General Fund, Education Trust Fund, Cigarette Tax and ALERT Fund.
200
150
100
50
0
$ M
illio
ns
Public Health Funding History
FY 1998 FY 1999 FY 2000 FY 2001 FY 2002
�� ��
1998 1999 2000 2001 200256.1 62.7 67.3 63.5 65.1
128.0 137.4 139.9 151.4 176.98.0 7.8 6.7 8.6 8.1
149.8 126.7 109.5 107.1 108.9
STATE�� FEDERAL
LOCALREIMB
��
��
��
FY 98 ETF funding is from General Fund.FY 99 Children’s Health Insurance Program includes $3.5 carry forward from FY 98.
80
60
40
20
0
$ M
illio
nsPublic Health Funding, General Fund and Education Trust Fund
FY 1998 FY 1999 FY 2000 FY 2001 FY 2002
1998 1999 2000 2001 2002ETF - EMS 4.6 4.8 4.6 4.3 4.1ETF - Health 11.5 12.1 12.6 10.2 10.1GF - Health 38.4 44.4 45.5 48.7 50.8GF - CHIP 1.5 8.5 9.0 16.2 6.6
Transfers (1.4%)
Env. & Reg. (5.9%)
Others (1.7%)
Adminstration (11.4%)
Clinical Laboratories (15.3%)
Communicable Disease (19.0%)
EMS (6.3%)
Family Health (5.9%)
Counties (33.1%)
use of state funds – FY 2002
GENERAL FUND AND ETF ONLY – $65.1 MILLION
Excludes Children’s Health Insurance Program & Children First Fund.
Aphca Projects
LAUDERDALE
LIMESTONEMADISON
JACKSON
DEKALBMARSHALL
LAWRENCE
JEFFERSON
CULLMANWINSTONMARION
LAMAR
PICKENS
FAYETTEWALKER
BLOUNT
MACON
LEE
RANDOLPH
CALHOUN
TALLADEGA
DALLAS
CHILTONCOOSA
SHELBYTUSCALOOSA
ST. CLAIR
TALLAPOOSA
CHEROKEE
WILCOX
ELMOREAUTAUGA
ESCAMBIACOVINGTON
BUTLER
MONTGOMERY
BULLOCK
CRENSHAW
GENEVA HOUSTON
DALE
MONROE
GREENE
MARENGO
CHOCTAW
WASHINGTON
MOBILE
BALDWIN
SUMTER
HALE
LOWNDES
BIBB
COFFEE
PIKE
PERRY
CLAY
RUSSELL
BARBOUR
CONECUH
CLARKE
CHAMBERS
CLEBURNE
ETOWAH
FRANKLIN
COLBERT
MORGAN
HENRY
54
NO PROJECTS
COMPLETED
UNDERWAY
NEEDEDMORE THAN ONE PROJECTIN COUNTY
The Office of Personnel andStaff Development processesrequests for personnel actionssuch as new hires, promotions,transfers, dismissals, leavereports, performance appraisalsand disciplinary actions. TheEmployee Relations Section pro-vides guidance to employees andsupervisors in resolving work-place conflicts and coordinates(through referrals) the EmployeeAssistance Program. In addition,the office coordinates the depart-ment’s Mediation Program,Recruitment Program,Affirmative Action Program andthe State Employee InjuryCompensation Trust FundProgram.
2002 Service Activities� Designed Web site page for easy
access to personnel informationsuch as the employee handbook,personnel policies, frequentlyasked personnel questions andlinks to other relevantinformation.
� Revised the department’saffirmative action plan.
� Developed a recruitment work-shop and attended severalrecruitment exercises.
� Developed a policy on separa-tion of employment and revisedseveral other personnel policies.
� Revised the following classseries: nurse, nurse practitioner,health services aide and radia-tion safety specialist.
� Established a new classificationof radiological health assistantdirector.
� Transferred personnel forms todisk to make them more readilyavailable and easier to complete.
Office ofPersonneland staff development
55
adph
PERSONNEL ACTIONS PROCESSED
Merit New Hires 680
Promotions 293
Dismissals 5
Retirements 73
Transfers (out) 48
Separations 505
Employee Assistance Program Referrals 23
Hours of Sick Leave Donations 4,123.30
Annual Leave Appraisals 2,495
Probationary Appraisals 779
Alabama Department of Public Health Employees 2001 vs. 2002
CATEGORY AS OF DEC. 2001 AS OF DEC. 2002
Officials/Administrators 749 866
Professionals 952 920
Technicians 83 70
Protective Service Workers 1 3
Paraprofessionals 999 261
Administrative Support/Clerical 858 864
Skilled Craft 7 6
Service Maintenance 84 46
OVERALL TOTALS* 3,733 * 3,036 **
56
* Excluding Contract Employees only (515)** Excludiing Contract Employees (515) and Form 8 (769) Employees
adph 2002 minority employment comparison
50
40
30
20
10
0MANAGERS
LM11.09
ADPH16.63
PROFESSIONALS
LM16.89
ADPH23.91
OFFICE/CLERICAL
LM16.65
ADPH38.66
ALABAMA LABOR MARKET (LM) VS. ADPH IN THREE EEO JOB CATEGORIES
Perc
enta
ge o
f Tot
als
Office ofProgramintegrity
57
adph
The Office of ProgramIntegrity serves the state healthofficer to provide assurancesregarding the integrity of thedepartment’s financial systems,compliance with federal auditrequirements, and compliancewith applicable state laws andregulations.
During 2002, the Office ofProgram Integrity continued itsmission of objective evaluationsof county health departments andcentral office units in the areas offinancial and administrative
activities. Contract agencies pro-viding services on behalf of thedepartment were evaluated toensure compliance with pro-gram/contract requirements.
