BISMARCK, N.D. – North Dakota's efforts are leading the nation to keep kids away from tobacco and help those that do smoke, quit. A national report lists North Dakota as one of only two states in the country that funds tobacco prevention and cessation programs at levels recommended by the Centers for Disease Control and Prevention.

Donna Thronson, the health communications coordinator with the North Dakota Center for Tobacco Prevention and Control Policy, known as "Breathe N-D," says they work with people at the local level.

"We fund local public health units across the state to do community intervention on tobacco prevention," she explained. "They go into schools, and build comprehensive tobacco-free policies. And our work is never done, because you know, with the introduction of e-cigarettes, they had to go in and update all the policies."

North Dakota will collect almost $67 million this year from the 1998 state Tobacco Master Settlement, and will spend almost 15 percent of the money on tobacco prevention programs.

While 15 percent may not sound like much, most states divert all their federal tobacco-settlement money for other purposes. Thronson says North Dakota plans to continue its investment in keeping people from becoming tobacco users.

"The rest of the payments that come in, to the tune of a half-billion dollars, are payments that will continue in perpetuity," she said. "So, these funds we have were never designated for anything but tobacco prevention."

Outgoing Gov. Jack Dalrymple had wanted to eliminate the Center for Tobacco Prevention and Control Policy and divert its funding, and it's unclear what Gov. Doug Burgum's plans are for the center. But Thronson warns that cutting spending would ramp up health care costs, significantly.

"If you want to address health-care costs, you can't do that without addressing the problem of tobacco," she added. "Because tobacco costs our state $326 million in health-care costs alone each year, and $56 million in Medicaid expenses."

North Dakota's top ranking is in a report released by the Campaign for Tobacco-Free Kids.


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A bill just introduced in Congress would raise public awareness of issues surrounding the end of life, including palliative care, and hospice.

The Compassionate Care Act would establish guidelines for advance care planning between health providers and patients.

Lisa Pahl, a licensed clinical social worker from Torrance, guides families through hospice.

"We live in a culture that is very avoidant of conversations on death and dying," Pahl observed. "Public education around the importance of planning ahead will improve access, so that everyday Americans know to ask for hospice and palliative care."

The bill would direct the government to develop education resources for providers, expand telehealth options and facilitate a study of a national advance care planning registry, which would allow patients to transfer their advance directives from state to state.

Pahl encouraged people to spell out what they want at the end of life so their relatives do not have to make expensive and painful decisions.

"Unless we have these conversations, we won't know," Pahl pointed out. "Health care providers typically will err on the side of doing it all, rather than going with comfort measures."

The bill is co-sponsored by Rep. Nanette Barragán, D-Calif., and Sen. Richard Blumenthal, D-Conn. A similar bill stalled in the House of Representatives in 2020 and never got a vote.


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The National Association of Community Health Centers is meeting in Atlanta this weekend to address the issues affecting the health care system as more people seek essential services.

In Georgia alone, about 400 centers serve more than 700,000 patients each year. With underfunded primary care, workforce shortages and rising drug costs, doctors said the need for the centers is increasing.

Kyu Rhee, president and CEO of the association, said community health centers have seen an increase of almost 3 million patients in the last four years.

"Community health centers have served as the employer, provider and partner of choice across our nation since 1965 nearly six decades," Rhee pointed out. "And now serve one in 10 people across our nation, or over 32-and-a-half million people"

Despite the growth, Rhee believes the demand for community health centers is even greater and they should be reaching one in three people based on national health needs. Gov. Brian Kemp and Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention, are slated to speak at the conference.

Rhee noted 90% of those served at the centers live below of the federal poverty level, meaning access to care can often be hindered by various barriers. He emphasized a key strength of these centers is the ability to meet patients where they are, extending care beyond the exam room and financial status.

"If you think about other parts of the health system, in general, you have to have a certain type of insurance you have to pay before you're seen," Rhee observed. "The beauty of what community health centers deliver is that we serve everyone, regardless of their ability to pay."

As the conference delves into health care issues, Rhee stressed the importance of examining the roles of other providers and the pharmaceutical industry, both crucial in supporting the mission of community health centers and the populations they serve.


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Wildfires are becoming bigger and more frequent in Colorado and across the Mountain West, and health experts are offering tips to breathe easy even during bad air-quality days.

Dr. Anuj Mehta, pulmonary and critical-care physician at Denver Health said pregnant women, infants, children, older adults and people with heart or lung disease are most at risk.

"Wildfire smoke has a lot of particulate matter. So really, really small microscopic particles that can cause inflammation in the lungs. Just breathing in that particulate matter, that inflammation may not just stay in your lungs. It can really cause inflammation around your body," Mehta said.

Exposure to smoke from wildfires has been linked to an increased risk of heart attack, stroke, lung cancer and a decline in cognitive function. Using air purifiers with HEPA filters and high MERV rated air conditioning filters can improve indoor air quality. Limiting strenuous activities is also a good idea, because when your breathing rate goes up, you inhale more particulates.

Workers and others who need to be outdoors can get air-quality updates on particulate matter and ozone pollution levels online at colorado.gov/airquality. Mehta says N-95 masks and respirators can also help, if worn correctly.

"If you can be indoors, that's going to be really good. If you have to be outdoors, and you are somebody with underlying breathing problems, wearing the mask actually can reduce the amount of particulate matter that you are going to breathe in," Mehta continued.

Colorado has already seen six wildfires that have burned more than 1,000 acres since May, and as humans continue to burn fossil fuels, wildfire risks are widely expected to increase into the foreseeable future. Mehta said it's important to understand the risks, and to be prepared.

"So every summer we're going to be dealing with bad air quality days. And so people, especially people with underlying health concerns, should be discussing with their medical teams about a bad air-quality plan," Mehta continued.


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