Injury Prevention

AzPHA Public Health Policy Committee Revising our Firearm Violence Resolution

Our AzPHA Policy Committee has been hard at work updating our existing Resolution on firearm injuries and deaths to prepare for the upcoming legislative session. 

From 2009 through 2013, Arizona had more than 5,500 suicides, 2,000 homicides and another almost 900 undetermined deaths- needless to say these deaths represent a tremendous public health challenge in Arizona. 

The social costs to the community and the overall quality of life for Arizona residents are adversely impacted by homicides and suicides in our communities. 

Among the resources that the team is using are the compilation of research papers and analytic essays on public health and firearms on the APHA website.  Firearm research is available now available to everybody (including non-members) regarding the effect of state legislation on firearm homicide, interventions to improve safe firearm storage, employer firearm policies and workplace homicide, public opinion on carry laws.

Also included is research on role firearms play in establishing homicide as a leading cause of death for pregnant and postpartum women, the urban-rural differences in firearm suicides, how law enforcement and firearm retailers can serve as partners in suicide prevention, loaded handgun carrying, the financial cost of firearm injury, among other subjects.

Violent death surveillance data are available from the CDC and their National Violent Death Reporting System (NVDRS), which provides data to better understand violent deaths and to guide local decisions about efforts to prevent violence and track progress over time (the NVDRS is the only state-based reporting system that pools data on violent deaths from multiple sources into a usable, anonymous database).

The extensive data abstraction process collects information covering all settings, age groups and circumstances of violent deaths. The system gathers and collates information on violent deaths from: 1) State health department official death certificate data; 2) Medical Examiner reports at autopsy; and 3) Law enforcement investigation reports.

Many States Using State Earned Income Tax Credits as a Prevention Strategy for ACEs

Is it Arizona’s Turn?

It’s no secret that exposure during childhood to negative events called adverse childhood experiences increase a person’s likelihood of having long-term chronic or behavioral health issues like heart disease, violence, suicide, and substance use.  ACEs like child abuse, neglect, parent incarceration, substance use, or separation are often clustered.

Policymakers in many states are looking for ways to prevent ACEs… which includes strategies to strengthen protective factors like social connectedness, access to healthcare and community resources, enhancing parental skills to promote healthy child development, and providing quality care and early education, and reduce risk factors before they occur. Arizona took a step forward this year by passing a budget bill that will draw down more than $60M in additional funds to support affordable childcare in Arizona.

Leading evidence-based policies to prevent ACEs before they occur are usually linked in some way to strengthening economic supports to help working families out of poverty and reduce parental stress. One well known economic support is the federal Earned Income Tax Credit

Many states are recognizing that they can also play a role through their state-based tax codes – and implementing Earned Income Tax Credits at the state level. Arizona hasn't done so yet.

Here’s how they work. The Earned Income Tax Credit is a refundable income tax credit that can be used to reduce the tax burden for low- to moderate-income working people.  The federal government along with 29 states have established them at the local level. Arizona doesn’t.

Economic support from Earned Income Tax Credits is associated with improved infant and maternal health, better school performance for children, and increased college enrollment. Research suggests they reduce risk factors for child abuse and neglect ACEs by offsetting the costs of raising a child among working families.

This webpage from the National Conference of State Legislatures has a host of information about which states have state based Earned Income Tax Credits and how they work. They’re usually based on a reference to the federal EITC.

State Earned Income Tax Credits are a promising economic support for working families that help to raise more than six million people—half of them children—above the poverty line each year.

Arizona lawmakers have long had a zeal for reducing taxes.  Perhaps next year they should look at taxes from a new angle- using tax policy to support an evidence-based policy a state based earned income tax credit- that will that prevent negative childhood events and bad public health outcomes.

Arizona Research will Change EMS Brain Injury Care

Traumatic brain injury is involved in about 1/3 of all injury-related deaths... it’s clearly a public health issue.  That’s why back in 2013 Arizona created the Excellence in Pre-hospital Injury Care (EPIC) project- which has been aimed at improving brain injury outcomes in AZ. 