In addition to routine auditservices, Program Integrity staffresponded to requests to evaluateexisting internal controls, con-ducted facility reviews at HealthCare Authority sites, and partici-pated as consultants to otherunits developing policies andprocedures to become HIPAAcompliant.
2001 2002
Financial/Administrative Audits 23 25
Property Audits
County health departments 27 0
State level sites 8 0
External WIC sites 10 0
Federal Program Audits
County health departments 19 28
External WIC sites 10 0
WIC Training Center site 1 0
Home Health County Audit Projects 0 0
EMS Agency Audits
State level 1 0
Regional agencies 2 4
State-level Projects 2 5
Activities Conducted in 2002 Compared to 2001
AREA/COUNTYNAME AND TITLE MAILING ADDRESS TEL. NO. FAX NO. STREET ADDRESS
PUBLIC HEALTH AREA 1Karen M. Landers, M.D., AHO Box 929, Tuscumbia 35674-0929 256-383-1231 383-8843 1000 Jackson Hwy., Sheffield 35660-5761Roger Norris, Area Adm. Box 929, Tuscumbia 35674-0929 256-383-1231 383-8843 1000 Jackson Hwy., Sheffield 35660-5761
COLBERT–Karen M. Landers, M.D., AHO Box 929, Tuscumbia 35674-0929 256-383-1231 383-8843 1000 Jackson Hwy., Sheffield 35660-5761
NW AL REGIONAL H H OFFICE Box 929, Tuscumbia 35674-0929 256-383-1234 383-8843 1000 Jackson Hwy., Sheffield 35660-5761FRANKLIN–
Karen M. Landers, M.D., AHO Box 100, Russellville 35653-0100 256-332-2700 332-1563 300 E. Limestone St., Russellville 35653-2448LAUDERDALE–
Karen M. Landers, M.D., AHO Box 3569, Florence 35630 256-764-7453 764-4185 4112 Chisholm Rd., Florence 35630MARION–
Roger Norris, Area Adm. Box 158, Hamilton 35570-0158 205-921-3118 921-7954 2448 Military St. South, Hamilton 35570HOME HEALTH OFFICE Box 158, Hamilton 35570-0158 205-921-2859 921-7282 2448 Military St. South, Hamilton 35570Winfield Branch (open Thurs. only) Box 158, Hamilton 35570-0158 205-487-3688 Winfield Community Center, Winfield
WALKER–Roger Norris, Area Admin. Box 3207, Jasper 35502-3207 205-221-9775 221-8810 705 20th Avenue East, Jasper 35502-3207
WINSTON–Roger Norris, Area Adm. Box 1029, Double Springs 35553-1029 205-489-2101 489-2634 24714 Hwy. 195, South, Double Springs 35553HOME HEALTH OFFICE Box 1047, Haleyville 35565-1047 205-486-3159 486-3673 2324 14th Ave., Haleyville 35565HALEYVILLE BRANCH Box 1047, Haleyville 35565-1047 205-486-2479 486-8764 2324 14th Ave., Haleyville 35565(Open Tuesday and Thursday only)
PUBLIC HEALTH AREA 2Ron Grantland, Acting Area Adm. Box 1628, Decatur 35602-1628 256-340-2113 353-4432 201 Gordon Drive, S.E., Decatur 35601
CULLMAN–Tony Williams, M.D., LHO Box 1678, Cullman 35056-1678 256-734-1030 737-9646 601 Logan Ave., S.W., Cullman 35055Ron Grantland, Acting Area Adm. Box 1678, Cullman 35056-1678 256-734-1030 737-9646 601 Logan Ave., S.W., Cullman 35055HOME HEALTH OFFICE Box 1086, Cullman 35056 256-734-0258 734-1840 601 Logan Ave., S.W., Cullman 35055ENVIRONMENTAL OFFICE Box 1678, Cullman 35056-1678 256-734-0243 737-9646 601 Logan Ave., S.W., Cullman 35055
JACKSON–Ron Grantland, Acting Area Adm. Box 398, Scottsboro 35768-0398 256-259-4161 259-1330 204 Liberty Ln., Scottsboro 35769-4133HOME HEALTH OFFICE Box 398, Scottsboro 35768-0398 256-259-3694 574-4803 204 Liberty Ln., Scottsboro 35769-4133ENVIRONMENTAL OFFICE Box 398, Scottsboro 35768-0398 256-259-5882 259-5886 204 Liberty Ln., Scottsboro 35769-4133
LAWRENCE–Tony Williams, M.D., LHO Box 308, Moulton 35650-0308 256-974-1141 974-5587 13299 Alabama Hwy. 157, Moulton 35650Ron Grantland, Acting Area Adm. Box 308, Moulton 35650-0308 256-974-1141 974-5587 13299 Alabama Hwy. 157, Moulton 35650HOME HEALTH OFFICE Box 308, Moulton 35650-0308 256-974-7076 974-7073 13299 Alabama Hwy. 157, Moulton 35650ENVIRONMENTAL OFFICE Box 308, Moulton 35650-0308 256-974-8849 974-7073 13299 Alabama Hwy. 157, Moulton 35650
LIMESTONE–Ron Grantland, Acting Area Adm. Box 889, Athens 35612 256-232-3200 232-6632 310 West Elm St., Athens 35611HOME HEALTH OFFICE Box 69, Athens 35612 256-230-0434 230-9289 110 Thomas St., Athens 35611
MADISON–Lawrence L. Robey, M.D., LHO Box 467, Huntsville 35804-0467 256-539-3711 536-2084 304 Eustis Ave., S.E., Huntsville 35801-3118ENVIRONMENTAL OFFICE Box 467, Huntsville 35804-0467 256-539-8101 535-6545 311 Green St., Huntsville 35801
