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MEETING PACKET JUNE 2017 DUNE 2017 CITY OF SALEM, MASSACH , U 7 1. BOARD OF HEALTH 06 Health 120 WASHINGTON STREET,4'11 FLOOR CITY C Prevent.promote,Protect TEL. (978)741-1800 FAx(978) 745-034f ALEll,HA%.:. KIMBERLEY DRISCOLL lramdin@salem.com MAYOR LARRY RAMDIN,RS/REI IS,CHO,CP-F HEALTH AGENT NOTICE OF MEETING You are hereby notified that the Salem Board of Health will hold its regularly scheduled meeting Tuesday June 13, 2017 at 7.•00 PM City Hall Annex 120 Washington Street Room 313 MEETING AGENDA 1. Call to order 2. Approval of Minutes This notice posted on "Official Bulletin Board" ity Hall, Salem, Mass. on ''o, 7l� 3. Chairperson Communications It 1'•,)-k A in accordance with MGL Chap. 30A, :sections 18-25. 4. Public Health Announcements/Reports/Updates a. PHN Report b. Health Agent C. Administrative d. Council Liaison Updates 5. Hearing 2°d Violation Kwik Shop Market, 10 Jefferson Avenue 6. Enabling Needle Exchange Programs—Mary Wheeler 7. Gas-Powered Leaf Blowers Presentation—Jeanne Kempthorne 8. Board of Health program planning &city health status discussion 9. New Business/Scheduling of future agenda items • Items that could not be anticipated prior to the posting of the agenda • Discuss summer meeting schedule Larry Ramdin, Health Agent cc: Mayor Kimberley Driscoll, Board of Health, City Councilors Next regularly scheduled meeting is July 11, 2017 at 7:00pm at City Hall Annex, 120 Washington Street Yd Floor Room 313. Know your rights under the open meeting law MGL chapter 30A ss 18-25 and City Ordinance section 2-2028 through 2-2033 CITY OF SALEM BOARD OF HEALTH MEETING MINUTES May 9, 2017 MEMBERS PRESENT: Chairman Paul Kirby, Dr. Jeremy Schiller, Mary Lauby, Kerry Murphy EXCUSED: Nancy Crowder OTHERS PRESENT: Larry Ramdin, Health Agent, Suzanne Doty, Public Health Nurse, Maureen Davis, Clerk of the Board, Beth Gerard, Council Liaison, Dr. Brita Lundberg, Infectious Diseases Specialist, Richard Stafford, resident, Sarah Keiler&Mamie Biondi—Expect Program students, Salem State University TOPIC DISCUSSION/ACTION 1. Call to Order 7:01pm J. Schiller motioned'to move item`#5-out of order on the Agenda. M. Lauby 2"d A11 in favor. Motion passed. 2. Approval of Minutes M.Lauby motioned to,approve the minutes,`with corrections. (April 18, 2017) J. Se &2"d. All in favor. Motion passed. 3. Chairperson Announcements Welcome'to"new Board member'Kerry Murphy. P. Kirby will meet withher soon to'update her on Board programs, etc. M Lauby motioned to move Health Agent's Report out of order. J. Schiller2°a. All in favor. Motion passed. 4. Monthly Reports-Updates A. Public Health . Number of.flu cases going down after a spike in cases. Nurse's Report Doctors are testing baby boomers for Hep C now because there is a cure. Working on Wellness program was discussed. S. Doty delivered reusable bags and wire fruit baskets to City departments with wellness information, activity challenge instructions, pedometers, etc. Included in the baskets were apples donated by Crosby's Marketplace. Participants in the activity challenge will be using the "Map my" app where they will map the number of miles either walked or run. Met with Katie at the Salem YMCA and got free passes for the new yoga studio. Planning to do a class for stress reduction with the Employee Assistance Program, which is provided to all employees and their families. Copy available at the BOH office B. Health Agent's L. Ramdin was joined by the SSU Communications students from Report the Expect Program who spoke about their project to provide awareness and help destigmatize addiction. They presented small portions of their video "Decide to Destigmatize", which can be viewed online on YouTube and has been shared on Facebook and other social media outlets. The project was very professional. They worked closely with Larry and Suzanne from the Health Dept. and also with Emily Chi from the Salem Overdose Coalition. P. Kirby extended an invitation to the students to come join us at the June meeting where Mary Wheeler, Program Director for the Healthy Streets Outreach Program, will speak about the state of health in Salem. P. Kirby inquired about the status of Vapor Outlet's suspension. p p Have been waiting to.see if Eric Stone did in fact bring his case to court as stated at the'April meeting. Have not heard anything yet. M. Lauby asked=for clarification of"small mammals" from the Health Agent's report. L. Rarndin explained it; s not just rats and mice, but includes racoons, squirrels, etc. L. Ramdin received,a call from the Mayor wanting an understanding of pop-up permits. There was a rumor and she thought we were prohibiting pop-ups It.was explained to her that there was a pop-up at botch and their"outdoor paiin'-has crushed stone/gravel, which is not,an appropriate surface because it is not cleanable. When Notch opened; the patio`was approved because they were only going to be serving pretzels and the like, which is easy to clean because they are dry. Smokin' Betty's'was told they could not serve food outside on crushed stone, so`why is it ok for Notch? L. Ramdin will have discussion with owner of Notch to explain, and will clarify.that no scheduled pop up food events at Notch will be affected for the duration of the 2017 outdoor season. However, patio surface