Back in 2013 the National Institutes of Health chose AZ as the only state to evaluate the national standards for pre-hospital emergency care of brain injury (under a grant application led by AZPHA member Ben Bobrow, MD). 

EPIC has been a unique partnership between state government, the U of A and more than 130 fire departments and ground/air ambulance companies.  Together they implemented a series of pre-hospital traumatic brain injury treatment interventions and measured the effectiveness of the results.

The interventions included: 1) prevention of hypoxia by early oxygen administration; 2) airway interventions to optimize oxygenation; 3) prevention of hyperventilation; and 4) quickly treating low blood pressure by infusing fluids.

Participating EMS agencies sent treatment information to the ADHS and the UA College of Medicine for tracking and evaluation. An early donation from the Ramsey Justice Foundation made it possible for the agencies to receive special breathing devices to implement the new protocol and assist in the treatment patients at no cost.

More than 5 years of work by literally hundreds of Arizonans resulted in the publication of the results this week in JAMA Surgery entitled Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines with Patient Survival Following Traumatic Brain Injury.

Remarkably, the team found that implementation of the protocol doubled the chances of survival among persons with a critical traumatic brain injury and improved neurological outcomes. Doubling the chances of survival is no small thing for a public health intervention, so this is really a landmark study.

This Arizona study will change the way EMS providers treat traumatic brain injury in the field around the globe. That shows the importance of publishing. When hard work like this with dramatic results is published in reputable journals- people take note. It won’t be long before the Arizona protocol becomes a global EMS standard for traumatic brain injury care. For more info go to

A huge public health thank you to the entire research team including Dan Spaite, MD; Ben Bobrow, MD; Sam Keim, MD, MS; Bruce Barnhart, RN, CEP; Vatsal Chikani, MPH; Joshua Gaither, MD; Duane Sherrill, PhD; Kurt Denninghoff, MD; Terry Mullins, MPH, MBA; P. David Adelson, MD; Amber Rice, MD, MS; Chad Viscusi, MD; and Chengcheng Hu, PhD.

Preventing Suicide: A Toolkit for High Schools

SAMHSA has a toolkit that is aimed at being part of a nationwide effort to help the one out of every fifteen high school students who attempt suicide each year. The toolkit is called Preventing Suicide: A Toolkit for High Schools and it helps high schools and school districts to design and implement strategies to prevent suicide and promote behavioral health.

It provides guidelines for school administrators, principals, mental health professionals, health educators, guidance counselors, nurses, student services coordinators, teachers and others for identifying those teenagers who are at risk and it provides resources for taking appropriate actions to provide help.

It provides high schools with useful information on the many federal, state and community programs that are available to help strengthen their suicide prevention efforts, including the National Suicide Prevention Lifeline (link is external) 1-800-273-TALK (8255). This Lifeline is a 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress.

Legislative Update

The only committees that met last week were Rules and Appropriations. The other standing committees (e.g. Health and Human Services) have finished their work. The House Appropriations was particularly dramatic with several strike-everything bills and tensions running high- but nothing really tied to the public health bills we’re interested in. 

We have a whole bunch of bills that need to make it through the Rules Committees (especially the House Rules Committee) before they can go to the floor (the Rules Committee's job is to basically make sure the bill is constitutional). 

Lots of the bills that we care about will be heard this week in the Rules Committee Monday at 1:30pm (here's the agenda). I put an asterisk by the bills below that will be heard Monday. If they all pass- they could move quickly to floor votes (3rd read) this week. Here's this week's spreadsheet summary of the bills.

Bills that have been amended in the opposite house will need to return to their house of origin for another vote.  If there isn't agreement on the amendments, there may need to be conference committees set up to hammer out a solution.

In other news, we were delighted to see that the Senate Health and Human Services Committee this week unanimously recommended that Jami Snyder’s confirmation by the full Senate to be the new AHCCCS Director.  Her nomination will now go to the Senate floor for confirmation.

