American Public Health Association
800 I Street, NW • Washington, DC 20001-3710
(202) 777-APHA • Fax: (202) 777-2534 •

Chiropractic Health Care
Section Newsletter
Fall 2003

Message from the Chair

This has been an interesting year for APHA and for the Chiropractic Health Care (CHC) Section. I think it best described as a year of change.

It has also been an unsettled year in this country due to both economic concerns and anxiety surrounding the war with Iraq.

During such times there are a lot of distractions, but the CHC section has been able to effectively address its concerns as well as make progress in areas important to chiropractic, the CHC section and to public health. The two key objectives I determined to focus on during my tenure as section chair were (1) to address how chiropractic, particularly the CHC Section, could participate in and positively influence emergency disaster preparedness issues relative to the chiropractic profession’s participation in providing such services, and (2) to address recent declining section membership.

They say “timing is everything,” and the disaster preparedness issue was already being investigated by a number of our members. Karen Konarski-Hart, DC, and CHC Section Councilor, was successful in the formulation and promotion of a resolution adopted by the ACA. (See related article in this issue for more details.). Congratulations and thank you to Dr. Konarski-Hart and those she worked with in getting this important matter before, and acted upon, by the leadership of the profession.

Membership was the other area of concern. It was approached with a blitz of articles by various members of the section which were published in professional journals as well as popular newspapers in the profession. Particular thanks goes to Donald M. Peterson Jr., editor/publisher of Dynamic Chiropractic, for supporting a series of articles in his publication. A special thank you also goes to Rand Baird, DC, Nominations Chair and member of the Publicity Team, for motivating a number of us to write and for handling much of the editing and submission process relative to Dynamic Chiropractic.

The national APHA central organization has been involved with substantial administrative changes and streamlining, and its staff has also been adjusting to significant modifications. All of this is for the betterment of the Association, and I feel that the future is bright for APHA. The Association provides almost an unlimited opportunity for the chiropractic profession to advance its position within APHA, and throughout the entire public health community nationwide.

It’s not been a particularly exciting year, but rather one of “staying the course” during a troubled and uncertain period. However, it has been an effective year for the CHC section as evidenced by our successes with the interdisciplinary booth, and the cross-disciplinary, collaborative research liaisons and presentations that have developed. And, the infusion of “fresh blood” resulting from our membership drive will provide needed new energy to the section’s activities into the future. I want to thank the section leadership team that has made my year as chair successful, and I am confident that next year’s accomplishments under Lisa Killinger’s tenure will be even greater!

Come visit us in San Francisco during the APHA Annual Meeting and Exposition, Nov. 15-19. The theme is "Behavior, Lifestyle and Social Determinants of Health." What theme could be more appropriate for chiropractic? You will be proud to experience and be a part of the Chiropractic Health Care Section’s activities in this 50,000 membership organization’s Annual Meeting. See you there!

Thomas L. Carpenter, DC
Chair, CHC

APHA's E-Advocacy Tool

In January, APHA purchased its first e-advocacy tool to help mobilize its members to send letters to their members of Congress electronically. In the last six months APHA has organized several advocacy efforts through the system. In June APHA used its e-advocacy tool to rally more than 1,500 public health professionals to send electronic letters to their members of Congress. As members become comfortable with this tool, APHA anticipates that these numbers will dramatically increase as our members become more familiar with the system. APHA's new advocacy tool has many great features that we encourage all members and public health professionals to use when advocating on behalf of a public health issue. These resources include:

a. Mega Vote <>: Sign up to receive a weekly e-mail on how your senators and representative voted during the week on important issues.
b. Elected Official Finder <>: Find biographical information on elected officials including the president, members of congress and agency heads.
c. Issues and Legislation <>: In this section you will find Capitol Hill Basics, pending public health legislation and key public health votes.
d. Media Guide <>: Send electronic letters to the editor on issues important to public health directly to your local media outlets with APHA's media advocacy tool.
e. Legislative Action Center <>: See the latest APHA Action Alerts. Send e-mails to your members of Congress on legislation important to APHA. This tool also always members to customize our list.

APHA appreciates the advocacy efforts of its members and the entire public health community on issues that ultimately affect all of America. Members of APHA can view a more in depth legislative update on APHA's Web site. This legislative information is updated weekly.