MARSHALL–Ron Grantland, Acting Area Adm. Drawer 339, Guntersville 35976 256-582-3174 582-3548 4200-B, Hwy. 79, S., Guntersville 35976HOME HEALTH OFFICE Drawer 978, Guntersville 35976 256-582-8425 582-0829 4200-A, Hwy. 79, S., Guntersville 35976ENVIRONMENTAL OFFICE Drawer 339, Guntersville 35976 256-582-4926 582-3548 4200-B, Hwy. 79, S., Guntersville 35976WIC CLINIC Drawer 339, Guntersville 35976 256-582-7381 582-3548 4200-B, Hwy. 79, S., Guntersville 35976
MORGAN–Ron Grantland, Acting Area Adm. Box 1628, Decatur 35602-1628 256-353-7021 353-7901 510 Cherry St. N.E., Decatur 35602HOME HEALTH OFFICE Box 2105, Decatur 35602-2105 256-306-2400 353-6410 201 Gordon Dr., S.E., Ste. 107,, Decatur 35601ENVIRONMENTAL OFFICE Box 1866, Decatur 35602-1866 256-340-2105 353-7901 510 Cherry St. N.E., Decatur 35602
PUBLIC HEALTH AREA 3Albert T. White, Jr., M.D., AHO Box 70190, Tuscaloosa 35407 205-345-4131 759-4039 1200 37th St. East, Tuscaloosa 35405William W. Denton, Area Adm. Box 70190, Tuscaloosa 35407 205-554-4501 556-2701 1200 37th St. East, Tuscaloosa 35405
BIBB–William W. Denton, Area Adm. Box 126, Centreville 35042-1207 205-926-9702 926-6536 281 Alexander Ave., Centreville 35042HOME HEALTH OFFICE Box 70190, Tuscaloosa 35407 205-554-4520 507-4718 1200 37th St. East, Tuscaloosa 35405
FAYETTE–William W. Denton, Area Adm. Box 351, Fayette 35555-0351 205-932-5260 932-3532 211 First St., N.W., Fayette 35555-2550HOME HEALTH OFFICE Box 70190, Tuscaloosa 35407 205-932-3963 507-4718 1200 37th St. East, Tuscaloosa 35405
GREENE–J. Fred Grady, Asst. Area Adm. Box 269, Eutaw 35462-0269 205-372-9361 372-9283 412 Morrow Ave., Eutaw 35462-1109HOME HEALTH OFFICE Box 70190, Tuscaloosa 35407 205-554-4520 507-4718 1200 37th St. East, Tuscaloosa 35405
LAMAR–William W. Denton, Area Adm. Box 548, Vernon 35592-0548 205-695-9195 695-9214 300 Springfield Rd., Vernon 36692HOME HEALTH OFFICE Box 548, Vernon 35592-0548 205-695-6916 695-9100 300 Springfield Rd., Vernon 36692
PICKENS–J. Fred Grady, Asst. Area Adm. Box 192, Carrollton 35447-9599 205-367-8157 367-8374 Hospital Drive, Carrollton 35447-9599HOME HEALTH OFFICE Box 70190, Tuscaloosa 35407 205-554-4520 507-4718 1200 37th St. East, Tuscaloosa 35405
TUSCALOOSA–J. Fred Grady, Asst. Area Adm. Box 2789, Tuscaloosa 35403 205-345-4131 759-4039 1101 Jackson Ave., Tuscaloosa 35401HOME HEALTH OFFICE Box 70190, Tuscaloosa 35407 205-554-4520 507-4718 1200 37th St. East, Tuscaloosa 35405ENVIRONMENTAL OFFICE Box 70190, Tuscaloosa 35407 205-554-4540 556-2701 1200 37th St. East, Tuscaloosa 35405
58
alabama Department of Public healthmailing and street address roster of county health departments,
health officers and administrators
AREA/COUNTYNAME AND TITLE MAILING ADDRESS TEL. NO. FAX NO. STREET ADDRESS
PUBLIC HEALTH AREA 4Michael E. Fleenor, M.D., AHO Box 2648, Birmingham 35202-2648 205-933-9110 930-0243 1400 Sixth Ave. S., Birmingham 35233-1502Michael E. Fleenor, M.D., LHO Box 2648, Birmingham 35202-2648 205-930-1500 930-0243 1400 Sixth Ave. S., Birmingham 35233-1502Gwen Veras, Area Adm. Box 2648, Birmingham 35202-2648 205-930-1510 930-1576 1400 Sixth Ave. S., Birmingham 35233-1502BESSEMER HEALTH CENTER 2201 Arlington Ave., Bessemer 35020-4299 205-424-6001 426-1410 2201 Arlington Ave., Bessemer 35020-4299CENTRAL HEALTH CENTER 1400 Sixth Ave., S., Birmingham 35233-1598 205-933-9110 930-1350 1400 Sixth Ave. S., Birmingham 35233-1502CHRIS MCNAIR HEALTH CENTER 1308 Tuscaloosa Ave. S.W., Birmingham 35211 205-715-6121 715-6173 1308 Tuscaloosa Ave. S.W., Birmingham 35211EASTERN HEALTH CENTER 5720 First Ave., S., Birmingham 35212-2599 205-591-5180 591-6741 5720 First Ave., S., Birmingham 35212-2599LEEDS HEALTH CENTER 210 Park Drive, Leeds 35094-1846 205-699-2442 699-8406 210 Park Drive, Leeds 35094-1846MORRIS HEALTH CENTER Box 272, Morris 35116-0272 205-647-0572 647-0109 586 Morris Majestic Rd., Morris 35116-1246NORTHERN HEALTH CENTER 2817–30th Ave., N., Birmingham 35207-4599 205-323-4548 521-6851 2817-30th Ave., North, Birmingham 35207-4599WESTERN HEALTH CENTER 1700 Ave. E. Ensley, Birmingham 35218-1543 205-788-3321 785-8495 1700 Ave. E. Ensley, Birmingham 35218-1543WESTERN M H CENTER 1701 Ave. D. Ensley, Birmingham 35218-1532 205-788-7552 788-7552 1701 Ave. D. Ensley, Birmingham 35218-1532
