East Oregonian

Umatilla County Health message to cigarette advertisersBig tobacco, tear down this wall

In-store advertising seduces would-be smokers, hopeful quitters

Tobacco companies can no longer advertise through billboards, radio or television, but they can still pour millions of dollars into “power walls.”

The walls are hard to miss, located behind the cashier at many convenience stores — an expanse of hundreds of tobacco products, logos and colorful posters. The vibrant barrage of tobacco advertising worries many who work to keep kids from smoking.

“We don’t have tobacco billboards or tobacco ads on TV, but in Oregon, the tobacco industry spends $112 million every year on ads and promotions,” said Janet Jones, community health educator for Umatilla County Public Health. “The tobacco industry spends an inordinate amount of money at the point of sale.”

Umatilla County recently won a $133,000 grant to fund a tobacco prevention coordinator. The mission? To make tobacco less appealing to youth.

According to Centers for Disease Control and Prevention research, power walls and other displays seduce young, would-be smokers. The opposite is also true for adolescents: If smoking is out of sight, it’s out of mind. However, more than 90 percent of middle school and high school students reported seeing tobacco ads inside convenience stores, on store fronts or online. Research has established a causal relationship between advertising and teens starting to smoke.

“We know kids who regularly see tobacco advertising are more likely to experiment with tobacco,” Jones said.

Grant funding will allow the county to explore the issue. Coordinator selection is in process. Jones expects the 18-month effort to spark “an open and honest conversation about how tobacco is sold in our local communities,” starting in Pendleton, Hermiston, Milton-Freewater and Umatilla. The subject is a relevant one, said Jones.

“Tobacco is still the leading preventable cause of death,” she said.

According to a statewide survey by the Oregon Health Authority, about 12,700 people in Umatilla County smoke. Twenty-three percent of Umatilla County adults smoke compared with the statewide average of 19 percent. Almost 3,000 have serious illness caused by tobacco and each year 148 of them die a tobacco-related death. More than a quarter of 11th graders smoke or use non-cigarette tobacco.

The effort to tackle the issue locally rather than at the state level came after the demise of a bill to license tobacco retailers. Senate Bill 1559 would have combated sales to minors by licensing retailers with the Department of Revenue and revoking the license for repeat violations, much the same as with alcohol.

“Oregon is one of the few states that doesn’t have tobacco retail licenses,” Jones said. “In Oregon you have to have a license to sell Christmas trees, but you don’t need a license to sell tobacco.”

The bill was set aside after it became something of a partisan bargaining chip, according to the bill’s sponsor, Sen. Elizabeth Steiner Hayward, D-Beaverton, who accused Republicans of acting childishly and putting politics ahead of children.

Sen. Bill Hansell (R-Athena) said the Senate simply ran out of time to sand down some of the rough spots before the short session ended. An example of a rough spot was a section of the bill that would have prevented new stores from selling tobacco within 1,000 feet of schools. Current businesses would have been grandfathered in, but transfers to new owners, even those in the family, were not.

“In Athena, we have two establishments that would both fall within 1,000 feet,” he said. “If they sold the businesses, the grandfathers would not go with them.”

He expects a similar bill to show up in next year’s full session.

“I’m sure it will be back and we’ll have time to work through it,” he said.

A couple of Oregon counties (Lane and Multnomah) and one city (Cottage Grove) aren’t waiting. They acted to require licenses at the local level to sell tobacco or inhalant delivery systems such as e-cigarettes. Umatilla County is taking this first step to develop a strategy.

Jones said the Umatilla County effort will engage retailers, community partners and especially youth.

“Youth have a lot of power and they care about their generation,” Jones said.

Toni Walters, who manages Dave’s Chevron, explained that the “power wall” is the result of agreements with tobacco companies.

“Tobacco companies offer merchant contracts that bring down prices of cigarettes,” Walters said. “In exchange, the power wall is put up the way they want it.”