If you would like additional information about APHA's advocacy efforts, please don't hesitate to contact Lakitia Mayo, Director of Grassroots Advocacy and Affiliate Affairs, at
American Public Health Association
800 I Street, NW
Washington, DC 20001
(202) 777-2515 Phone
(202) 777-2532 Fax

CHC Election results: Congratulations to the following CHC Section Officers!

Chiropractic Health Care
John K. Hyland, DC, (MPH cand.), DACBR

Elaine Morschhauser, DC

Section Council
Ashley E. Cleveland, MA, DC
Karen Konarski-Hart, DC, DABCO

Governing Council
Monica Smith, DC, PhD

Chiropractic Health Care Section Scores Big at 2002 Annual Meeting

The 2002 APHA Annual Meeting will be a tough one to beat for the Chiropractic Health Care Section! A grant from APHA’s Inter-Sectional Council facilitated collaboration at the 2002 Annual Meeting between the Chiropractic Health Care Section (CHC), the Podiatric Health Section, The Vision Care Section and the Oral Health Section. Together, these four sections combined forces to offer a “Mega Health Booth” wherein attendees could get free health screenings related to each section. The Oral Health Section conducted oral health screenings, the podiatrists examined feet, the Vision Care Section offered vision and macular degeneration screenings and the CHC Section did osteoporosis screenings and body mass index assessment, both combined with health promotion information. The booth won 2nd prize in competition with more than 900 booths and displays and was truly the ‘talk of the town.' It was wonderful experience to see so much public health ACTION taking place at a booth designed and implemented by the CHC! The great news is that this booth collaboration will continue again this year! (See article entitled “Mega 2” elsewhere in this issue.)

Beyond the exhibit hall, collaboration also occurred in an unprecedented way. Several of the scientific sessions that included chiropractic were collaborative sessions with contributions from the Vision Care and Podiatry sections. This collaboration not only broadened our audience, but created an atmosphere of interdisciplinary dialogue that was truly enriching. This collaboration was largely due to the hard work of our 2002 program planner, Dr. Monica Smith; effort that really showed in the quality and depth of the sessions. This coming year, Dr. Smith has again outdone herself with a stellar collaborative program, and an invited theme session on the topic of Healthy Aging. (Please see program description in this newsletter.)

It was a big year as well for chiropractors in APHA, with two chiropractic publications in the prestigious American Journal of Public Health. Congratulations to Dr. Eric Hurwitz and Dr. Monica Smith, the lead authors on those outstanding publications. Such scholarly work in a widely read inter-professional publication lays the foundation for future positive dialogue between chiropractors and other health professionals and health advocates.

2002 was an awesome year for the CHC, and this year promises to be outstanding as well, when the Annual Meeting convenes in San Francisco this November. With so many chiropractors practicing in California, we hope to see record numbers of DCs turn out for this event. Our 2002 Chairperson, Dr. Tom Carpenter, and I extend our personal invitation to all California DCs to join us at APHA 2003. We look forward to seeing all of you in San Francisco!

Lisa Z. Killinger, DC
Chair Elect; CHC

Connecting Chiropractors for Disaster Preparedness

WHEREAS, the House of Delegates approved the following: “Resolved that the ACA seek to gain national and state recognition for doctors of chiropractic to serve in disasters and seek to establish a protocol for doctors of chiropractic serving as primary care providers at the scene of disasters.”

So begins a resolution that has been approved by the American Chiropractic Association’s Board of Governors. The resolution spells out details requisite of disaster preparedness in today’s turbulent social and political climates. Of significant importance is the included algorithm that sequences proper responses and the many elements involved in association with disaster events. Within the resolution, skills or training required for DCs, proper use of communications and chain of command through various local and national agencies, necessary preparations, and procedures for DCs to follow in such emergencies are outlined and described.

What must be remembered is that certain core emergency preparedness competencies are required of all public health workers and are based on essential services of public health. They also provide for personal and agency development. The competencies additionally provide a foundation for improving preparedness for any public health emergency including bioterrorism. Recent history has shown that chiropractors do play a role in responding to these events.

Some competencies are applicable to all health care workers. Others may apply only to administrative, professional, and technical or support personnel. Competencies must be tailored for each individual public health agency, with training and assessment issues developed accordingly. Obviously a document of this nature requires careful crafting as well as continued follow-up as the environment changes.