PUBLIC HEALTH AREA 5Mary Gomillion, Area Adm. Box 267, Centre 35960 256-927-7000 927-7068 833 Cedar Bluff Rd., Centre 35960Jane Burt, Asst. Area Adm. Box 267, Centre 35960 256-927-7000 927-7068 833 Cedar Bluff Rd., Centre 35960 AREA 5 HOME HEALTH HEADQTRS Box 681106, Ft. Payne 35968 256-845-6020 845-0035 2401 Calvin Dr., S.W., Ft. Payne 35967
BLOUNT–Jane Burt, Asst. Area Adm. Box 208, Oneonta 35121-0004 205-274-2120 274-2210 1001 Lincoln Ave., Oneonta 35121HOME HEALTH OFFICE Box 8306, Gadsden 35902 256-547-5012 543-0067 109 S. 8th Street, Gadsden 35902LIFE CARE OFFICE 1001 Lincoln Ave., Oneonta 35121 205-274-9086 or 625-4490 1001 Lincoln Ave., Oneonta 35121
1-888-469-8806ENVIRONMENTAL OFFICE Box 208, Oneonta 35121-0004 250-274-2120 274-2575 1001 Lincoln Ave., Oneonta 35121
CHEROKEE–Jane Burt, Asst. Area Adm. Box 176, Centre 35960-0176 256-927-3132 927-2809 833 Cedar Bluff Road, Centre 35960HOME HEALTH OFFICE Box 680347, Ft. Payne 35968 256-845-8680 or 845-0331 2401 Calvin Dr., S.W., Ft. Payne 35967
1-800-732--9206LIFE CARE OFFICE Box 347, Ft. Payne 35968 256-845-8685 or 845-0790 2401 Calvin Dr., S.W., Ft. Payne 35967
1-800-600-0923DEKALB–
Jane Burt, Asst. Area Adm. Box 680347, Ft. Payne 35968 256-845-1931 845-2967 2401 Calvin Dr., S.W., Ft. Payne 35967HOME HEALTH OFFICE Box 680347, Ft. Payne 35968 256-845-8680 or 845-0331 2401 Calvin Dr., S.W., Ft. Payne 35967
1-800-732-9206LIFE CARE OFFICE Box 680347, Ft. Payne 35968 256-845-8685 845-0790 2401 Calvin Dr., S.W., Ft. Payne 35967
1-800-600-0923ENVIRONMENTAL OFFICE Box 347, Ft. Payne 35968 256-845-7031 845-2817 2401 Calvin Dr., S.W., Ft. Payne 5967
ETOWAH–Mary Gomillion, Area Adm. Box 555, Gadsden 35902-0555 256-547-6311 549-1579 109 South 8th St., Gadsden 35901-2454HOME HEALTH OFFICE Box 8306, Gadsden 35902 256-547-5012 543-0067 109 South 8th St., Gadsden 35901-2454LIFE CARE OFFICE 1001 Lincoln Ave., Oneonta 35121 205-274-9086 or 625-4490 1001 Lincoln Ave., Oneonta 35121
1-888-469-8806ST. CLAIR–
Mary Gomillion, Area Adm. Box 627, Pell City 35125 205-338-3357 338-4863 1175 23rd St. N., Pell City 35125HOME HEALTH OFFICE Box 8306, Gadsden 35902 205-547-5012 543-0067 109 South 8th St., Gadsden 35901-2454LIFE CARE OFFICE 1001 Lincoln Ave., Oneonta 35121 205-274-9086 or 625-4490 1001 Lincoln Ave., Oneonta 35121
1-888-469-8806Satellite Clinic (Wednesday only) P.O. Box 249, Ashville 35953 205-594-7944 594-7588 411 N. Gadsden Hwy., Ashville 35953
SHELBY–Mary Gomillion, Area Adm. Box 846, Pelham 35124 205-664-2470 664-4148 2000 County Services Dr., Pelham 35124ENVIRONMENTAL OFFICE Box 846, Pelham 35124 205-620-1650 664-3411 2000 County Services Dr., Pelham 35124
PUBLIC HEALTH AREA 6Teresa A. Childers, Area Adm. Box 4699, Anniston 36204-4699 256-236-3274 237-7974 3400 McClellan Blvd., Anniston 36201
CALHOUN–Donald Bain, Asst. Area Adm Box 4699, Anniston 36204-4699 256-237-7523 238-0851 3400 McClellan Blvd., Anniston 36201ENVIRONMENTAL OFFICE Box 4699, Anniston 36204-4699 256-237-4324 238-0851 3400 McClellan Blvd., Anniston 36201
CHAMBERS–Donald Bain, Asst. Area Adm. 5 North Medical Park Dr., Valley 36854 334-756-0756 756-0765 5 North Medical Park Dr., Valley 36854LaFayette Clinic (WIC only Thursday) 5 North Medical Park Dr., Valley 36854 334-7864-8834 864-8805 18 Alabama Ave. East, LaFayette 36854
CLAY–Teresa Childers, Area Adm. 86892 Hwy. 9, Lineville 36266 256-396-6421 396-9172 86892 Hwy. 9, Lineville 36266HOME HEALTH OFFICE 86892 Hwy. 9, Lineville 36266 256-396-9307 396-9236 86892 Hwy. 9, Lineville 36266
CLEBURNE–Donald Bain, Asst. Area Adm. Box 36, Heflin 36264-0036 256-463-2296 463-2772 Brockford Road, Heflin 36264-1605
COOSA–Teresa Childers., Area Adm. Box 219, Rockford 35136-0235 256-377-4364 377-4354 Main Street, Rockford 35136
