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Alabama’s Infant Mortality Rate Lowest Ever in 2017

Alabama’s Infant Mortality Rate Lowest Ever in 2017

The Alabama Department of Public Health announced the infant mortality rate of 7.4 deaths per 1,000 live births in 2017 is the lowest in Alabama history and is an improvement over the 2016 rate of 9.1. A total of 435 infants born in Alabama died before reaching 1 year of age in 2017; 537 infants died in 2016.

While there is a longstanding disparity between birth outcomes for black and white infants, the infant mortality rate for black infants declined to an all-time low in 2017, and the infant mortality rate for white infants was the second lowest. The rate of 11.2 for black infants was an improvement over the 15.1 rate in 2016, and the rate of 5.5 for white infants was a drop over the 6.5 rate for whites in 2016.

Alabama enjoyed many positive indicators. Teen births and smoking during pregnancy are risk factors that contribute to infant mortality, and both are continuing to decline. The percentage of births to teens (7.3) and the percentage of births to mothers who smoked (9.6) are the lowest ever recorded in Alabama, with the largest decrease among teen mothers. There was also a decline in the number of infants born weighing less than 1,000 grams and infant deaths to those small infants.

While there was a significant decline in infant mortality, the percent of low weight births and births at less than 37 weeks gestation remained the same. Statisticians look at average infant mortality rates for three-year periods. Between the years 2015 through 2017, the combined rate of 8.3 was tied with the years 2009 through 2011 as the two lowest three-year rates of infant mortality in Alabama.

“Due to the sharp decline in the infant mortality rate for 2017, the Alabama Center for Health Statistics worked diligently to ensure all infant deaths were reported,” Center Director Nicole Rushing said. “A decrease in the number of infant deaths reported was seen at almost all hospitals.”

State Health Officer Dr. Scott Harris said, “We are encouraged with the progress in improved pregnancy outcomes we are seeing, but many challenges remain such as addressing persistent racial disparities, the opioid epidemic and ensuring access to health care.”

Gov. Kay Ivey said, “We must continue our efforts to reduce the number of families who experience the profound sadness of infant deaths. Alabama has developed an infant mortality reduction plan that includes a pilot project to reduce infant mortality by 20 percent in five years.”

Components of the pilot project being conducted in Macon, Montgomery and Russell counties include home visitation, preconception and interconception health care, screening for substance use, domestic violence and depression, safe sleep education, and breastfeeding promotion.

The top three leading causes of infant deaths in 2017 that accounted for 43.4 percent of infant deaths were as follows:

  • Congenital malformations, deformations and chromosomal abnormalities
  • Disorders related to short gestation and low birth weight
  • Sudden infant death syndrome

These top causes of infant deaths parallel those for the U.S. as a whole in 2016.

Graphs and detailed charts are available at the Alabama Department of Public Health website at http://www.alabamapublichealth.gov/healthstats/assets/IM_17.pdf

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National Rural Health Day is Nov. 15!

National Rural Health Day is Nov. 15!

National Rural Health Day is an annual observance that emphasizes the importance of rural America and promotes the need for accessible, high-quality health care. National Rural Health Day falls on the third Thursday in November each year and recognizes the efforts of those serving the health needs of over 60 million people across the nation.

The Alabama Department of Public Health’s Office of Primary Care and Rural Health (OPCRH), the Medical Association, the Alabama Family Practice Rural Health Board, the Alabama Hospital Association, the Alabama Primary Health Care Association and the Alabama Rural Health Association are proud to recognize the innovation, quality of care, and dedication of health professionals and volunteers in the state during National Rural Health Day 2018.

This year, Dr. Peter Strogov of Fort Payne, one of Alabama’s many fine health professionals, has been selected as a “Community Star” for his many contributions to health care in rural communities. The annual “Community Stars” publication honors and gives a personal voice to rural people, providers, advocates and communities across the country. His story will appear in the 2018 edition that will be available on the https://www.PowerofRural.org website, the official hub for National Rural Health Day and the Power of Rural movement, beginning Nov. 15.