The profession and the CHC section owe Karen Konarski-Hart, DC, (Section Councilor for the CHC section) and the team she put together a debt of gratitude for the herculean efforts put forth in formulating and promoting this resolution through to its approval and adoption.

Kudos to Christine Goertz, DC, PhD

Please join in congratulating our Christine Goertz on the occasion of her being named a Fellow of the International College of Chiropractors. Christine can now use the letters "FICC" after her name.

This is a rare honor in recognition of "valiant service to the profession." Only 1,321 DCs have been so honored since 1939---and only 618 are still living.

Mega 2: Intersectional Collaboration Continues!

Many of you will recall last year’s smash hit booth for the Chiropractic Health Care Section. Called the Mega Health Booth, it included collaboration with the Chiropractic, Podiatric, Vision Care and Oral Health Sections of APHA. The collaboration was funded by a 2002 APHA Intersectional Council Grant. More than 200 APHA attendees visited each of the four sections of the Mega Booth and participated in health screenings related to each profession.

Well, this year, all of the collaborating sections said, “Let’s do it again!” So, in spite of the fact that we are not supported by a grant, the four sections will all be located next to each other and will again offer health screenings, in keeping with this year’s conference theme: “Behavior, Lifestyle, Social Determinants of Health.” Such collaboration requires a great deal of effort from our section members, so I am asking that you all step up and pitch in! A few things we will need are listed below:

    1. People to staff the booth, handing out literature and screening tools to passers by. To volunteer please contact Dr. Bonnie Hillsberg at: <>.
    We will especially need people on Monday, Nov. 17 and Tuesday,
    Nov. 18, the busiest days for the exhibit hall.
    2. Ideas for give-aways for the booth. The ever-popular spine keychains? If anyone has connections and could score some gift certificates, etc for a business that is common across the nation, that would be great! Also, if you are from San Francisco and know of any local businesses that may want to donate candy, fruit, or other snacks, please contact Dr. Elaine Morschhauser at <>.
    3. People to help pack up the booth on Wednesday, Nov. 19, about noon.
    4. Someone to contact ICA or ACA to get cool pens or other giveaways.

It’s going to be another great year at APHA. Let’s try for a prize winning booth two years in a row!

Lisa Zaynab Killinger, DC
Chair-elect; APHA CHC

The APHA Network on Globalization and Health Report: Fall 2003: FTAA Threatens Global Health; Plans Coincide with APHA Annual Meeting

How does the global economy affect health status and disparities in health status, public health systems and policy, access to coverage within private and public health care systems, occupational health and safety, injury control, environmental health, access to pharmaceuticals and to safe water, and social and economic equality? What do international trade agreements have to do with public health?

Members of the APHA Network on Globalization and Public Health will address these and other issues during the APHA Annual Meeting in November 2003. A Town Hall meeting on Nov. 16 from 2 to 4 pm in San Francisco’s Moscone Convention Center will offer brief presentations, and a chance to network with some local and national research and advocacy groups based in the Bay Area. The meeting will include observers from the September meeting of the international World Trade Organization ministerial in Cancun, Mexico, and members of international public health associations. Join the planning with an e-mail to Ellen Shaffer <>. (Please see final schedule for exact room location.)

This year’s APHA Annual Meeting takes place just before the international gathering of trade ministers in Miami planning the Free Trade Area of the Americas (FTAA). FTAA would extend NAFTA to the entire western hemisphere (except Cuba). The Network will help sponsor a press conference and other FTAA-related events.

APHA has been actively involved in support of its 2001 resolution, which opposes including health care, water, and other vital human services in international trade agreements. Along with the Center for Policy Analysis on Trade and Health (CPATH) and the American Nurses Association, APHA alerted members of Congress in July that smaller scale nation-to-nation trade agreements were setting dangerous precedents for international agreements such as FTAA. The letter, which was circulated to the U.S. House of Representatives by Rep. Sherrod Brown, explained that U.S. agreements with Singapore and Chile will:

Impede access to life-saving medicines, contradicting Congress’ earlier support for policies that would modify the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS

Ease the terms of trade on tobacco products, reducing tobacco tariffs for Singapore to zero. While public health protections have reduced tobacco use in the U.S., this provision will make it easier to dump tobacco products in Singapore.