RANDOLPH–Donald Bain, Asst. Area Adm. 468 Price St., Roanoke 36274 334-863-8981 863-8975 468 Price St., Roanoke 36274HOME HEALTH OFFICE 3882 Hwy. 431, Roanoke 36274 334-863-8983 863-4871 3882 Hwy. 431, Roanoke 36274WEDOWEE SATELITE (Open Tues. P.M. & Wed.) 468 Price St., Roanoke 36274 256-357-4764 Randolph County Court House, Wedowee 36278
TALLADEGA–Teresa Childers, Area Adm. 501 W. South St., Talladega 35160 256-362-2593 362-0529 501 W. South St., Talladega 35160HOME HEALTH OFFICE 311 North Elm Ave., Sylacauga 35150 256-249-4893 208-0886 311 North Elm Ave., Sylacauga 35150SYLACAUGA CLINIC 311 North Elm Ave., Sylacauga 35150 256-249-3807 245-0169 311 North Elm Ave., Sylacauga 35150
TALLAPOOSA–Teresa Childers, Area Adm. 2078 Sportplex Blvd., Alexander City 35010 256-329-0531 329-1798 2078 Sportplex Blvd., Alexander City 35010DADEVILLE CLINIC Box 125, Dadeville 36853-0125 256-825-9203 825-6546 220 LaFayette St., Dadeville 36853
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AREA/COUNTYNAME AND TITLE MAILING ADDRESS TEL. NO. FAX NO. STREET ADDRESS
PUBLIC HEALTH AREA 7Ruth Underwood, Acting Area Adm. Box 480280, Linden 36748-0280 334-295-1000 295-0006 303 Industrial Drive, Linden 36748-0877
CHOCTAW–Ashvin Parikh, Asst. Area Adm. 1001 S. Mulberry Ave., Butler 36904-0629 205-459-4026 459-4027 1001 South Mulberry Ave., Butler 36904HOME HEALTH OFFICE 1001 S. Mulberry Ave., Butler 36904-0629 205-459-4011 459-4016 1001 South Mulberry Ave., Butler 36904ENVIRONMENTAL OFFICE 1001 S. Mulberry Ave., Butler 36904-0629 205-459-4026 459-4027 1001 South Mulberry Ave., Butler 36904
DALLAS–Ashvin Parikh, Asst. Area Adm. 100 Sam O. Moseley Dr., Selma 36702-0330 334-874-2550 875-7960 100 Sam O. Moseley Dr., Selma 36702-0330HOME HEALTH OFFICE 100 Sam O. Moseley Dr., Selma 36702-0330 334-872-2323 872-0279 100 Sam O. Moseley Dr., Selma 36702-0330ENVIRONMENTAL OFFICE 100 Sam O. Moseley Dr., Selma 36702-0330 334-872-5887 872-4948 100 Sam O. Moseley Dr., Selma 36702-0330
HALE–Ashvin Parikh, Asst. Area Adm. Box 87, Greensboro 36744-0087 334-624-3018 624-4721 1102 N. Centerville St., Greensboro 36744-0087HOME HEALTH OFFICE Box 87, Greensboro 36744-0087 334-624-3657 205-652-2366 1102 N. Centerville St., Greensboro 36744-0087ENVIRONMENTAL OFFICE Box 87, Greensboro 36744-0087 334-624-3018 624-4721 1102 N. Centerville St., Greensboro 36744-0087
LOWNDES–Ziba M. Anderson, Asst. Area Adm. Box 35, Hayneville 36040-0035 334-548-2564 548-2566 507 Montgomery Hwy., Hayneville 36040HOME HEALTH OFFICE Box 35, Hayneville 36040-0035 334-548-5345 548-5424 507 Montgomery Hwy., Hayneville 36040
MARENGO–Ashvin Parikh, Asst. Area Adm. Box 480877, Linden 36748-0877 334-295-4205 295-0124 303 Industrial Drive, Linden 36748-0877HOME HEALTH OFFICE Box 480877, Linden 36748-0877 334-295-0000 205-459-4016 303 Industrial Drive, Linden 36748-0877ENVIRONMENTAL OFFICE Box 480877, Linden 36748-0877 334-295-1000 295-0006 303 Industrial Drive, Linden 36748-0877
PERRY–Ashvin Parikh, Area Adm. Box 119, Marion 36756-0119 334-683-6153 683-4509 Rt. 2 Box 4-C, Hwy. 45 South, Marion 36756HOME HEALTH OFFICE Box 119, Marion 36756-0119 334-683-8084 872-0279 Rt. 2 Box 4-C, Hwy. 45 South, Marion 36756ENVIRONMENTAL OFFICE Box 119, Marion 36756-0119 334-683-6153 683-4509 Rt. 2 Box 4-C, Hwy. 45 South, Marion 36756UNIONTOWN SATELLITE (Open T., W.) Box 119, Marion 36756-0119 334-628-6226 628-3018 200 North St., Uniontown 36786
SUMTER–Ashvin Parikh, Asst. Area Adm. P. O. Drawer 340, Livingston 35470 205-652-7972 652-7919 1121 N. Washington St., Livingston 35470HOME HEALTH OFFICE P. O. Drawer 340, Livingston 35470 205-652-2273 652-2366 1121 N. Washington St., Livingston 35470ENVIRONMENTAL OFFICE P. O. Drawer 340, Livingston 35470-0340 205-652-7972 652-7919 1121 N. Washington St., Livingston 35470
WILCOX–Ziba Anderson, Asst. Area Adm. Box 547, Camden 36726-0547 334-682-4515 682-4796 107 Union St., Camden 36726-0547HOME HEALTH OFFICE Box 547, Camden 36726-0547 334-682-5122 872-0279ENVIRONMENTAL OFFICE Box 547, Camden 36726-0547 334-682-4515 682-4796 107 Union St., Camden 36726-0547
PUBLIC HEALTH AREA 8Bobby H. Bryan, Area Adm. 6501 U.S. Hwy 231 N., Wetumpka 36092 334-567-1165 514-5832 6501 U.S. Hwy 231 N., Wetumpka 36092