Rural health care professionals, hospitals, county health departments, and clinics are dedicated to providing health care in Alabama’s 54 rural counties, which are home to almost 2 million people. These rural communities have unique health care needs and challenges, including the distance to the nearest health care facility. In addition, these counties have a population that is generally older, and with health conditions that require a greater need for health care.

Rural hospitals are the economic foundation of many rural communities, but they are being threatened with declining reimbursement rates and disproportionate funding levels that make it more difficult to serve their residents. The OPCRH is dedicated to addressing these issues through a number of programs, such as the following:

  • Loan repayments for physicians, dentists and other health care professionals through the National Health Service Corps
  • No-cost recruitment of physicians using a national recruitment and retention database
  • Adoption of telehealth services to bring distant health care to the local community
  • Designation of physician and dental shortage areas for federal assistance programs
  • Assisting rural clinics in becoming certified to receive enhanced medical payments

In addition, OPCRH works closely with rural hospitals and safety net providers to identify problems and provide needed technical assistance and resources. More than 150 health care providers are presently working throughout the state under programs administered by the office, dispersed among the state’s 138 community health centers, 106 rural health clinics, and other providers. The OPCRH’s services are available to any rural health care organization that is dedicated to providing accessible, high-quality health care to its community.

Gov. Kay Ivey has issued a proclamation encouraging citizens to recognize the valuable services of rural health practitioners on this day.

To learn more, visit http://alabamapublichealth.gov/ruralhealth/

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Call It Quits Nov. 15! Join the Great American Smokeout!

Call It Quits Nov. 15! Join the Great American Smokeout!

Smokers who want to quit tobacco can use their fingers to dial for free help instead of lighting up a cigarette. On Thursday, Nov. 15, the Great American Smokeout challenges smokers and vapers to take the first step by quitting for the day or making a plan to quit for good.

Callers in Alabama can dial 1-800-QUIT NOW (1-800-784-8669) to reach the AlabamaDepartment of Public Health’s Tobacco Quitline. Enrollment in the free program can provide the caller an individualized quit plan, counseling from certified tobacco treatment specialists, and up to eight weeks of nicotine replacement therapy (NRT) patches if the caller is medically eligible and enrolled in the program.

In Alabama, 20.9 percent of adults are smokers compared to the national rate of 17.1 percent, according to the Centers for Disease Control and Prevention’s (CDC) 2017 Behavioral Risk Factor Surveillance System. Smoking is the number one cause of preventable death and disease in the nation and kills more than 8,600 adults in Alabama each year. Annually, the state spends more than $1.88 billion in health care costs directly caused by smoking.

“Tobacco use doesn’t just harm the smoker,” said Julie Hare, ADPH Tobacco Prevention and Control Program’s cessation manager. “Secondhand smoke can cause adverse health effects for anyone exposed.” CDC’s Tips from Former Smokers national advertising campaign which shows the cost for patients living with a tobacco-caused disease and the effect on their families has inspired thousands of Alabamians to call the Quitline for help, she said.

Tobacco users and vapers can also register for services online at quitnowalabama.com. The Quitline is open from 6 a.m. to midnight seven days a week.

Medicaid callers are offered Quitline counseling but are referred to Medicaid’s program to obtain their medications. “Medicaid pays for a full course of any of the seven Food and Drug Administration-approved medications to help quit tobacco,” Hare said. “Smokers who want to quit should ask their private insurance carrier about medication coverage,” she said. “Under the Affordable Care Act, tobacco cessation is required to be covered as a preventive service.”

Hare said other ways to reduce smoking include the adoption of comprehensive smoke-free policies in cities. Some 32 Alabama cities have adopted smoke-free ordinances that prohibit tobacco use in workplaces, including restaurants and bars. At least half of those ordinances include e-cigarettes, she said.

The American Cancer Society has sponsored the Great American Smokeout since 1975.

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Estimated 1.9 Million Vapers in U.S. and Growing

Estimated 1.9 Million Vapers in U.S. and Growing

A research team including experts from Johns Hopkins conducted a survey to determine trends in e-cigarette use. Based on more than 400,000 responses from the national telephone survey led by the Centers for Disease Control and Prevention, the researchers estimate that 1.4 percent of the population in the U.S. vapes. Yet these roughly 1.9 million people do not report smoking cigarettes regularly.