improvements will be needed after that. P Kirby asked if we should revisit the fees for October. L: Ramdin believes we should due to increased staff time with the large number of vendors in October. J. Schiller thought the $300.00 fee was based on time. M. Lauby said fees are not intended to balance the budget. They are not sum certain. Haunted Happenings generates a lot of money for the City. I Schiller feels some of the money generated for the City should go to the Health Dept. for increased staff time. Feels out of town vendors are taking away business from Salem businesses so they should pay more. • L. Ramdin acknowledges the Board's decision is our decision. P. Kirby wonders if we should increase fees for non-Salem businesses at Haunted Happenings. L. Ramdin shares that Assistant City Solicitor Victoria Caldwell advised it is not discriminatory to charge out of town vendors more money. J. Schiller feels the City Council should care about permit prices since it goes into the general fund and helps the overall budget. B. Gerard says there are budget hearings with the Council on 5/30, 5/31, 6/1, 6/6 and 6/7. Explains that the Council votes only on what the Mayor recommends. The Board will support the Health Dept. in any way possible. L. Ramdin has asked for an increase in the overtime budget and an increase in hours to 19 for the part-time inspector. P. Kirby says the Board can write a letter to the Mayor in support of budget issues. L. Ramdin discussed the proposal.to Council for a Certificate of Fitness ordinance to require an inspection every three years. If the ordinance goes through, the Mayor is willing to add an inspector with flexible hours to cover nights and weekends. Currently, 641/6 o;f:Salem's housing units ##_multi-family units. Copy available at the BOH office C. Administrative Report Copy available:at the BOH office D. City Council Liaison Continuing discuss.on s'on food trucks. Need to outline specifics, Updates such as whether there is even a'.market for it in Salem? Is there enough space to accommodate? B..'Gerard explains the process is to make a recommendation to the Committee ._then the Committee takes it to Council. L 'Ramdin`pointed out zoning changes to allow food trucks on private property would open a can of worms. M. Lauby feels they may bring more people out and not just be bad for loca 'competition. Ramdm points out food trucks would also mean an increase in inspections. Discussion about the train station as a possible location for food trucks. City owns land there for Housing Development Improvement Plan. M. Lauby asks what's happening with the Sanctuary for Peace? B. Gerard says the Council voted twice,both times 7 to 4. There is talk about an Inclusion Commission comprised of 1 I members, chosen by the Mayor. People against it threatened that either the Council rescind their vote or they will petition to put it on the ballot. A petition was started,but the people obtaining signatures were not being truthful to voters. There were challenges to some of the • signatures and people who were misled had a limited time to request their signature be removed from the petition. Residents are tense about the issue. There is conflicting information on Facebook. Sanctuary for Peace is meant simply for all people to be treated with respect. J. Schiller motioned to accept the reports. Kerry Murphy 2nd. All in favor. Motion passed. 5. Fracked Gas Dr. Brita Lundberg gave handout from Mass. Medical Society Infrastructure issue regarding health risks of natural gas pipelines. Copy available at the BOH office. Showed map of proposed Massachusetts sites to export gas to Canada. We need to change the,narrative;needs are not increasing and it is not for our benefit,:it-is for the benefit of the gas companies. Attorney General 1Vlaura Healey says she is against it because it is an unnecessary project and 80%of the gas will be exported. Accidents, such as explosions and fires, have.increased five-fold in the last decade. Most of the problems occur in;the distribution lines. Hazardous substances are eriritted by the pipelines. Company called Spector submitted a list of:hazardous substances to the DEP. Fracked gas goes.into radioactive layers of the earth. J. Schiller:asks what,is a safe level of radium? Thus far, only environmental impacts have been look at, not human Not sure yet of the health effects. Just now beginning to see Comprehensive Health Impact Assessments. One such assessment from Colorado showed that younger children are affected most with severe heAdaches, leukemia, birth defects and neurological issues. Boston Public Health Commission suggested to stop all work on the West Roxbury sitd�until more CHIAs are completed. 50 ' f.our gas right now is fracked. Dr. Lundberg would like us to speak in one voice by signing the letter to Governor Baker requesting CHIAs. J .Schiller asked if gas lines are safe. Dr. Lundberg said legislators are already saying they are not safe .and are in support of CHIAs and a change in site Board regulations. Fracking is not happening in Massachusetts,but there are harmful substances in our gas from the fracking occurring elsewhere. K. Murphy asks who is responsible for implementing CHIAs? They are usually done by academics, such as BU and Harvard. Departments of Health can do them, but they are very expensive— around $50,000.00. Have sent letters to 351 Boards. Governor Baker is in favor of pipelines. J. Schiller points out it is a no-brainer to be in favor of CHIAs. Dr. Lundberg gave Board members two House bill docket numbers so they can look them up for more details. 