Open the door to further privatization and deregulation of vital human services including standards for health care professionals, and provision of health care and water, sectors better addressed through open international collaboration rather than through commercial trade negotiations. While some services and some professions are exempted from coverage by some trade rules, these exemptions are too narrow to assure full protection. The United States has no exemptions for water and sanitation, leaving the country open to challenges from foreign private corporations and their subsidiaries.

Grant foreign private investors greater rights than US investors. Under NAFTA, similar provisions have led to lawsuits by private companies that overturned important health and environmental protections. Again, this contradicts the negotiating objectives of the Trade Act of 2002.

Other social and public services are poorly defined, leaving trade tribunals rather than elected officials and regulators to decide whether basic public health protections are barriers to trade. Covered services include income security or insurance, social security or insurance, social welfare, public education, health, and child care. Trade panels are not required to have any expertise in health care or public health.

The letter urges Congress to advocate for trade agreements that exclude vital human services such as health care and water, that improve access to life-saving medications, and that do not threaten efforts to reduce exposure to dangerous substances. Further, it encourages support for enforceable commitments to advancing population health, and to achieving universal access to health care and to safe, affordable water in the United States and internationally. The U.S.-Singapore and U.S.-Chile Free Trade Agreements do not meet these objectives, and therefore should not serve as models for other trade agreements, including the Free Trade Area of the Americas (FTAA) or the Central America Free Trade Area of the Americas (CAFTA).

The CPATH Web site, <>, provides additional background information on economic globalization and health. APHA groups involved with the Network include: Medical Care, Mental Health, Environmental Health, International Health, Injury Control and Emergency Health Services, Occupational Health and Safety sections, Peace Caucus, Socialist Caucus, Spirit of 1848, DisAbility Forum, Hawai’i Public Health Association, and the Public Health Association of New York City.

CHC Events at APHA Annual Meeting

APHA Annual Meeting 2003, Chiropractic Health Care Section Scheduled Events:
Please note that All Chiropractic Health Care (CHC) sessions, including business meetings and scientific sessions, will be in the Moscone Convention Center.

Business Meetings:

253 Chiropractic section Business meeting I: Sunday, Nov. 16, 4-5:30 p.m.
301 Chiropractic section Business meeting II: Monday, Nov. 17, 6:30-8 a.m.

APHA-CHC Scientific Sessions (Presentation details follow this abbreviated schedule):

3018 Integrating CAM curricula into medical education: An intersectional joint session. (CHC session joint-sponsored with CAM SPIG)
Monday, Nov. 17, 8:30-10 a.m. (moderator Monica Smith)

3109 Prevention in Chiropractic. CHC session.
Monday, Nov. 17, 10:30 a.m.-12 noon. (moderator John Pammer)

3176 Chiropractic Professional Issues: Populations, Conditions, Settings. CHC session.
Monday, Nov. 17, 12:30-2 p.m. (moderator Rand Baird)

3263 Healthy Aging: Cross-Disciplinary Perspectives.
(CHC session joint-sponsored with Public Health Nursing and Gerontological Health sections)
Monday, Nov. 17, 2:30-4 p.m. (moderator Lisa Killinger)

Other Scientific Sessions to note:

4087 Ambulatory Care Topics (Joint-sponsored by Oral Health, Vision Care & Chiropractic Health Care sections).
This is a Vision Care session, but includes a paper by Hawk et al.
Tuesday, Nov. 18, 2003: 8:30 a.m.-10:00 a.m.

4227 Preventive Programs in Podiatric, Chiropractic, and Vision Care Settings (Joint-sponsored by Podiatric Health, Chiropractic Health Care, and Vision Care sections).
This is a Podiatry session, but includes papers by Hurwitz et al and Hyland et al.
Tuesday, Nov. 18, 2003: 2:30 p.m. – 4 p.m.

MONDAY, NOV. 17, 2003: 8:30 a.m.-10:00 a.m.
(3018.0) Integrating CAM curricula into medical education: An intersectional joint session
Bringing Community CAM Practitioners into the Research Process: Bridging the Gap between Practice and Research. S. M. Zick, ND, MPH; R. Benn, PhD; E. Gillespie, BS. University of Michigan.