E-cigarettes contain the addictive chemical nicotine, and as they are unregulated can contain other harmful chemicals. Although adults report using e-cigarettes to wean themselves off of traditional cigarettes, younger generations are taking up vaping without prior experience smoking.

Their findings in a brief research report, published on Oct. 9 in the Annals of Internal Medicine, suggest that regulating sales and education for vulnerable young people may be needed to prevent more people from getting hooked on nicotine. The researchers found that 60 percent of vapers were younger than 25 years old. Michigan had the highest prevalence of vapers in the population, whereas Alaska had the fewest. People who only smoked e-cigarettes also engaged in more risky behavior, such as binge drinking, risky sex and drug use.

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REPORT: Nearly Half of Resident Physicians Report Burnout

REPORT: Nearly Half of Resident Physicians Report Burnout

ROCHESTER, Minn. – Resident physician burnout in the U.S. is widespread, with the highest rates concentrated in certain specialties, according to research from Mayo Clinic, OHSU and collaborators. The findings appear in the Journal of the American Medical Association. Physician burnout is a dangerous mix of exhaustion and depersonalization that contributes to physicians making mistakes while administering health care.

The study found 45 percent of respondents experienced at least one major symptom of burnout, with those in urology, neurology, emergency medicine and general surgery at the highest risk. Regardless of specialty, high levels of anxiety and low levels of empathy reported during medical school were associated with burnout symptoms during residency.

“Our data show wide variability in the prevalence of burnout by clinical specialty, and that anxiety, social support and empathy during medical school relate to the risk of burnout during residency,” says Liselotte Dyrbye, M.D., a Mayo Clinic researcher and first author of the article.

Residents with burnout had more than a threefold increase in odds of regretting their decision to become a physician. When asked, “If you could revisit your career choice, would you choose to become a physician again?” those in pathology and anesthesiology were also most likely to respond “definitely not” or “probably not.” Similarly, the higher the level of anxiety reported during medical school, the greater the chance of regretting becoming a physician.

Previous research has shown physician burnout has some relation to gender and ethnicity. Residents who identified as female had a higher risk of burnout symptoms, matching studies of later-career physicians.

Although the problems facing female physicians have been reported, the study illustrated the less-studied plight of residents who self-identified as Latino or Hispanic. These individuals were more likely to regret their specialty choice. While the study did not examine the cause directly, the authors speculate that minority physicians often are pressed into participating in various institutional diversity initiatives that overtax their schedules compared to nonminority physicians.

Not all of the study’s findings were negative. The majority of residents are satisfied with their career choice and specialty. In particular, participants who reported high empathy scores during medical school appeared to be more resilient to burnout during residency. This is counter to the common narrative that physicians need “thick skin” or an emotional aloofness to perform.  Similarly, high empathy scores during medical school were associated with a willingness to choose the same specialty again. In addition, participants who reported higher emotional social support during medical school were generally happier with their specialty choice.

Other burnout studies have focused on physicians-in-practice. This was the first national study to longitudinally follow medical trainees from the beginning of medical school into residency to explore predictors of burnout. The study included nearly 3,600 participants who were surveyed in the fourth year of medical school with follow-up in second year of residency. It was derived from a larger study of medical students called the Cognitive Habits and Growth Evaluation Study that has tracked a group of students from their first year of medical school through the last year of residency.

About 50 medical schools were included in the research. Residents were asked to provide information about their specialty, ethnicity, educational debt and other demographic characteristics. They then completed surveys that have previously been developed to measure anxiety, emotional social support, empathy and burnout.

The study was supported by a grant from the National Heart, Lung and Blood Institute, and the Mayo Clinic Department of Medicine Program on Physician Well-Being. Researchers from Mayo Clinic, Syracuse University, University of Minnesota, Yale University, Stanford School of Medicine, and OHSU distributed, collected and analyzed the surveys. Michelle van Ryn, Ph.D., OHSU School of Nursing was the principal investigator.

 

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Speak Out! Don’t Allow Suicide to Take Another Physician’s Life.

Speak Out! Don’t Allow Suicide to Take Another Physician’s Life.