6. Hearing 2"d Violation Kwik Attorney representing Kwik Shop Market had to reschedule for the Shop Market, 10 Jefferson June 13, 2017 meeting. Avenue i 7. Board of Health program planning M. Lauby will come to the June meeting with materials. & city health status discussion 8. Continue discussion on banning L. Ramdin stated there is a draft ordinance before the Council for Smoking in public parks and not smoking, but just in the Common. beaches P. Kirby wondered if conversation should begin in Council about no smoking in parks and beaches, or if we should wait to bring it up. L. Ramdin feels we should wait,until after budget season is over to bring it up with Council. Spoke to Chief Butler who agreed that signage will work to enforce. 9. New Business/Scheduling of future For June meetini Mary Wheeler—Needle Exchange agenda items Kwik Shop,-"Tobacco Hearing Jeanne Kempthorne— Gas Powered Leaf Blowers When asked to tell the Board;about herself, Kerry Murphy shared that she works`for.Mass in Motion, and is paid through Partners and Mass Dept: of Public Health. She also works with Green Space. • L. Ramdin asked about indoor,and rooftop gardening. Reference was made to the SNAP Program for buying fruits and ve etables. Maui Streets couid'have UMass Extension School do cooking demos at th'e Fanner's Market. Ramdin said;therels a Community Supported Agriculture managed by Milk &Honey. MEETING ADJOURNED: �M. Lauby motioned to adjourn. J. Schiller 2"d. All in favor. Motion passed. 9:30pm Respectfully submitted, Maureen Davis Clerk of the Board of Health Next regularly scheduled meeting is June 13, 2017 at 7.00pm at City Hall Annex, • 120 Washington Street, 31 floor, Room 313 t' Suzanne Doty RN BSN Salem Board of Health Public Health Nurse Public Health Nurse Report Reporting on May 5, 2017 through June 7, 2017 Disease Prevention and Health Promotion • Investigated reportable diseases and reported case information to MDPH. • Coordinating follow up with North Shore Pulmonary Clinic on tuberculosis cases. • Continually recording and submitting refrigerator temperature logs, flu doses and clinic information into the Massachusetts Immunization Information System(MIIS)for up to date vaccine records and better continuity of care between clinics and providers. • Scheduling all camp inspections and completing necessary forms for students to attend camp at the end of the school year. Camp inspections are beginning June 7, 2017. Meetings/Trainings • Continued modules, conference calls and Working on Wellness webinars. Submitting on • going assignments as plans become more finalized. First round of seed funding of$2,000 awarded on December 151h and arrived mid-January. Second round of seed funding for $7,000 has also been awarded and arrived mid-February. The program launched on Monday May lst, Mayor Kim Driscoll send out an all staff launch email. I prepared for this launch by creating a newsletter, ordering materials and putting together and delivering gift baskets and bags for all departments involved. The first month of the activity challenged finished and a winner was announced, more employees have joined for the month of June. Stairwell signs are made and getting put up the stairwells and blood pressure monitor kits for the departments as well. • Attended the Immunization Update on May 30, a mandatory annual vaccine manager seminar by the Department of Public Health regarding any updates on vaccine handling and storage, the MIIS and emerging disease. • Attended the Salem Substance Abuse Prevention Workshop on June lst where stakeholders from several disciplines participated in 3 parallel workshops (Making the Salem door-knock case: how to `export' the Salem success; Reaching out to parents:how to create more effective and wider contact;and Increasing collaboration: how to intensify cooperation with partners Peabody and Lynn)to discuss what has and has not been working in Salem, help improve our efforts, collaborate with other communities and continue to actively strengthen our activities and approach towards substance abuse prevention. • Monthly Report of Communicable Diseases: May 2017 Disease New Carry Over Discharged/ Total#Of Running Total for Total fors , Reported Cases this Total for 2016 42r Closed Month 2017 Tuberculosis 0 0 0 0 0 4 (Active) Latent 1 0 0 1 4 31 Tuberculosis* Arbovirus* 0 0 0 0 0 0 0 Babesiosis 0 0 0 0 0 0 ;1 a<� Calicivirus/No 0 0 0 0 0 0 Y f rovirus Campylobacte 1 0 1 1 1 15 riosis Fl Chikungunya 0 0 0 0 0 0 "0 Dengue* 0 0 0 0 0 0 0 Ehrlichiosis 0 0 0 0 0 0 4d1 Enterovirus 0 0 0 0 0 01 Giardiasis 0 0 0 0 2 6 2 ,y Group A 0 0 0 0 1 0 r4 Streptococcus ` Group B* 0 0 0 0 3 2 t,77� Streptococcus ` ww Human 0 0 0 0 0 1 1 ' Granulocytic t Anaplasmosis Haemophilus 1 0 1 1 2 211 Influenzae • f Disease New Carry Over Discharged/ Total#Of Running Total for T`. tltitlsftlr` r _.. Reported Cases this Total for 2016 61'f Closed Month 2017 r Hansen's 0 0 0 0 0 0 0 Disease Hepatitis A 0 0 0 0 0 0 0 Hepatitis B* 0 0 0 0 1 8 0; Hepatitis C* 0 0 0 0 18 30 29 Influenza* 3 0 3 3 65 19 29; Legionellosis 0 0 0 0 0 