AUTAUGA–Bobby H. Bryan, Area Adm. 219 N. Court, Prattville 36067 334-361-3743 361-3718 219 N. Court St., Prattville 36067HOME HEALTH OFFICE 219 N. Court, Prattville 36067 334-361-3753 361-3806 219 N. Court St., Prattville 36067
BULLOCK–Ron Wheeler, Asst. Area Adm. Drawer 430, Union Springs 36089-0430 334-738-3030 738-3008 103 Conecuh Ave., W., Union Springs 36089-1317
CHILTON–James R. Martin, Asst Area Adm. Box 1778, Clanton 35045-1778 205-755-1287 755-2027 301 Health Ctr. Dr., Clanton 36405LIFE CARE OFFICE Box 1778, Clanton 35045-1778 205-755-8407 755-8432 301 Health Ctr. Dr., Clanton 36405
ELMORE–Bobby H. Bryan, Area Adm. 6501 U.S. Hwy 231, Wetumpka 36092 334-567-1171 567-1186 6501 U.S. Hwy 231, Wetumpka 36092
LEE–Bobby H. Bryan, Area Adm. 1801 Corporate Dr., Opelika 36801 334-745-5765 745-9830 1801 Corporate Dr., Opelika 36801LIFE CARE OFFICE 1801 Corporate Dr., Opelika 36801 334-745-5293 745-9825 1801 Corporate Dr., Opelika 36801
MACON–James R. Martin, Asst. Area Adm. Box 830180, Tuskegee 36083-0180 334-727-1800 727-7100 812 Hospital Rd., Tuskegee 36083
LIFE CARE OFFICE Box 830180, Tuskegee 36083-0180 334-727-1888 727-1874 812 Hospital Rd., Tuskegee 36083MONTGOMERY–
James R. Martin, Asst Area Adm. 3060 Mobile Hwy., Montgomery 36108 334-293-6400 293-6410 3060 Mobile Hwy., Montgomery 36108HOME HEALTH OFFICE 3060 Mobile Hwy., Montgomery 36108 334-293-6525 293-6402 3060 Mobile Hwy., Montgomery 36108ENVIRONMENTAL OFFICE 3060 Mobile Hwy., Montgomery 36108 334-293-6456 3060 Mobile Hwy., Montgomery 36108LIFE CARE OFFICE 3060 Mobile Hwy., Montgomery 36108 334-293-6528 293-6402 3060 Mobile Hwy., Montgomery 36108
RUSSELL–James R. Martin, Asst. Area Adm. Box 548, Phenix City 36868-0548 334-297-0251 291-5478 1850 Crawford Rd., Phenix City 36867HOME HEALTH OFFICE Box 548, Phenix City 36868-0548 334-298-5581 291-0498 1850 Crawford Rd., Phenix City 36867
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AREA/COUNTYNAME AND TITLE MAILING ADDRESS TEL. NO. FAX NO. STREET ADDRESS
PUBLIC HEALTH AREA 9Ruth Underwood, Area Admin. Box 1227, Robertsdale 36567 251-947-6206 947-6262 22070 Highway 59, Robertsdale 36567
BALDWIN–Charles Watterson, Asst. Area Adm. Box 369, Robertsdale 36567-0369 251-947-7015 947-5703 23280 Gilbert Dr., Robertsdale 36567ENVIRONMENTAL OFFICE Box 369, Robertsdale 36567-0369 251-947-3618 947-3557 23280 Gilbert Dr., Robertsdale 36567BAY MINETTE BRANCH Box 160, Bay Minette 36507 251-937-0217 937-0391 257 Hand Ave., Bay Minette 36507-0547
BUTLER–Ziba M. Anderson, Asst. Area Adm. Box 339, Greenville 36037 334-382-3154 382-3530 350 Airport Rd., Greenville 36037GEORGIANA SATELLITE (Open Tues. & Fri.) Box 339, Greenville 36037 Jones Street, Georgiana 36033
CLARKE–Ruth Underwood, Area Adm. Box 477, Grove Hill 36451 251-275-3772 275-4253 140 Clark Street, Grove Hill 36451ENVIRONMENTAL OFFICE Box 477, Grove Hill 36451 251-275-4177 275-8066 120 Court Street, Grove Hill 36451
CONECUH–Charles Watterson, Asst. Area Adm. Box 110, Evergreen 36401 251-578-1952 578-5566 526 Belleville St., Evergreen 36401HOME HEALTH OFFICE Box 110, Evergreen 36401 251-578-5265 578-5679 101 Court Street, Evergreen 36401ENVIRONMENTAL OFFICE Box 110, Evergreen 36401 251-578-9729 578-5679 101 Court Street, Evergreen 36401
COVINGTON–Ziba M. Anderson, Asst. Area Adm. Box 186, Andalusia 36420-0186 334-222-1175 222-1560 County Road 56, Andalusia 36420OPP SATELLITE (Open Tues. Only) Box 186, Andalusia 36420-0186 334-493-9459 108 N. Main Street, Opp 36467LIFE CARE OFFICE Box 186, Andalusia 36420-0186 334-222-5970 222-1560 County Road 56, Andalusia 36420ENVIRONMENTAL OFFICE Box 186, Andalusia 36420-0186 334-222-1585 222-1560 County Road 56, Andalusia 36420
ESCAMBIA–Charles Watterson, Asst. Area Adm. 1115 Azalea Place, Brewton 36426 251-867-5765 867-5179 1115 Azalea Place, Brewton 36426ENVIRONMENTAL OFFICE 1115 Azalea Place, Brewton 36426 251-867-5765 867-5179 1115 Azalea Place, Brewton 36426ATMORE BRANCH 8600 Hwy. 31 N., Suite 17, Atmore 36502 251-368-9188 368-9189 8600 Hwy. 31 North, Atmore 36502