Developing a CAM Educational Infrastructure: Baccalaureate programs in the US. A. Burke, PhD,MPH,LAc; K. Aparicio, BS; K. Burrows, MPH; E. Peper. San Francisco State University.

Results are in...Students and Faculty of various health professions express their need for complementary and alternative medicine (CAM) education. D. Peoples-Lee, MS. Temple University.

Training practicing medical physicians, nurse practitioners, and physician's assistants in integrative chiropractic through distributed learning. J. M. Menke, MA,DC; L. Soloff, ND,MPH; R. B. Lutz, MD. University of Arizona.

MONDAY, NOV. 17, 2003: 10:30 a.m.-12:00 p.m.
(3109.0) Prevention in Chiropractic
Sponsor: Chiropractic Health Care
Adherence to exercise recommendations: Practice-based evaluation of chiropractic patients. J. K. Hyland, DC, MPH; C. Hawk, DC, PhD; K. J. Sherman, PhD, MPH; A. McTiernan, MD, PhD

Systems analysis models of exercise promotion in chiropractic practice. J. K. Hyland, DC, MPH

Proactivhealth: A Resource for the Integration of Primary Preventive Health Care Services into the Chiropractic Practice. J. M. Whedon, DC
Chiropractors’ amenability to using multidisciplinary preventive guidelines in clinical practice. M. Smith, DC, PhD; E. C. Morschhauser, DC

Use of guidelines on nutrition and smoking cessation counseling in chiropractic practice. M. Smith, DC, PhD; L. Carber, BS
MONDAY, NOV. 17, 2003: 12:30 p.m.-2:00 p.m.
(3176.0) Chiropractic Professional Issues: Populations, Conditions, Settings
Sponsor: Chiropractic Health Care
Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA Neck Pain Study. E. L. Hurwitz, DC, PhD; H. Morgenstern, PhD; M. Vassilaki, MD, MPH; L. M. Chiang, MS

Physical activity variation by population density of place of residence: The Iowa Bone Development Study. E. Morschhauser, DC; K. F. Janz, EdD; S. M. Levy, DDS

Implementation of Chiropractic in the long term care skilled nursing facility. V. Dolan, DC; V. E. Dolan, DC

A community outreach program in a chiropractic educational setting. J. E. Black, DC, MS Ed

Healthy People 2010 Objectives: Chiropractic's Role in Meeting the Healthcare Needs of an Increasingly Aged and Diverse Society. L. Killinger, DC

MONDAY, NOV. 17, 2003: 2:30 p.m.-4:00 p.m.
(3263.0) Healthy Aging: Cross-Disciplinary Perspectives (An intersectional joint session)
Sponsor: Chiropractic Health Care [4 invited speakers]

Complex Problems, Complex Solutions.
Kathleen Jaskowiak, MSN.
Learning Objectives:
1. Recognize one cost benefit to the recipient of care, the agency and the community of providing a safe environment for providing care in the community.
2. List three new actions to use when working in a community setting that enhances their safety.
3. Discuss the impact of reimbursement issues in providing safe, timely services to elders in the community.

This area of study began in 1994. Services were being moved out of hospitals to peripheral locations, and analysis of the impact included consideration of safety issues involved in providing care in the community with home visits, issues involving mental health care availability, and with the utilization of professional office locations. Most recently, reimbursement issues have been examined given the impact on the services and protection in place at site seniors frequently visit for care.

Applying a social marketing framework to consumers' perspectives on
long-term care: What is the advantage?
Lené Levy-Storms, PhD, MPH, Randi Jones, JD, Verónica Gutierrez, MPH.
Department of Medicine, Division of Geriatrics, UCLA, 10945 Le Conte
Ave., Suite 2339, Los Angeles, CA 90095-1687, fax: 310 312 0546