2ls Lyme 0 0 0 0 0 0 `21 Disease* ` (4) (4) (4) (4) (27**) (Probable) .. Malaria 0 0 0 0 0 2 Ql Measles 0 0 0 0 0 1 0 eningitis 0 0 0 0 0 0 01 Mumps 0 0 0 0 0 1 Pertussis 0 0 0 0 0 1 tll Rocky 0 0 0 0 0 0 0' Mountain Spotted Fever Salmonellosis 1 1 2 2 4 11 `6. ; Shigatoxin 0 0 0 0 0 0 0} Producing Organism Shigellosis 0 0 0 0 0 3 s" Streptococcus 0 0 0 0 3 8 31 Pneumoniae* Varicella* 0 0 0 0 0 1 0 . • ,Disease New Carry Over Discharged/ Total#Of Running Total for Total fury Reported Cases this Total for 2016 2015; Closed Month 2017 Vibrio 0 0 0 0 0 i West Nile 0 0 0 0 0 0 Og Yersoniosis 0 0 0 0 0 0 Zika Virus 0 0 0 0 0 1 0� Infection Total 7 1 7 8 104 204 140 May 2017 *Notifications only, LBOH not required to follow up or investigation per DPH. **Total reflects cases that have also been reported as suspect cases. All Communicable disease totals above are subject to change in the event that the follow-up investigation results in the revocation of the diagnosis. • Yearly totals for 2016 have been updated for year end with the number of CONFIRMED cases. Summary of Current Communicable Diseases Campylobacteriosis: Case 1: This case has been treated and recovered. This case was not a food worker or working as a caregiver and also denies any household contacts to be as well.No further cases at the time and the case is closed. Group A Streptococcus: Case 1: This patient is currently being treated for an invasive infection. It was determined by the Infectious Disease specialist to likely be community acquired and not hospital acquired. Follow up with household contacts for symptoms surveillance has been completed and at this time there is no further follow up necessary per MDPH epidemiologist. Haemophilus Influenzae: Case 1: This case is living in a state in the western part of the country, however was report to MDPH as Salem was listed at permanent address. They were tested on the day they were born and found to be positive. An MDPH epidemiologist whom works with vaccine preventable diseases reached out to the hospital for confirmation. Due to the age of the patient there is no vaccine history to report. No further • follow up necessary at this time. Salmonella: Case 1 (carried over from last month): This case was seen in an outpatient setting and treated. I have not been able to reach this patient directly but did received information from the ordering provider who diagnosed and treated the patient. A letter has been sent to their home requesting a phone call for follow up which I am currently awaiting at this time. UPDATE: Case returned call after receiving my letter. They had recovered and were unsure of any high-risk foods they made have eaten. They are currently unemployed and no household contacts or known contacts have become ill.No further follow up necessary and the case is closed. Zika Virus Infection: 34 cases of Zika Virus Infection previously listed as cases have been revoked after lab tests. In the month of April, there were no new cases of testing and 2 revoked cases. Confirmed Case(June 2016): Case not pregnant at time of diagnosis. Case traveled to Dominican Republic and reported symptoms of fever and rash. Health Agent report May 2017 Announcements/Updates • The Department will be hosting 2 interns for the summer o Sarah Corley a BU MPH student who was granted an internship by the MDPH. Sarah will also be doing her community service externship with us. She will be working on a Community Health status report that I will advise her on. Sarah will be with us for the entire summer. o Deanna Mazina is a Public Health Undergraduate who is in a 4+1 Public Health Program Candidate, that allows her to earn a Master's Degree in Health Policy and Management, 1 year after graduating with her Bachelor's degree. Deanna, will be gaining exposure to local health operations with a focus on Environmental Health. She will be interning 4 hours per week on Fridays Community Outreach • We attended a walk through thru the Point neighborhood with the senior management team and representatives from Northshore CDC. A number of issues were identified and we are working on resolution. Meetings and Trainings • Larry Ramdin and Environmental Health team attended the MEHA Annual meeting in Devens MA. The meeting discussed several issues related to environmental Health practice • Janice Orta completed Housing Inspector training • Elizabeth Gagakis completed ICS 300 Environmental Health Activities • The environmental health team was engaged in swimming pool inspections for the greater part of May. • I met with Chris Lohring of Notch Brewery to discuss the surface in his outdoor patio and options. Mr. Lohring asked for a definition of the term smooth which I provided from the 2013 Food code as well as the specific sections that dealt with surfaces. He will review his options and then provide us with what will be economically feasible for his business and meets the requirements of the code. Inspections • • Inspection of Ledgers and Smoking Betty's for their Food permits. Item Monthly Total YTD 2016 Total Certificate of Fitness 25 151 506 Inspection Certificat e of Fitness 1 26 42 re-inspection Food Inspection 20 82 241 Food Re-inspections 7 36 31 Retail Food 0 5 17 Inspections Retail Food 0 1 12 re-inspection Temporary Food 10 35 48 General Nuisance 4 10 26 Inspections Food— 0 0 2 