Did you know cancer was the most common cause of death among residents? Suicide was the second-leading cause of resident death — and the most common cause of death among male residents. A 2015 review of studies estimated 22 to 32 percent of resident physicians in the U.S. suffer from depressive symptoms and multiple studies have shown that residency training places physicians at risk for mental illness and suicidal thoughts.

Monday, Sept. 17, is National Physician Suicide Awareness Day, organized by the Council of Emergency Medicine Residency Directors (CORD), in collaboration with AAEM, ACEP, ACOEP, EMRA, RSA, RSO and SAEM to annually dedicate the 3rd Monday in September to remind physicians and other health care workers that suicide can be prevented and resources are available.

“Medicine is a calling, and the practice of medicine can be a very stressful career,” said Medical Association Executive Director Mark Jackson. “Alabama’s physicians care for thousands of patients each year, but they may not always stop to take care of themselves when they need it most. Physicians have a multitude of options designed just for them when they feel they are reaching a breaking point, and that’s where we can be a lifeline.”

While estimates of the actual number of physician suicides vary, literature has shown that the relative risk for suicide being 2.27 times greater among women and 1.41 times higher among men versus the general population. Each physician suicide is a devastating loss affecting everyone – family, friends, colleagues and up to 1 million patients per year. It is both a very personal loss and a public health crisis.

Help is available for physicians who feel they need assistance. The Alabama Physician Health Program is a confidential, effective, first-line resource for physicians and other medical professionals with depression and other mental health issues. Physicians may contact the APHP at (800) 239-6272 or email staff@alabamaphp.org.

 

Additional Resources

Let’s Talk About Physician Burnout

Physician Suicide

Medical specialties with the highest burnout rates

Suicide Is Much Too Common among U.S. Physicians

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CDC STUDY: Steep and Sustained Increases in STDs in Recent Years

CDC STUDY: Steep and Sustained Increases in STDs in Recent Years

Nearly 2.3 million cases of chlamydia, gonorrhea, and syphilis were diagnosed in the United States in 2017, according to preliminary data released today by the Centers for Disease Control and Prevention at the National STD Prevention Conference in Washington, D.C. This surpassed the previous record set in 2016 by more than 200,000 cases and marked the fourth consecutive year of sharp increases in these sexually transmitted diseases.

The CDC analysis of STD cases reported for 2013 and preliminary data for 2017 shows steep, sustained increases:

  • Gonorrhea diagnoses increased 67 percent overall (from 333,004 to 555,608 cases according to preliminary 2017 data) and nearly doubled among men (from 169,130 to 322,169). Increases in diagnoses among women — and the speed with which they are increasing — are also concerning, with cases going up for the third year in a row (from 197,499 to 232,587).
  • Primary and secondary syphilis diagnoses increased 76 percent (from 17,375 to 30,644 cases). Gay, bisexual and other men who have sex with men (MSM) made up almost 70 percent of primary and secondary syphilis cases where the gender of the sex partner is known in 2017. Primary and secondary syphilis are the most infectious stages of the disease.
  • Chlamydia remained the most common condition reported to CDC. More than 1.7 million cases were diagnosed in 2017, with 45 percent among 15- to 24-year-old females.

“We are sliding backward,” said Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “It is evident the systems that identify, treat and ultimately prevent STDs are strained to near-breaking point.”

Chlamydia, gonorrhea and syphilis are curable with antibiotics, yet most cases go undiagnosed and untreated — which can lead to severe adverse health effects that include infertility, ectopic pregnancy, stillbirth in infants, and increased HIV risk. Prior studies suggest a range of factors may contribute to STD increases, including socioeconomic factors like poverty, stigma, and discrimination; and drug use.

Continued concerns about antibiotic-resistant gonorrhea

The threat of untreatable gonorrhea persists in the United States, and reports of antibiotic-resistant gonorrhea abroad have only reinforced those concerns. Over the years, gonorrhea has become resistant to nearly every class of antibiotics used to treat it, except to ceftriaxone, the only remaining highly effective antibiotic to treat gonorrhea in the United States.

In 2015, CDC began recommending health care providers prescribe a single shot of ceftriaxone accompanied by an oral dose of azithromycin to people diagnosed with gonorrhea. Azithromycin was added to help delay the development of resistance to ceftriaxone.