Shawn Abdullah, owner of Bare Bones in Pendleton, didn’t reject the idea of working with the county’s new coordinator, but he doesn’t necessarily think it’s the correct approach. Many of the young smokers he knows have parents who smoked and provided a bad example. Boosting the smoking age to 21 as California is considering might push off the decision to smoke until they are more mature.

“I think it’s the only way,” he said. In any case, “we always ID anyone who looks 26 or younger.”

He stood near the store’s wall of cigarettes, cans of chewing tobacco, vaping supplies and tobacco posters. The store focuses on adult products such as tobacco and alcohol, though it also offers beverages and snacks.

Jone said tobacco advertising in stores affects not only adolescents, but former smokers and other adults who are trying to quit.

“We are really out to keep the next generation from being addicted to tobacco,” she said. “We also want to help the 75 percent of tobacco users who are trying to quit.”

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Contact Kathy Aney at [email protected] or call 541-966-0810.

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Syphilis spikes in state

Umatilla County experiences gonorrhea epidemic

On a graph, the spike in Oregon syphilis cases looks like a piece of steep roller coaster track climbing into the sky.

Oregon health officials say that the number of cases increased by 1,500 percent since 2007 — from 30 to 450 so far in 2015.

Syphilis is a bacterial disease spread mostly by sexual activity. Men make up 90 percent of the cases. Gay and bisexual men are the biggest demographic.

So far, the state trend hasn’t touched Umatilla County — the last time the county had a case of syphilis was 2013 — but a rise in syphilis may be on its way. Gonorrhea is epidemic here. The county had 63 cases this year, up from 48 in 2014, 21 in 2013 and four in 2012.

“It’s increasing exponentially,” said Umatilla County Public Health Nursing Supervisor Sharon Waldern.

The upswing in gonorrhea likely means a rise in the even-more-dangerous syphilis is right around the corner, Waldern said.

“It’s a pattern we’ve seen at the state level and in other counties,” Waldern said. “They saw a sharp increase in gonorrhea infections initially followed by a dramatic increase in syphilis.”

The two STDs share risk groups, which include men who have sex with other men, illicit drug users, people with HIV and people with multiple sexual partners. Differences in testing might explain the lag.

“The gonorrhea/chlamydia test is an easy, fairly inexpensive text,” Waldern said. “Syphilis testing costs more and requires a blood draw and interpretation of the results.”

Dr. Sean Schafer, a medical epidemiologist with the Oregon Public Health Division, is worried about the statewide jump in syphilis.

“It’s huge,” Schafer said. “We’re alarmed and we would really like to see more people at risk get screened.”

The numbers have ebbed and flowed over the years, though a couple of decades ago some thought syphilis was on its way out.

“It’s a disease that’s been around forever,” he said. “We had hope of eliminating it in the early part of the last decade, but that didn’t materialize.”

Because syphilis is epidemic in the Portland metro area, an organization call Syph Aware recently rolled out a public awareness campaign that includes signs on TriMet buses and MAX trains.

The group’s website proclaims “Oregon is known for many things: natural beauty, coffee, beer and pinot noir. Did you know that Oregon is also known for syphilis?”

Syphilis is stealthy. The disease often appears as a small painless sore in the genital or mouth areas. After three to six weeks or so, the sore disappears. The next stage, which varies in length from weeks to months, brings a non-itchy rash or spots on the palms or the soles of the feet and sometimes fever, swollen lymph nodes or headaches.

Then it goes silent. The damage appears sometimes decades later in the form of tumors, blindness, paralysis, dementia or damage to the nervous system.

Pregnant women are of special concern because they can pass the infection to their babies. Schafer recommends screening at the first prenatal visit, at 28 weeks and again at delivery.

Both Schafer and Waldern say they are urging physicians and other health care providers to be systematic when gathering information from patients and taking meticulous sexual and drug use histories.

“Syphilis has been so rare for so long that a lot of physicians have never seen a case,” Schafer said. “It’s not that they’re bad clinicians, they just haven’t seen it.”

Earlier this month, Umatilla County Public Health sent letters to providers to alert them to the gonorrhea spike, its implications and recommendations for screening.