Administrative Hearings Housing Inspections 7 40 94 Housing re- 3 26 25 inspections Rodent Complaints 2 2 24 Court 0 0 3 Hearings/filings • Item YTD 2016 Trash Inspections 97 371 574 Orders served by 0 0 3 Constable Tanning Inspections 0 0 0 Body Art 0 0 0 Swimming pools 14 14 9 Bathing Beach 0 0 108 Inspection/testing Recreational Camps 0 0 6 Lead Determination 1 1 2 Septic Abandonment 0 0 0 Septic System Plan 0 0 0 Review Soil Evaluation 0 0 0 Percolation tests 0 0 0 Total 187 789 1699 AW Health Dept. Clerical Report F 17 • Burial Permits Permits Plan Reviews -certificate of Copies / Fines Revenue Permit Fees Jul -16 $475.00 $2,210.00 $1,950.00 $4,635.00 Food Service Est. <25seats $iyo August $700.00 $985.00 $1,500.00 $3,185.00 25-99 seats $280 >99 seats $420 September $1,475.00 $2,165.00 $4,300.00 $300.00 $8,240.00 Retail Food <i000sq' $70 October $475.00 $3,415.00 $2,150.00 $6,040.00 loon-lo,000 $28o >1o,000 $420 November $500.00 $7,785.00 $2,150.00 $150.00 $10,585.00 Temp.Food 1-3 days s35 December $700.00 $36,265.00 $700.00 $37,665.00 4-7days vo. >7days $ January-17 Exarn4;1 1 11°tbri�p fo ";permit: $750.00 $12,220.00 $90.00 $600.00 $13,660.00 z4.(luys div *te1 42 xs7v_silo Februa $1,075.00 $1,495.00 $1,400.00 $3,970.00 Frozen Desserts $25 March $1,525.00 $2,660.00 $1,080.00 $2,100.00 $500.00 $7,865.00 Mobile Food $210 April $775.00 $2,175.00 $810.00 $1,000.00 $525.00 $5,285.00 Plan Reviews New $z80 May $1,125.00 $2,325.00 $90.00 $1,000.00 $650.00 $5,190.00 Remodel. s90 June Catering $25Pereventl$200 catering kitchen Body Art Est. $315 Total $9,575.00 $73,700.00 $2,070.00 $18,850.00 $2,125.00� $106,320.00 Body Art Practitioner s135 Review Plans $180 Fiscal Year Budget 2017 Suntan Est. $140 Rec.Day Camp $10 Salary Starting Ending Expenses Ext.Paint Removal s35 Full Time $359,539.00 $52,133.30 Starting Ending Transport Off.Subst. sio5 Part Time $28,306.00 $4,548.70 $19,000.00 $5,904.29 Tobacco Vendors $135 Overtime $4,500.00 $2,114.86 Swimming'. wimming Pools Seasonal $146. Balance $392,345.00 $58,796.86 Health Clinic Revolving Account Annual S210 N6*bfit$40 $12,415.74 Title V Review si8o Well Application s18o Disposal works $225/18o Breakdown bf Permits and Fines May 2017 Permit Description Total Permits Issued Permit Cost Total Annual Food 1 $280.00 $280.00 1 $140.00 $140.00 Temporary Food - Pop Up(1-3 days) 15 $35.00 $525.00 Temporary Food - Pop Up(1-3 days)- Non-Profit 1 $25.00 $25.00 Ice Cream Truck 1 $210.00 $210.00 Plan Review- Remodel 1 $90.00 $90.00 Burial Permit 45 $25.00 $1,125.00 Exterior Paint Removal 1 $35.00 $35.00 Camp Permit 2 $10.00 $20.00 Pool Permit 6 $140.00 $840.00 Pool Permit- Non-Profit 1 $40.00 $40.00 Certificate of Fitness 20 $50.00 $1,000.00 Tobacco Retailer 1 $135.00 $135.00 Tobacco Violations 2 $100.00 $200.00 2 $200.00 $400.00 Funeral Director License 1 $75.00 $75.00 BOH Ticket Violation-Trash 1 $50.00 $50.00 Total = 5,190.00 Health Department Mission Statement-Why We Exist The mission of the Salem Board of Health is to deliver public health services to residents,businesses and visitors to benefit the culturally diverse population of the City of Salem. Public health includes preventing and monitoring disease, providing health education and enforcing public health codes and regulations.This mission is accomplished through the core values of public health which are to prevent, promote,and protect. Significant Budget & Staffing Changes for FY 2018 The Board of Health is requesting the addition of a Senior Clerk Typist to assist in the clerical duties and increasing workload.Also,a Public Health Program Coordinator to assist in developing new health improvement and outreach programs that will positively impact health status of the community; increasing the hours of a part-time Inspector to 19 hours to enhance response to increasing citizen complaints. Suzanne Doty returned to the Department as the Public Health Nurse replacing Erica Rimpila,who returned to her former position in the non-profit sector.Janice Orta joined the Department as a Sanitarian;Janice is a Salem resident with a background in environmental testing and assessment. Recent Accom lishments p • Followed up on cases of reportable contagious diseases. • Secured grant of up to$10,000($9, 000 already approved)to support city employee wellness initiative • Responded to emergency calls from Police and Fire Departments. • Coordinates the Salem Overdose Awareness and Use Reduction Coalition, webpage WWW. Salem.com/opiate • Coordinated a panel series on Opiate awareness SATV entitled"Recovering in Salem" "" • Coordinated hosting the "Road to Recovery Series"with SATV • Hosted 2 video/panel discussions on Substance use and Overdose awareness at the Salem Visitor Center • Provided a community Health information program including, Blog, Facebook and Twitter presence. • Provided Public Health information at Farmer's Market, Community wellness fair including Naloxone training • Provided vaccination clinics for influenza to seniors, city retirees' employees and residents. • Ensured compliance with conditions set for various developments. • Ensured compliance with tobacco regulations. • Enforced the State Sanitary Code for housing, food establishments bathing beaches, swimming pools and other permitted facilities conducting over 1600 inspections. • Provided sanitary inspections for