MONROE–Ruth Underwood, Area Adm. 416 Agriculture Dr., Monroeville 36460 251-575-3109 575-7935 416 Agriculture Drive, Monroeville 36460HOME HEALTH OFFICE 416 Agriculture Dr., Monroeville 36460 251-575-2980 575-2144 416 Agriculture Drive, Monroeville 36460ENVIRONMENTAL OFFICE 416 Agriculture Dr., Monroeville 36460 251-575-7034 575-7935 416 Agriculture Drive, Monroeville 36460
WASHINGTON–Ruth Underwood, Area Adm. Box 690, Chatom 36518 251-847-2245 847-3480 2024 Granade Ave., Chatom 36518HOME HEALTH OFFICE Box 690, Chatom 36518 251-847-2257 847-3299 2024 Granade Ave., Chatom 36518ENVIRONMENTAL OFFICE Box 690, Chatom 36518 251-847-2245 847-3480 2024 Granade Ave., Chatom 36518
PUBLIC HEALTH AREA 10Russell Killingsworth, Area Adm. P. O. Box 1055, Slocomb 36375-1055 334-886-2390 886-2842 465 S. Kelly, Slocomb 36375
BARBOUR–Ron Wheeler, Asst. Area Adm. Box 238, Eufaula 36027-0238 334-687-4808 687-6470 133 N. Orange St., Eufaula 36027-1619HOME HEALTH OFFICE Box 217, Clayton 36016-0217 334-775-9044 775-9129 25 North Midway Street, Clayton 36016CLAYTON BRANCH Box 217, Clayton 36016-0217 334-775-8324 775-3432 41 North Midway Street, Clayton 36016
COFFEE–Russell Killingsworth, Asst. Area Adm. 2841 Neal Metcalf Rd., Enterprise 36330 334-347-9574 347-7104 2841 Neal Metcalf Rd., Enterprise 36330HOME HEALTH OFFICE 2841 Neal Metcalf Rd., Enterprise 36330 334-347-9574 347-3124
CRENSHAW–Ron Wheeler, Asst. Area Adm. Box 326, Luverne 36049-0326 334-335-2471 335-3795 100 East 4th Street, Luverne 36049
DALE–Russell Killingsworth, Asst. Area Adm. Box 1207, Ozark 36361-1207 334-774-5146 774-2333 200 Katherine Ave., Ozark 36360
GENEVA–Kenneth Ball, Asst. Area Adm. 606 S. Academy St., Geneva 36340-2527 334-684-2257 684-3970 606 S. Academy St., Geneva 36340-2527
HENRY–Russell Killingsworth, Area Adm. Box 86, Abbeville 36310-0086 334-585-2660 585-3036 505 Kirkland St., Abbeville 36310-2736HEADLAND BRANCH Box 175, Headland 36345-0175 334-693-2220 693-3010 2 Cable Street, Headland 36345-2136
HOUSTON–Peggy Blakeney, Asst. Area Adm. Drawer 2087, Dothan 36302-2087 334-678-2800 678-2802 1781 E. Cottonwood Rd., Dothan 36301-5309HOME HEALTH OFFICE Drawer 2087, Dothan 36302-2087 334-678-2805 678-2808 1781 E. Cottonwood Rd., Dothan 36301-5309ENVIRONMENTAL OFFICE Drawer 2087, Dothan 36302-2087 334-678-2815 678-2816 1781 E. Cottonwood Rd., Dothan 36301-5309
PIKE–Ron Wheeler, Asst. Area Adm. 900 So. Franklin Dr., Troy 36081-3850 334-566-2860 670-0719 900 So. Franklin Dr., Troy 36081-3850HOME HEALTH OFFICE 900 So. Franklin Dr., Troy 36081-3850 334-566-8002 670-0719 900 So. Franklin Dr., Troy 36081-3850
PUBLIC HEALTH AREA 11Bernard H. Eichold II, M.D., AHO Box 2867, Mobile 36652-2867 251-690-8101 432-7443 251 N. Bayou St., Mobile 36603-1699HOME HEALTH SERVICES Box 2867, Mobile 36652-2867 251-690-8130 690-8907 248 Cox St., Mobile 36604INSPECTION SERVICES Box 2867, Mobile 36652-2867 251-634-9801 634-9806 1110 Schillinger Rd., Suite 200, Mobile 36608SOCIAL SERVICES Box 2867, Mobile 36652-2867 251-690-8981 694-5004 251 N. Bayou St., Mobile 36603WOMEN'S CLINIC Box 2867, Mobile 36652-2867 251-690-8935 690-8929 1557 Springhill Ave., Mobile 36604IMMUNIZATION OFFICE Box 2867, Mobile 36652-2867 251-690-8883 690-8899 251 N. Bayou St., Mobile 36603CALCEDEAVER CLINIC Box 2867, Mobile 36652-2867 251-829-9884 829-9507 1080AA Red Fox Rd., Calcedeaver 36560CITRONELLE CLINIC Box 2867, Mobile 36652-2867 251-866-9126 866-9121 19250 Mobile St., Citronelle 36522EIGHT MILE CLINIC Box 2867, Mobile 36652-2867 251-456-1399 456-0079 4547 St. Stephens Rd., Eight Mile 36663TEEN CENTER Box 2867, Mobile 36652-2867 251-694-3954 694-5037 248 Cox St., Mobile 36604SCHOOL BASED CLINIC Box 2867, Mobile 36652-2867 251-456-2276 456-2205 800 Whitley St., Plateau 36610
AHO–AREA HEALTH OFFICER, LHO–LOCAL HEALTH OFFICER
NOTE: THE PRIMARY "MAILING ADDRESS" FOR COUNTY HEALTH DEPARTMENTS WITH MULTIPLE SITES IS THE FIRST LINE LISTED UNDER THECOUNTY NAME IN BOLD PRINT. ALL OTHER SITES SUCH AS HOME HEALTH, ETC., SHOULD BE SENT TO EACH SPECIFIC ADDRESS ASSHOWN ABOVE. "STREET ADDRESSES" ARE USED ONLY FOR PONY EXPRESS, FEDERAL EXPRESS, AND UPS DELIVERIES!