Emerging resistance to ceftriaxone has not been seen since the dual therapy approach was implemented, and there has not yet been a confirmed treatment failure in the United States when using this recommended therapy.

New CDC findings released today, however, show that emerging resistance to azithromycin is now on the rise in laboratory testing — with the portion of samples that showed emerging resistance to azithromycin increasing from 1 percent in 2013 to more than 4 percent in 2017.

The finding adds concerns that azithromycin-resistant genes in some gonorrhea could crossover into strains of gonorrhea with reduced susceptibility to ceftriaxone — and that a strain of gonorrhea may someday surface that does not respond to ceftriaxone.

“We expect gonorrhea will eventually wear down our last highly effective antibiotic, and additional treatment options are urgently needed,” said Gail Bolan, M.D., director of CDC’s Division of STD Prevention. “We can’t let our defenses down — we must continue reinforcing efforts to rapidly detect and prevent resistance as long as possible.”

A renewed commitment from health care providers — who are encouraged to make STD screening and timely treatment a standard part of medical care, especially for the populations most affected — is an important component to reverse current trends.

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STUDY: Doctor Burnout in Small Practices Is Dramatically Lower Than National Average

STUDY: Doctor Burnout in Small Practices Is Dramatically Lower Than National Average

Physicians who work in small, independent primary care practices — also known as SIPs — report dramatically lower levels of burnout than the national average (13.5 percent versus 54.4 percent), according to a study led by researchers at NYU School of Medicine published online July 9 in the Journal of the American Board of Family Medicine. The findings indicate that the independence and sense of autonomy that providers have in these small practices may provide some protection against symptoms of burnout.

Physician burnout is a major concern for the health care industry. It is associated with low job satisfaction, reduced productivity among physicians, and may negatively impact the quality of care. Multiple national surveys suggest that more than half of all physicians report symptoms of burnout.

Research on physician burnout has focused primarily on hospital settings or large primary care practices. The researchers say that this is the first study that examines the prevalence of burnout among physicians in small independent primary practices — practices with five or fewer physicians.

Researchers examined data collected from 235 physicians practicing in 174 SIPs in New York City. The rate of provider reported burnout was 13.5 percent, compared to the 2014 national rate of 54.4 percent. A 2013 meta-analysis of physician surveys conducted in the United States and Europe found that lower burnout rates were associated with greater perceived autonomy, a quality and safety culture at work, effective coping skills, and less work-life conflict.

“Burnout is about the practice culture and infrastructure in which primary care doctors work. So the obvious question is: what is it about the work environment that results in low burnout rates in small practices?” says Donna Shelley, MD, professor in the Departments of Population Health and Medicine at NYU Langone Health, and the study’s senior author. “It’s important to study the group that’s not showing high burnout to help us create environments that foster lower burnout rates. The good news is that a culture and systems can be changed to support primary care doctors in a way that would reduce the factors that are leading to burnout.”

How the Study Was Conducted

Researchers analyzed data as part of the HealthyHearts NYC (HHNYC) trial, which is funded by the Agency for Healthcare Research and Quality’s (AHRQ) EvidenceNOW national initiative. AHRQ is a division of the U.S. Department of Health and Human Services. The HHNYC trial evaluates how practice coaching or facilitation helps SIPs adopt clinical guidelines for the treatment and prevention of cardiovascular disease.

Each physician answered a multiple choice question with response options indicating various levels of burnout. Options ranged from no symptoms of burnout to feeling completely burned out and questioning whether or not to continue practicing medicine. The question was validated against the Maslach Burnout Inventory, a nationally recognized measure that identifies occupational burnout. Physician respondents were categorized as burned out if they checked one of the last three options in the multiple choice question.

As part of the HHNYC trial, physician respondents were also asked a number of questions about the culture of their practices. The tool used specifically measures “adaptive reserve,” or a culture where individuals have opportunities for growth and the ability to learn from mistakes by talking and listening to each other. Physicians who described this kind of culture in their practice reported lower levels of burnout. According to Dr. Shelley, practices, where employees feel they are included in decisions and have control over their work environment, are referred to as having “high adaptive reserve.”