problem areas in neighborhoods. • Addressed increased complaints through" Seeclickfix Too]" • Participated in community health and wellness fairs on the North Shore. • In conjunction with other North Shore communities and North Shore Elder Services participant in task force to handle hoarding issues on the North Shore. • Coordinate a region wide Asthma reduction program that provides information on multi-unit housing owners on smoke free housing, Integrated pest management and smoking cessation programs • Participated in a reciprocal agreement with the City of Beverly to allow residents of both communities to participate in household hazardous waste collections twice per year. Collected hazardous waste from over 200 households • Board of Health receives and processes communicable diseases online. _=iACTIV,TY E§E' ;3?3VP�u��7„w., • Participated with Salem Police Department and Mayor's office "International Overdose Awareness Day"and"National k Night Out" EflGM¢'INSS' HE • Participated in Youth Substance Abuse Prevention grant with Lynn, Marblehead and Swampscott that focuses on underage po , 'N11hUN _. W,3m ALTH `u drinking and substance use prevention .-`=r ENV NONMENE BODY ENERGY • Assisted local communities in communicable disease response, immunization clinics • Hosted a MPH student intern from Walden university • Board of Health voted to prohibit sale of flavored tobacco products in Under 21 Establishments wno«soME z � • Larry Ramdin was elected Regional Vice President of the National Environmental Health Association,representing the New England,New York and New Jersey. FY 2018 Goals & Objectives • Continue enforcing the 6 General laws, 17 State regulations, 28 Board of Health Regulations and City Ordinances we are directly responsible for,especially Food, Housing, Certificate of Fitness, Trash and Public Nuisance laws. • Increase staffing to address increased workload and demands placed on the Health Department • Continue Community Health improvement program geared towards reducing Chronic disease risks within Salem,thus improving the health of the community • Continue ongoing Staff development to improve the service delivery to the community • Improve communication with residents to improve general health and well-being and resolve citizen concerns • Use Technology to improve efficiencies and responsibilities in complaint tracking, inspection, increase and service delivery to residents • Limit the exposure and incidence of infectious diseases through investigation,detection and prevention. • Participate in an opiate risk reduction program with Lynn and Peabody • Respond to residents' concerns regarding illness and sanitation issues. • Maintain an inventory of vaccines and biologics required by the City sponsored clinics. • Provide immunization clinics and educational seminars. • Ensure that the public health policies of the Board, City and State are followed. • 0 • Maintain preparedness for public health emergencies. • Maintain and strengthen working relationships with other City departments. • Use the media and other avenues as a tool for disseminating information regarding public health concerns and education. • Comply with Massachusetts Dept of Public Health regulations regarding inspection requirements for establishments governed by the State Sanitary Code. • Respond to residents' public health concerns. • Manage regional Shared Public Health services grant the was over$250,000 • Manage Regional Asthma grant of$165,000 • Enable staff to attend conferences and training to acquire/maintain credentials necessary to perform their duties and enhance their skill sets Outcomes and Performance Measures Actual Act ual Estimated Estimated FY 2015 FY 2016 FY 2017 FY 2018 Number of inspections not all inspections listed below 1720 1699 1700 1950 Number of permits issued from the Board of Health 1284 1314 1400 1460 Number of Death Certificatesprocessed/issued 413 438 450 450 Number of trash and general nuisance inspections 624 574 600 600 Number of Certificate of Fitness inspections/re-inspections 538 542 600 700 Number of food establishment inspections/re-inspections 454 337 475 480 Body art establishments 5 6 7 10 Recreational cam inspections 28 24 20 20 Pool inspections Swimming beach sampling 36 108 23 23 1 28 8 108 30 30 136 Total number of communicable disease investigations 120 204 250 300 Flu Shots Administered 319 324 250 250 How FY 2018 Departmental Goals Relate to City's Overall Long & Short Term Goals • Reduce the number of trash complaints through education and active enforcement with increased staffing • Reduce the number of housing complaints through landlord outreach, scheduled inspections, education and active enforcement • Increase programs that will reduce risk factors and impact of chronic disease. • Increase delivery of services and response by increasing use of technology. • Enhance skill sets in the departmental staff that will impact better public health protections for community. • Participate in an Opiate overdose reduction project with Lynn and Peabody to reduce the scourge of Opiate use and overdose in Salem • Participate in Youth Substance use and reduction project with Lynn, Marblehead and Swampscott to inform and educate youth and parents on developing coping skills to face the challenges of substance use in the community • Improve messaging on Public health topics through use of social media 5/2/2017 CITY OF SALEM - I4..,r12 18 OPERATING BUDGET -- Expenditures Adopted Budget Adjusted Budget Y-T-D Expenses Department Mayor . 