Steve Pierce was appointed to fill Representative Stringer's seat in District 1 late in the week- which is why there was no floor action in the House this week. 

Bills that still need Floor Votes (3rd Read)

* Means bill will be heard in the Rules Committee Monday (1:30pm).

* SB 1040 Maternal Mortality Report (Brophy-McGee) – AzPHA Position: YES

Passed the Senate 30-0. Bill Passed the House Health Committee 9-0. Rules Committee this week. 

* SB 1085 Association Health Plans- 

Passed the Senate 24-6.  Passed the House Health and Human Services Committee 6-2-1. Rules Committee this week. 

SB 1088 Dental Care During Pregnancy (Carter) – AzPHA Position: YES

Passed the Senate 27-3.  Passed the House Health & Human Services Committee 8-1.  Passed House Appropriations 7-4. Rules Committee Next. Will still need to get into the final budget.

* SB 1089 Telemedicine Insurance Coverage (Carter) – AzPHA Position: Yes

Passed Senate 30-0. Passed the House Health & Human Services Committee 9-0.  Rules Committee this week. 

* SB 1165 Texting and Driving Prohibition (Brophy McGee) – AzPHA Position: YES

Passed Senate 20-10. Passed the House Transportation Committee 5-1-1.  Rules Committee this week. 

SB 1174 Tribal Area Health Education Center – AzPHA Position: Yes

Passed Senate 30-0. Passed the Senate Education Committee 13-0. Rules Committee Next.

* SB 1211 Intermediate Care Facilities (Carter) AzPHA Position: Yes

Passed the Senate 30-0. Passed the House Health & Human Services Committee 9-0. Rules Committee this week. 

* SB 1247 Residential Care Institutions (Brophy McGee) AzPHA Position: Yes

Passed the Senate 30-0.  Bill passed the House Health Committee 9-0. Rules Committee this week. 

SB 1245 Vital Records- Death Certificates (Brophy McGee) AzPHA Position: Yes

Passed the Senate 30-0.  Passed through all House Committees- ready for a Floor Vote.

SB 1354 Graduate Medical Information & Student Loan Repayment (Carter) AzPHA Position: Yes

Passed Senate 28-2.  Passed House Appropriations Committee 10-1, Withdrawn at the HHS Committee, but can still move forward if it can pass the Rules Committee. This is the most important access to care bills this year- it would do a great deal both in the short-term by boosting the primary care loan repayment program and really enhancing graduate medical education residencies over the coming years (important because where a practitioner does her or his residency greatly influences where they ultimately practice).

HB 2125 Child Care Subsidies (Udall) – AzPHA Position: YES

Passed House 46-13.  Passed the Senate Health and Human Services Committee 7-0-1. Rules Committee Next.

* HB 2488 Veteran Suicide Annual Report (Lawrence) AzPHA Position: Yes

Passed House 60-0. Passed the Senate Health and Human Services Committee 7-0-1. Passed 29-0 in the Senate, sent back to House because it's different than the original bill.  

SB 1009 Electronic Cigarettes, Tobacco Sales (Carter) – AzPHA Position: YES

Passed the Senate 30-0. Assigned to the House Health and Human Services Committee but didn't get a hearing- not a good sign.

* SB 1355 Native American Dental Care – AzPHA Position: Yes

Passed Senate 25-5.  Passed the House Health & Human Services Committee 9-0. Rules Committee this week. 

SB 1456 Vision Screening- AzPHA Position: Yes

Passed Senate 29-0. Passed the House Health & Human Services Committee 9-0. Rules Committee Next.

* SB 1468 Suicide Prevention- Schools- AzPHA Position: Yes

Requires school districts, charter schools, and Arizona teacher training programs to include suicide awareness and prevention training and requires the Arizona Health Care Cost Containment System Administration (AHCCCS) to make suicide awareness and prevention training available. Rules Committee this week. 

SB 1060 (Strike-all Amendment) Electronic Cigarettes. Smoke Free Arizona Act (Carter) – AzPHA Position: YES

Passed the Senate 28-0. Assigned to the House Health and Human Services Committee- but not heard.  Not a good sign. Probably dead.