Syphilis is treated with antibiotics.

Schafer doesn’t expect the syphilis numbers to drop soon. In fact, he hopes they rise because that would mean more people are being tested. Eventually, if all goes well, the numbers will start to wane.

“We want to diagnose more syphilis, not less,” he said. “We should see an increase in syphilis if our campaign is successful.”

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Contact Kathy Aney at [email protected] or call 541-966-0810.

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Umatilla County overhauls addiction treatment

Umatilla County’s troubled human services department is no more.

The board of county commissioners dissolved the department Wednesday in the face of a possible criminal investigation of its former director and two alcohol and drug counselors.

Commissioner George Murdock said addiction treatment and other services the department provided will continue under the purview of the Community Justice Department.

“It might not be under community justice forever, but it will not be a separate department again,” he said.

Murdock and fellow commissioners Bill Elfering and Larry Givens have spent the past couple years winnowing the number of departments in county government from 12 to eight and eliminating or combining department heads. This revamp might be the biggest move yet and results in cutting two manager positions.

In April, the county suspended then-human services director Carolyn Mason and husband-and-wife counselors Laura Aviles-Valdez and Juan Valdez while Greater Oregon Behavioral Health, Inc. investigated the department. The county fired the trio June 4, and GOBHI turned over its findings to the Oregon Department of Justice for a possible criminal investigation.

Murdock said the vacancies presented the county with an opportunity to restructure how it would provide addiction services. Murdock, outgoing community justice director Mark Royal, incoming community justice director Dale Primmer, human resources head Jennifer Blake and county counsel Doug Olsen held a flurry of meetings to put a plan together.

Now two positions will oversee the nine counselors providing alcohol and drug treatment. Mike Graber, program manager in community justice, will handle treatment operations, and Charlie Carnes, who worked in the county’s juvenile department, will supervise clinical services.

Carnes has the “extensive certification” required for that role, Murdock said, and that is the only new position created by the restructuring.

He also said county will not hire a program manager in place of Graber, and those savings, along with cutting the human services director, will go to providing direct services to clients.

Murdock also said the county enhanced its billing program to take advantage of reimbursements from federal and state sources.

“It’s money that’s been available to us, but we have not billed for it,” he said. “We think we can pay for 80 percent of our services through this.”

Veterans services and the developmental disabilities program also will be under community justice.

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Contact Phil Wright at [email protected] or 541-966-0833.

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Top employers take different approaches to drug tests

Measure 91 will change many things on July 1, but it won’t change a common practice among many large employers — drug screening.

Although marijuana possession and consumption will become legal this summer, Oregon legislators will continue to give employers the discretion to block a hire or terminate an employee based on a positive marijuana test.

Based on the changing landscape, two of Pendleton’s largest employers are taking different tacks when it comes to screening for marijuana.

Tom Young, the finance manager for Keystone RV Co., said the city’s second largest employer won’t change its drug testing policy.

In addition to marijuana, Keystone tests for other narcotics and alcohol.

Young, who’s also a member of the Pendleton City Council, said Keystone initiates tests in three different situations — a pre-employment screening, after work-related accidents and “probable cause” incidents where the company suspects an employee is impaired.

Young stressed that Keystone’s policy wasn’t anti-marijuana, but rather anti-impairment — the company wants to use drug tests to avoid work related mishaps that could endanger employees.

“We don’t need people lopping off fingers because they’re impaired,” he said.

There are a few exceptions to the rule. Young said employees and candidates can pass a drug test with the presence of prescription drugs in their system as long as they inform the tester ahead of time and show proper documentation.

That exception doesn’t apply to medical marijuana. Young said any type of marijuana is still grounds for termination because it’s against federal law.

Marijuana and other mind-altering substances have kept many potential employees from finding work at Keystone — Young said 40 percent of Keystone candidates are rejected because they couldn’t pass the pre-employment drug screening.

While marijuana regulations are loosened in Oregon and other states around the country, Young doesn’t anticipate Keystone changing its policy any time soon.