10:37:44AM FY 2016 FY 2017 FY 2017 FY 2017 FY 2018 FY 2018 Health-Personnel 15101 5111 SALARIES-FULL TIME 346,722.82 362,039.00 359,539.00 289,245.86 470,015.00 412,115.00- 15101 5113 SALARIES-PART TIME 6,337.29 28,306.00 28,306.00 21,959.28 42,297.00 43,354.00- 15101 5131 OVERTIME(GENERAL) 2,857.20 2,000.00 4,500.00 2,140.44 2,000.00 2,000.00 15101 5150 FRINGE/STIPENDS 2,500.00 4,500.00 4,500.00 1,250.00 4,500.00 4,500.00 Total Health-Personnel 358,417.31 396,845.00 396,845.00 314,595.58 518,812.00 461,969.00 16.41% Health-Expenses 15102 5218 HHWD 0.00 0.00 0.00 0.00 15,000.00 15,000.00 15102 5306 ADVERTISING 216.50 800.00 800.00 665.98 800.00 800.00 15102 5318 DENTAL/MEDICAL SERVI 2,453.22 2,500.00 2,500.00 1,034.50 2,500.00 2,500.00 15102 5396 HOUSING-SAN 4,334.92 4,500.00 4,500.00 3,286.36 4,500.00 4,500.00 15102 5421 OFFICE SUPPLIES(GEN 2,834.12 2,500.00 2,500.00 2,100.81 2,500.00 2,500.00 15102 5710 IN STATE TRAVEL/MEETINGS 499.98 400.00 400.00 . 0.00 400.00 400.00 15102 5785 RODENT CONTROL 5,150.00 5,000.00 7,500.00 4,900.00 5,000.00 6,000.00- 15102 5786 BEACH WATER ANALYSIS 0.00 800.00 800.00 0.00 800.00 800.00 Total Health-Expenses 15,488.74 16,500.00 19,000.00 11,987.65 31,500.00 32,500.00 96.97% 120 510 Department Total 373,906.05 413,345.00 415,845.00 326,583.23 550,312.00 494,469.00 19.63% 0 FY 2018 MANAGEMENT, BOAR►, _4KRS AND PART-TIME SALARIES • E== Voted By Current Dept Name Org/Obj Job Desc Hire Date Council Cod F #Hours =BoardRate Dept Prop Rate Dept Request Mayor Rate Mayor Propsed FY 2017 T Wkly=1Y 2017 FY 2018 FY 201a FY 2018 FY 2018 62.2 E0.0% 0.0% 52.0 2.5% 52.0 DAVIS MAUREEN 120 HEALTH 15101-5111 BOARDCLERK B 4 500.00 500.00 2,000.00 500.00 2,000.00 LYONS HEATHER 120 HEALTH 15101-5111 BOARD CLERK 2,000.00 B 4 500.00 RAMDIN LARRY 120 HEALTH 15101-5111 HEALTH AGENT 7/2/2012 84,353.14 1.00 1 100% 1,615.96 New 120 HEALTH 1,615.96 84,029.92 1,656.36 86,130.67 15101-5111 PUB HLTH COORDINATOR 1 00 1 100°h 1,153.85 60,000.20 _ _ 272,611.65 6.00 Total AFSCME 1818 323,983.99 323.983.99 358,964.79 8.00 Total Full Time-5111 470,014.11 412,114.66 REALE JOSEPH 120 HEALTH 15101-5113 PT CODE ENFORCEMENT OFF 9/21/2007 14,152.99 CODY ROBERTA 120 HEALTH 0.5 hours perwk 28.54 28.54 14,098.76 29.25 14,451.23 15101-5113 PT CODE ENFORCEMENT OFF 10/29/2008 14,152.99 0.0 hours perwk _ _ MANCINI JANET 120 HEALTH 15101-5113 PT CODE ENFORCEMENT OFF 716/16 19.0 hours perwk 28.54 28.54 28,197.52 29.25 28,902.46 28,306.98 Total PartTime-5113 42,296.28 43,363.69 120 HEALTH 15101-5131 ove time 2,000.00 z,000.o0 2,000.00 2,000.00 Total PartTime-5113 2,000.00 2,000.00 120 HEALTH 15101-5150 Mill supend 4,500.00 3.0 1,500.00 1,500.00 4,500. 0 1,500.00 4,500.00 Total PartTime-5113 4,500.00 4,500.00 4,500.00 Full-Time Equivalent Employees: FY 2016 6.00' 393,770.77 8.00 Department Total FY 3017 . 6.00 518,810.39 461,968.34 FY 20,18 8.00. variance 17 vs.18 2.00 Con 0 4MA -• FY 2018 AFSCME 1t. EMPLOYEE RATES • EMPLOYEE NAME Department Voted By P Org�bTftl. Job Start Job Council F Rate Incr Calc Rate STEP INCREASES Date Grp FY 2017 T FY 2017 FY 2018 FY 2018 Date Rate p Wks Dept RequestLY2018 Mayor 52.2 E FY 2018 Old New 5252 BAROSY JEFFREY 120 HEALTH 15101-5111 SANITARIAN 4127/15 3 56.437.19 1.00 1,101.77 1.005 1,107.28 100% 57,578.50 57,578.50 DAVIS MAUREEN 120 HEALTH 15101-5111 PRINCIPAL CLERK 2 1.00 920.16 1.005 924.76 100% 48,087.56 48,087.56 DOTY SUZANNE 120 HEALTH 15101-5111 PUB HLTH NURSE II/III 8/19/2016 3 - 1.00 1.038.68 1,005 1,043.87 8/19/2017 1,082.88 40.0 12.0 100% 54,281.42 54,281.42 GAGAKIS ELIZABETH 120 HEALTH 1 51 01-511 1 SR,SANITARIAN 1/7/2008 3 61,643.11 1.00 1,180.90 1.005 1,186.80 100/0 61,713.83 61,713.83 LYONS HEATHER 120 HEALTH 15101-5111 PRINCIPAL CLERK 10/12/04 2 48,032.33 0.00 920.16 1.005 924.76 ORTA JANICE 120 HEALTH 100% 48,087.56 48,087.56 15101-5111 SANITARIAN-Stepl/II 10/19/16 3 54,181.14 1.00 1,023.84 1.005 1,028.96 10/19/2017 1,067.34 33.0 19.0 100% 54,235.11 54,235.11 RIMPILA ERICA 120 HEALTH 15101-5111 PUB HLTH NURSE 12/3/2015 3 55,39114 0.00 1,038.68 0.000 New 120 HEALTH Resigned 16501-5111 SR.CLERK TYPIST 7/1/2016 1.00 1.005 767.51 100% 39,910.52 - 275 685.01 6.00 323 983.99 323 983.99 FY 2018 DETAILED 8 SPORTY EXPENSES - ✓ HEALTH-120 Approved y Voted by ORG OBJECT DESCRIPTION Dept Request Mayor Council 15102 5218 HOUSEHOLD HAZARDOUS WASTE DAY 15,000 15,000 TOTAL 15,000 15,000 15102 5306 ADVERTISING Public Health alerts,such as for Seasonal Flu,Avian Flu,other contagious diseases 800 800 and legal notices required for regulations. TOTAL 15102 5318 DENTAUMEDICAL SERVICES 800 800 TOTAL General medical supplies as needed 2,500 2,500 15102 5396 HOUSING/SAN 2,500 2,600 Educational Conferences:Contagious diseases,inspections,emergency preparedness, 700 700 Inspectional Equipment such as stem type thermometers,flashlights, batteries, 500 500 License for computerized inspection module 400 400 litmus paper,file,cameral supplies,hardware supplies 500 500 Codes from Mass DEP and MDPH 300 300 Professional Membership for 7 employees:MHOA,APHA, MPHA, NEHA, NALBOH 1,200 1,200 Beach signs, pool test kits,instructional videos,&Training 500 500 TOTAL Fees for expert consultant to review plans and specs as needed. 