Bills that Have Been Passed & Signed by the Governor

SB 1109 Short Term Limited Health Plans- extension – AzPHA Position: Opposed

This bill has passed both chambers and has been signed by the Governor.  It authorizes the sale of short- term limited health plans in Arizona for terms up to 3 years.  The previous limit was 1 year.  These plans don’t cover pre-existing conditions and have limited consumer protection because they aren’t required to cover the essential health services under the ACA and can drop enrollees.  We urged a not vote because of the poor consumer protections.

Today's National Public Health Week Topic: Violence Prevention

Gun violence is an epidemic in America. On this second day of National Public Health Week — which has a daily theme of “Violence Prevention” — about 100 Americans will be killed with guns, and hundreds more will be injured.  That's just today.

Beyond gun violence, 1 in 4 U.S. women experience intimate partner violence, 1 in 6 has been the victim of rape or attempted rape, and hundreds of thousands of children experience abuse and neglect. Yet violence is preventable with the right research, resources and policies.

In support of today’s NPHW theme, urge policymakers to pass commonsense measures to reduce gun violence and provide research funding on par with the nation’s gun violence epidemic. Learn about ways to help make your community safer for all, such as using trauma-informed services to identify victims of violence and calling on law enforcement officials to treat all people with dignity, respect and fairness.

Also remember (see below) that we have some free upcoming free Mental Health First Aid Certification Opportunites for AzPHA Members.

For more on Tuesday’s NPHW theme and ways to take action, read our Violence Prevention fact sheet and help spread the word on social media. And join APHA and the Coalition to Stop Gun Violence for a gun violence prevention Twitter chat at 4 p.m. ET today. Use the hashtag #PublicHealth4GVP to join in.

Also today, as part of APHA’s NPHW celebrations, the Association will host a webinar at 3 p.m. ET with the Aetna Foundation and U.S. News & World Report on the recently released Healthiest Communities ranking. RSVP for the event now.

Join APHS tomorrow for the 9th annual #NPHWchat hosted by @NPHW (RSVP here), and on Thursday for NPHW Student Day activities. Don’t forget to check our calendar of local NPHW events to see what’s happening in your community.


Free Mental Health First Aid Certification Opportunities for AzPHA Members

AzPHA is delighted to announce that we’re partnering with Crisis Response Network to provide our members a free opportunity to become certified in Mental Health First Aid.  We’ll have 3 separate opportunities in the next few months to take the 8-hour (one day) Mental Health First Aid course in which you’ll learn risk factors and warning signs for mental health and addiction concerns, strategies for how to help someone in both crisis and non-crisis situations, and where to turn for help.

When you take a course, you’ll learn how to apply the Mental Health First Aid action plan in a variety of situations, including when someone is experiencing:

  • Panic attacks

  • Suicidal thoughts or behaviors

  • Nonsuicidal self-injury

  • Acute psychosis (e.g., hallucinations or delusions)

  • Overdose or withdrawal from alcohol or drug use

  • Reaction to a traumatic event

Upon completion of the one-day course you’ll receive a three-year certification.  It’s a terrific opportunity to build your public health skill set while enhancing your professional credentials.

We’re offering the free Mental Health First Aid course on:

If you have any questions or concerns please reach out to Shelby Graves at

Distracted Driving: A Clear and Present Danger

Distracted driving kills people just like impaired (drunk) driving does. Thousands of people each year are killed by distracted drivers.

There are a lot of ways people can be distracted while driving... it happens anytime you take your eyes off the road.   Any non-driving activity is a distraction that increases your chances of crashing and hurting or killing yourself, your passengers or other drivers.

Let's face the facts.  Our cell phones are an increasing part of our lives whether we want to admit it or not.  It seems perfectly natural to pick up your smart phone and check email or texts or other social media, like twitter.  Sometimes we do it while driving, like at a stop light - when the main problem is not seeing that the light has turned green and the driver behind you honks at you to get going.  You make it through the light but the guy behind you doesn't.  That's a harmless irritation.