According to a 2014 survey by the Pendleton Chamber of Commerce, Keystone employees 565 people, second to only the Confederated Tribes of the Umatilla Indian Reservation as a source of jobs.

Many of the 1,612 employees of CTUIR work for the Wildhorse Resort and Casino, which recently changed its policy to allow the hiring of workers who test positive for marijuana.

Citing the length of time marijuana stays in a person’s system and the high percentage of workers that come from off the reservation, Wildhorse CEO Gary George told the Confederated Umatilla Journal that marijuana will no longer be a drug that prohibits a candidate from getting a job at the resort and casino.

This development comes as a surprise considering the tribal government’s steadfast ban on marijuana on the reservation.

George wrote in an email to the CUJ that managers could test employees they suspected were high on marijuana, similar to the way they would test employees that were under suspicion for being drunk.

“Personally, I don’t see any difference between marijuana and alcohol,” he wrote. “Except for Wildhorse and the Coyote Business Park, alcohol is illegal on the Umatilla Indian Reservation. At the present, marijuana illegal on the Umatilla Indian Reservation.”

Although Wildhorse’s location on tribal land differentiates it from Keystone, all employers will be faced with internal policy questions as marijuana laws come into effect.

Charlie Burr, the spokesman for the Oregon Bureau of Labor and Industry, said Measure 91 specifically states the legalization of marijuana won’t prohibit businesses from screening for marijuana.

Burr said the bureau recommends businesses adopt an explicit, written drug policy to prevent discriminatory practices.

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Contact Antonio Sierra at [email protected] or 541-966-0836.

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Listening session hears this: keep marijuana away from minors

Area residents told policymakers they do not want minors to have access to recreational marijuana and they want parents to handle educating children about the substance.

The messages came out Thursday night at the Pendleton Convention Center during the Oregon Liquor Control Commission’s kickoff to developing regulations for Measure 91, the state’s recreational pot law voters approved last November. More than 80 people attended the two-hour session to give feedback and learn about the law. The commission held its first listening session earlier Thursday in Baker City and OLCC chairman Rob Patridge said eight more sessions are in the works.

The crowd worked in small groups to list priorities it wants the OLCC to consider. Protecting children came up over and again, especially through clear packaging, limiting pot advertising and stiff penalties for selling to minors.

Most participants also wanted some kind of educational advertising and said the state needs to promote parents as responsible to educate children about pot. Some stressed education about marijuana should be unbiased and fact-based.

Patridge, who in his day job is the district attorney of Klamath County, explained to the audience that the law gave the liquor commission the job of regulating recreational pot and approving retail pot sales licenses for the new market. Possessing up to 8 ounces of pot and four plants in your home becomes legal under the state law July 1, but Patridge said OLCC rulemaking will take place March through October, and the commission must start approving retail sales licenses Jan. 4, 2016.

“As you can see, we’re on a pretty tight timeline,” he said.

Some in the crowd, including Pendleton City Councilman Chuck Wood, lamented what they saw as a backward approach of allowing marijuana before rules are in place.

Thursday’s gathering ended with a question and answer session, and the big takeaway is that a lot of unknowns remain. Patridge said there are people already lobbying for a changes to the law in the forthcoming Legislature.

Before the public session, Patridge and staff had a closed-door meeting with local law and enforcement and city leaders, including Pendleton police Chief Stuart Roberts, Hermiston police Capt. Travis Enyon and Umatilla County Sheriff Terry Rowan. After the public session, Patridge said cops and civic heads were like the rest of Oregonians: seeking to understand what the law means. He said the OLCC will help local governments “draw clear lines” regarding the law.

To find out more about Measure 91, the OLCC set up www.marijuana.oregon.gov.

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House calls, not ER visits

Community health workers make free stops at patients’ homes to encourage preventative care

Maybe all that’s needed to cure out-of-control health care costs are house calls, early intervention and compassion.

That’s the idea behind Connexions, a two-month-old program based at Good Shepherd Medical Center that uses community health workers to improve lives while cutting the cost of future care.