Dr. Shelley is careful not to minimize the challenges faced by physicians working in solo practices or SIPs. She cites that even though burnout rates are lower, many of these practices are struggling financially, and many of these physicians are on-call all of the time.

“The more we can understand what drives low rates of burnout, the more likely it is that we’ll find solutions to this problem,” says Dr. Shelley. “The hope is that our research can inform ways for larger systems to foster autonomy within practices so that there is space to carve out a work environment that is aligned with doctors’ needs, values, and competencies.”

Dr. Shelley lists a number of the study’s limitations. Since the findings are representative of physicians working in small practices in New York City, the study does not capture burnout rates in other cities across the country. It is also possible that the researchers underestimated the number of hours worked by physicians, since hours worked is associated with burnout. Dr. Shelley also cited the lack of data linking physician burnout to patient outcomes.

In addition to Dr. Shelley, study co-authors include Nan Jiang, PhDCarolyn Berry, PhD; and Gbenga Ogedegbe, MD, MPH, of NYU School of Medicine; Chuck Cleland, PhD, of NYU Rory Meyers College of Nursing; and Batel Blechter of Johns Hopkins University.

The research was supported by the Agency for Healthcare Research and Quality (AHRQ).

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CVS Health to Begin MinuteClinic Video Visits through App

CVS Health to Begin MinuteClinic Video Visits through App

CVS Health is rolling out a new virtual health care offering for patients with minor illnesses and injuries, skin conditions and other wellness needs through the company’s MinuteClinic section of the CVS app. MinuteClinic Video Visits, a telehealth offering via Teledoc, will provide patients with access to health care services 24 hours a day, seven days a week from their mobile device.

A video visit can be used to care for patients ages 2 years and up who are seeking treatment for a minor illness, minor injury, or a skin condition. Each patient will complete a health questionnaire, then be matched to a board-certified health care provider licensed in their state, who will review the completed questionnaire with the patient’s medical history, and proceed with the video-enabled visit.

During a MinuteClinic Video Visit, the provider will assess the patient’s condition and determine the appropriate course of treatment following evidence-based clinical care guidelines. For patients who require a prescription as part of their treatment plan, the provider will submit the prescription to the patient’s preferred pharmacy. If it is determined the patient should be seen in person for follow-up care or testing, the provider will recommend that the patient visit a health care provider in their community, such as their primary care provider or a nearby MinuteClinic.

A MinuteClinic Video Visit costs $59, which is currently payable by credit card or debit card. Insurance coverage will be added to the experience in the coming months. The service is currently available in nine states – Arizona, California, Florida, Idaho, Maine, Maryland, Mississippi, New Hampshire and Virginia – and Washington D.C. and is expected to be available nationwide, where allowed, by the end of 2018.

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WIC Income Guidelines Increase. Are Your Patients Eligible?

WIC Income Guidelines Increase. Are Your Patients Eligible?

Alabama families may qualify for the Special Supplemental Nutrition Program for Women, Infants and Children, better known as WIC. If you are a woman who is pregnant, who had a baby within the past six months, who is breastfeeding, or who is the parent or guardian of a child up to age 5, you are encouraged to apply for WIC at your local county health department or WIC agency.

Participants in the program receive free nutrition education and breastfeeding peer counseling support. In addition, participants have the option to receive up to three months of food benefits at a time for each qualified family member. Food benefits are redeemable at WIC-authorized stores throughout Alabama.

Under the 2018 federal poverty guidelines, more families may be eligible for the program. WIC is open to participants with incomes up to 185 percent of the federal poverty level. Check the table below to see whether your family qualifies:

WIC participants must have both a limited income and a nutritional need. Families who receive Medicaid, SNAP or Family Assistance already meet the income qualifications for WIC. Even families who do not qualify for these programs may be eligible for WIC because of its higher income limits.

Amanda Martin, WIC Director, Alabama Department of Public Health, said, “WIC encourages families to be healthy by providing nutritious foods. Nutritious foods help children grow to be healthy adults and pregnant women to have healthy babies.”

For more information, please go to http://www.alabamapublichealth.gov/wic or call the statewide toll-free line at 1-888-942-4673.

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