The purpose of this paper is explore the advantages of applying a social marketing framework to consumers' perspectives on long-term care. Much of the research on older adults' long-term care needs focus on either community-based or institutional care but not both simultaneously. To effectively design long-term care services to both, a framework that links issues with both consumer sectors would be helpful to creating services and policies that are sensitive to a broader scope of their needs as they navigate the nebulous long-term care continuum. Two distinct sets of focus groups were conducted with older African American and Hispanic women in the community and older, frail white elders residing in nursing homes. A total of six and eight focus groups were held in community-based and nursing home settings, respectively. Data were analyzed using open-coding techniques for thematic patterns and then organized within a social marketing framework. The social marketing framework includes four major domains: product, place, price and promotion. Thematic patterns within these domains revolve around interpersonal issues with both informal and formal care networks that emerge when these elders try to use their self-care behaviors to optimize their individual experiences with healthy aging. While these two groups of consumers have varied physical and mental health needs,
they share common emotional and social needs. Their voices call for equal attention to these latter needs as much as their physical and mental health needs have been considered in the design and delivery of long-term services. The implications for long-term care policy that focus on rehabilitation and optimization all aspects of consumers' needs will be discussed.

Learning objectives:

1. To explore the common needs of community-based and institutionalized elders
2. To understand how a social marketing framework allows insight into consumers' long-term care needs
3. To listen to consumers' of long-term care

Generational Partners: Developing a Culturally Appropriate Interprofessional Health Promotion Program with American Indian Elders.
Teresa M. Cochran PT, DPT, GCS, MA
Assistant Professor, Department of Physical Therapy; Co-Director, Office of Interprofessional Service and Scholarship
School of Pharmacy and Health Professions; Creighton University Medical Center, Omaha, Nebraska

This paper describes the development of a geriatric health promotion program based on needs assessment and qualitative study of health beliefs of Omaha Nation elders. The weekly interprofessional program includes physical therapy, occupational therapy, nutrition, diabetes education, pharmacy, medicine and podiatry. This presentation identifies key components to design and implementation, barriers and successful strategies. Emphasized is the innovation and importance of understanding health beliefs and behaviors of a target population, and understanding that to successfully impact profound health disparities, a comprehensive, interprofessional, sustained approach must be directed toward health promotion.

Learning Objectives: Upon completion of the session, the participant will be able to:
1. Explain the need for health care practitioners to understand and integrate health beliefs and concepts into health care provision
2. Appreciate the role of qualitative inquiry to gain insight into health beliefs in order to develop effective programs to modify health behaviors
3. Recognize the key components and successful strategies utilized in developing a interprofessional health promotion program for elders.

Chiropractic and cross-disciplinary care of our elders
Jacqueline Bougie, DC, MS
Southern California University of Health Sciences

Please note regarding Continuing Education Certification

CE credits will not be offered for the San Francisco APHA Annual meeting. Lack of participation by DC’s and the high cost of attaining approval has made offering credits for this year’s annual meeting impossible.

131st Annual Meeting of the American Public Health Association-Program Highlights

There are many exciting general sessions at this year’s Annual Meeting, but we would like to call your attention to the following three:

· President’s Session (3256.1) Monday, Nov. 17, 2:30 P.M.-4:00 P.M.

· Critical Issues in Public Health (4088.1) Tuesday, Nov. 18, 10:30 A.M.-12:00 P.M.

· APHA Closing Session (5190.0) Wednesday, Nov. 19, 4:30 P.M.-6:00 P.M.

Each session will include presentations on issues of great importance to the fulfillment of the public health mission in the 21st century by panels of outstanding experts. The panels are designed to provoke participants to view the future of their profession and to develop strategies for assuring public health effectiveness in the future.

Brief descriptions of these Sessions are provided below. For further information on the Sessions, go to <>.

President’s Session

This session will focus on the challenges and opportunities facing public health in the 21st century. Topics to be discussed are: the Institute of Medicine’s recommendations on the future of public health practice and education; strategies to eliminate health disparities; mobilizing public support for universal health care; and a summary of the present state of public health as a “starting point” for the future.

Critical Issues in Public Health

This Session will further amplify the discussion of issues of central concern in the 21st century. The topics to be covered in this session are: new strategies to reduce the prevalence of substance abuse; approaches towards controlling the epidemic of obesity; strategies to reduce the high incidence of traffic accidents; and dealing with the threat of emerging zoonotic infections.

Closing General Session

For the first time, the Closing General Session will feature a panel discussion. Three areas of central concern to public health in the 21st century will be discussed. The topics to be covered are: the impact of the rapidly advancing science of genomics on public health; the threat of new and emerging infectious diseases; and the promise of technology in helping disabled people to overcome their physical limitations.