Please notify the Bureau of Health Promotion & Chronic Disease of changes or errors,The RSA Tower, Suite 900, 201 Monroe Street, Montgomery, AL 36104, Telephone 334-206-5300.
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adph
PUBLIC HEALTHAREAS
Alabama is divided into
public health areas to
facilitate coordination,
supervision and development
of public health services.
Area offices are responsible
for developing local manage-
ment programs of public
health services and programs
particularly suited to the
needs of each area.
PHA 1Karen Landers, M.D., Area Health OfficerRoger Norris, Area AdministratorBox 929Tuscumbia, AL 35674-0929(256) 383-1231
PHA 2Ron Grantland, Acting Area AdministratorBox 1628, Decatur, AL 35602-1628(256) 340-2113
PHA 3Albert T. White, Jr., M.D., Area Health OfficerWilliam W. Denton, Area AdministratorBox 70190Tuscaloosa, AL 35407(205) 554-4501
PHA 4Michael Fleenor, M.D., Area Health OfficerGwen Veras, Area AdministratorBox 2648Birmingham, AL 35202-2648(205) 930-1500
PHA 5Mary Gomillion,Area AdministratorBox 267Centre, AL 35960(256) 927-7000
PHA 6Teresa Childers Stacks, Area AdministratorBox 4699Anniston, AL 36204-4699(256) 236-3274
PHA 7Ruth Underwood, Acting Area AdministratorBox 480280Linden, AL 36748-0280(334) 295-1000
PHA 8Bobby H. Bryan, Area Administrator6501 US Hwy. 231 North,Wetumpka, AL 36092(334) 567-1165
PHA 9Ruth Underwood, Area AdministratorBox 1227Robertsdale, AL 36567(334) 947-6206
PHA 10Russell Killingsworth, Area AdministratorP.O. Box 1055Slocomb, AL 36375-1055(334) 886-2390
PHA 11Bernard H. Eichold, II, M.D., Area Health OfficerBox 2867Mobile, AL 36652-2867(334) 690-8101
RANDOLPH
WILCOX
MOBILE
CHOCTAWMARENGO
SUMTER
GREENEHALE
PERRY
BIBB
CHILTON
AUTAUGA
DALLAS
LOWNDES
MONTGOMERY
BULLOCK
MACON RUSSELL
LEE
CHAMBERSTALLAPOOSA
CLAY
CLEBURNE
CALHOUN
CHEROKEE
ETOWAH
DEKALB
JACKSONMADISON
MARSHALLMORGAN
CULLMAN
LIMESTONE
LAUDERDALE
LAWRENCE
COLBERT
FRANKLIN
MARION WINSTON
WALKER
LAMAR FAYETTE
PICKENSTUSCALOOSA
JEFFERSON
SHELBY
TALLADEGA
COOSA
ELMORE
BLOUNT
ST. CLAIR
11 22
3344
55
66
77 88
1111HOUSTONGENEVA
BARBOUR
1010MONROECLARKE
BALDWIN
COVINGTONESCAMBIA
BUTLER
99 CONECUHWASHINGTON
CRENSHAW
PIKE
COFFEE
DALE HENRY
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64Photograph by Mark L. Wright
The Alabama Department of Public Health Annual Report is published by the Bureau of Health Promotion and Chronic Disease.
Director, Bureau of Health Promotionand Chronic Disease James J. McVay, Dr.PA
Director, Communications and Social Marketing Division Sally Palmer
Director, Public Information Division Arrol Sheehan, MA
Editor Takenya Stokes, JD
Photography Mark L. Wright
Production Assistants Marianne LansdonToni Prater
For additional copies of this report contact:
Takenya Stokes or Toni Prater
Alabama Department of Public Health
Bureau of Health Promotion and Chronic Disease
The RSA Tower, Suite 900
201 Monroe Street
P.O. Box 303017
Montgomery, Alabama 36130-3017
(334) 206-5300
Informational materials in alternative formats will be madeavailable upon request.
This document may also be obtained through the AlabamaDepartment of Public Health’s Web site at www.adph.org.
State ofAlabamaDepartmentof PublicHealth
The RSA Tower201 Monroe StreetMontgomery, Alabama36104
www.adph.orgInformational materialsin alternative formatswill be made availableupon request.