Boardman resident Lisa Rose opened her front door Monday to find two community health workers on her porch. Heather Metcalfe and Catie Brenaman had stopped by to check on Rose, who was diagnosed with multiple sclerosis in March. The two community health workers initiated small talk, petted the dog, then started asking questions about Rose’s condition.

“When was your last fall?” Brenaman asked.

“Friday,” said Rose, who had parked her walker and eased into an overstuffed chair. She wore a purple sweatshirt emblazoned with the word “Whatever…” and stroked the fur of Mia, who had jumped onto her lap.

Brenaman, who has a public health background, and Metcalfe, a nurse, aim to improve health and keep people from needing expensive emergency room care by visiting people in their homes, helping their clients set health goals and carry them out. The service is free to anyone in Umatilla and Morrow counties. Referrals come from agencies, concerned friends and family members and individuals themselves.

At Rose’s apartment on Monday, the trio discussed doctor’s visits, medications, physical therapy, a faulty shower chair, transportation, smoking cessation, insurance, stress and the ultra-dim lighting in Rose’s apartment that might contribute to falls. Brenaman and Metcalfe often connect clients with services and communicate with providers on their behalf (after the proper release of information documents are signed). They make calls, assist in filling out applications for various social services, pick up prescriptions and whatever else they believe could help. In a rolling tote, the community health workers carry client files, exam gloves, a blood pressure cuff, scales, glucose monitor, advance directives, a computer and other tools of the trade.

New clients often initially react with suspicion, then with gratitude.

“The first visit can be a little tearful from the stress of it all,” Brenaman said. “You can see the relief, the smiles.”

Metcalfe and Brenaman are joined by two other community health workers, Leidi Rodriguez and Maritza Madrigal. Both have medical backgrounds and are fluent in Spanish. The program is catching on so quickly, the workers may have to find a way to clone themselves.

At first, referrals trickled in, Brenaman said, but now are up to more than 10 each day.

At a formal launch this week of the program, Brenaman, Metcalfe and others associated with the program spoke to about 65 people from various agencies and the public who had gathered for lunch in a hospital conference room about Connexions. Juli Gregory, Good Shepherd’s Director of Education Services, said the need for this personal and proactive service is great.

“People keep falling through the cracks,” Gregory said. “This is a team approach. Hopefully, it will decrease inappropriate use of the ER and the doctor’s office. Some people use the ER as their doctor. Some don’t go to the doctor at all.”

Good Shepherd Educator Kathy Thomas shared some heady statistics.

“The use of community health workers has reduced health care spending by $4 billion (in the U.S.) and saved over 15,000 lives,” Thomas said. “This data helped define our program.”

The program is one of 23 funded by Transformation Grants awarded by the Eastern Oregon Coordinated Care Organization using $1.6 million in funds provided by the State of Oregon Transformation Center. The EOCCO, which serves 12 Eastern Oregon counties, examined 36 proposals, looking for innovation and ideas that could be transferred to larger populations.

The EOCCO awarded three grants in Umatilla County. Good Shepherd received $91,290. The Yakima Valley Farm Workers was awarded $100,000 to embed a behavioral health clinician at the Mirasol Family Health Center in Hermiston. Lifeways received $88,118 to place community health workers inside St. Anthony and Good Shepherd to focus on people with behavior health issues who end up at the emergency room in crisis.

A Morrow County project uses a care team to improve prenatal care, promote well-child checkups and encourage screening for children and pregnant women.

The grants pay for a year of service. Kevin Campbell, the CEO of the EOCCO, said he is cautiously optimistic the funding will continue.

“There’s a lot of pretty innovative stuff here,” he said. “This is an incubator for creative ideas. I expect a good return on the investment.”

Lisa Rose said Connexions is a blessing after a frightening diagnosis.

“It’s scary,” she said. “They help me figure out what to do and where to go.”

For more information about Connexions, call 541-667-3504 or go to [email protected].

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Contact Kathy Aney at [email protected] or call 541-966-0810

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