But sometimes people check their phones while they're driving- and that's what's lethal. Sending or reading a text or checking or social media takes your eyes off the road for at least 5 seconds.  At 55 mph, that's like driving the length of an entire football field, blindfolded. 


The Data

A study published in the New England Journal of Medicine found the risk of crashes increases significantly when:  dialing a cell phone (odds ratio 8); reaching for a cell phone (odds ratio 7); sending or receiving text messages (odds ratio 3.9); reaching for an object other than a cell phone (odds ratio 8), and eating (odds ratio 3).  In other words, a person dialing a cell phone while driving is at an 800% increased risk of crashing.

Does that sound safe to you?  Of course not, but chances are you've done it.  It's super dangerous, but most of us don't recognize how dangerous it is.

The National Traffic and Highway Safety Administration (NTHSA) tracks data regarding distracted driving…  allowing elected officials to have some data with which to make public policy regarding texting or social media and driving. 

So, we know that distracted driving is a clear and present danger.  The question is what should we do about it in terms of public policy?  Many states have made public policy decisions to reduce distracted driving from cell use- but AZ (as a state) has not been one of them so far.

Cell Use Laws

Currently, 46 states ban text messaging for all drivers.  Forty-one of those even have primary enforcement, meaning that law enforcement folks can pull you over for violating the distracted driving law.  

Of the 4 states without an all driver texting ban (Arizona is one of those 4), 2 at least prohibit texting by novice drivers.  In Arizona, the only restriction applies to school bus drivers and people under 18 in the first 6 months of their learner’s permit.  Montana doesn't even prohibit school bus drivers from texting. NTHSA tracks what the state laws are that address distracted driving.  You can visit their State Laws page to what the laws are in the various states.  

Over the years Arizona lawmakers have introduced bills that tried to put a little muscle into distracted driving laws, to no avail.  This year there’s increasing optimism that AZ might actually be able to pass a law that deals with distracted driving because of the makeup of the new legislature.  

SB 1165

There have been a few cell-use bills proposed this year.  We’re supporting SB 1165, sponsored by Senator Kate Brophy McGee because it’s the most comprehensive of the bills.  It’s progressing nicely- passing through the Senate by a vote of 20-10.  It basically prohibits using a hand-held cell phone while driving with some common-sense exemptions (for example if the person is using it hands free etc). 

Violations are a civil money penalty (no driving points) with the first offense being between $75- $150 and the 2nd offense between $150 and $250.  The bill would provide a state overlay so the cell phone use laws would no longer be different from jurisdiction to jurisdiction.  Warnings would be given between now and January 1, 2020- with the citations coming after that.

Interested in adding your voice and learning more about how you can make a difference?  You could always join AZPHA and participate in our Public Policy Committee which continually tracks and advocates for bills like these that enhance public health in Arizona.

Interested in learning more about distracted driving generally?  Check our NTHSA's website on distracted driving.

Legislative Committee Hearings This Week

Senate Health & Human Services Committee

Wednesday, March 13, 9 am (SHR 1)


HB 2125 Child Care Subsidies (Udall) – AzPHA Position: YES

Passed House 46-13.  Assigned to House Health and Human Services Committee.


HB 2488 Veteran Suicide Annual Report (Lawrence) AzPHA Position: Yes

Passed House 60-0. Assigned to Senate Health and Human Services Committee.

House Transportation Committee

Wednesday, March 13, 2 pm (HHR 2)


SB 1165 Texting and Driving Prohibition (Brophy McGee) – AzPHA Position: YES

Passed Senate 20-10. Assigned to House Transportation Committee. 

House Health & Human Services Committee

Thursday, March 14, 9 am (HHR 4)

SB 1088 Dental Care During Pregnancy (Carter) – AzPHA Position: YES

Passed the Senate 27-3.  Assigned to House Health & Human Services Committee.


SB 1211 Intermediate Care Facilities (Carter) AzPHA Position: Yes

Passed the Senate 30-0. Assigned to House Health & Human Services Committee.