400 400 15102 5421 OFFICE SUPPLIES 4,500 4,600 TOTAL General Office Supplies as needed 2,500 2,500 15102 5710 IN STATE TRAVEL 2,500 2,500 TOTAL Mileage reimbursement for travel outside of Salem 400 400 15102 5785 RODENT CONTROL 400 400 TOTAL 40 professional exterminations @$125 each 5,000 6,000 15102 5786 BEACH WATER ANALYSIS 5,000 6,000 Bacterial analysis of swimming water 800 800 TOTAL 800 800 TOTAL PROPOSED 31,500 32,500 Ran A_1 AR RECEIVED Jon T. Skerry APR 2 72017 • Attorney and Counsellor At Law Six Lynde Street CITY OF SALEM Salem, MA 01970 BOARD OF HEALTH Phone 978-745-9481 Facsimile 978-741-8354 Email sixlyndestreet@aol.com April 27, 2017 City of Salem, Massachusetts Board of Health 120 Washington Street, 41h Floor Salem, MA 01970 Hand Delivered Dear Sir or Madam: This office represents Kwik Shop Market, 10 Jefferson Avenue, Salem. • Being aggrieved by your recent Order, Kwik Shop exercises its right to a hearing before the Board of Health. V truly your , J T. Ske JTS/mc • CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH PubliaHeth Prevent,Promote.Protect. 120 WASHINGTON STREET,4"FLOOR KIMBERLEY DRISCOLL TEL. (978)741-1800 FAX(978) 745-0343 lramdinna,salem.com LARRY RAMDIN,RS/REHS,CHO,CP-FS MAYOR HEALTH AGENT April 18,2017 Kwik Shop Market 10 Jefferson Avenue Salem, MA 01970 Dear Owner: Kwik Shop Market is in violation of the Salem Board of Health Regulation Affecting sales to a minor. According to this section,the sale of cigarettes,chewing tobacco,snuff,or any tobacco in any of its forms to any person under the age of twenty-one shall be punished by a fine of$200.00 Hundred Dollars for the second offense plus a 7- day suspension.You will be advised of the dates of.the suspension by the Health Agent. On Thursday, March 30,2017 at 4:03pm personnel from the Tobacco Control Program conducted a compliance check. During that compliance check,a 17-year-old female,a minor,was sold flavored tobacco from a clerk in • your store,which is also a violation of the flavor ban effective March 1,2017. Documentation is now on file at the Board of Health regarding that sale. FOLLOWING THE THIRD(3RD)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. Therefore,you are ordered to pay a fine of$200.00 for the violations.A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street,4t"floor,within ten days of receipt of this notice. Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven(7)days of receipt of this Order. At said hearing, you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports,orders, and other documentary information in the possession of this Board,and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification, please call me at 978-741-1800. Sincerely yours, Larry Ramdin Health Agent LR/md CERTIFIED MAIL: 70121640 0002 33131451 • cc: North Shore/Cape Ann Tobacco and Alcohol Policy Program Paul Kirby, Board of Health Chair and Members ]j j7, t��S d4 '.Z r .. j,0'A. � -'t t I 1 F' � �;`�L:��*�." N.a•"� T; t<.. I t ':T K� I.J'< t ��''.v+ �J�,r�;T"ripy'. q�l .?�.i r _ €.:4 x ! c •g�-ri:. ,�'i* Q7av Sf �`r � ) -..�a"�+x r z,'t3,'{t, w "'r"-1.7'.z' �§_.a 3,f, :�!�J ..1.. S..: �''ri• ..'s ,d r I ! 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Welcome Pete King Change My Password I Edit my Profile I Logout MTCP RECEIVED Massachusetts Tobacco Control Program Home i Compliance Checks Inspections Pricing I Enforcement I Establishments I Administrative I Users APR 132017 Create New Survey I View/Edit Surveys Create Survey Using Route I Reports ^�� Chain store Sales Report I Establishmem Compliance Check History I Compliancem m Check Results by Municipality I Municipal Compliance Check Data Summary Report I V OF SALEM Excel Spreadsheet of All Compliance Check data fields I Route Authorimlion Form I Statewide Sales Summary Report I Enfwcemem Data Repoli I Liquor license Establishment Sales RapAOARD OF HEALTH Stores Where Under 37 Material is Displayed Establishment Compliance Check History Towns: Isatem v From Date: 03-30-2014 To Date: 03-31-2017 Establishment: JKVAK SHOP MARKET AND DELI-10 JEFFERSON AV V Output Formats: O CSV @ HTML O PDF Generate Report Independent Establishment Name: KWIK SHOP MARKET AND DELI Establishment Address: 10 JEFFERSON AV Town: SALEM Establishment Style: Convenience Store • Establishment Type: DOR License: 04305 BOH Permit: Was the Tobacco Was Was the Type of Brand of Was cost a oa Survey Supervisor Purchaser was purchaser Gender the up survey purchaser tobacco tobacco �ofthe Copliance Date completed marketed asked for I[D age/her of clerk purchesed purchased m� rodnet Ch ckDate P OS-15- 02014 p Pete King 240917 0 Yes Over the No No Female Cigars Other 2.00 17 12P-229- i 214: Jo ce 973314 Yes Aver the Yes No Female Eti arette Other N 16 01 PM00 Rel FOrd (2864923) Counter 9 07-27- 2015 JoYce 920322 over the 12�00 Redford (14333004) Yes Counter Yes No Female Cigars Other No 17 04 21- 2016 Joyce 973314 pverthe 11:Al2M00 Redford (2864923) Yes Counter Yes No Female Cigarettes Newport No 17 01-19- 2017 JoyYce 021821) Yes Over the Yes No Male Cigarettes 03:PM00 Rat Ord (7825936 Counter 9 Newport No 17 03-31- 04 M00 Pete King (155913852) Yes Over No No Male Cigars Other Y 6.99 ,G 17 E ©Commonwealth of Massachusetts Site Policy Contact Us Help Site Map • httn://www_maggtrn.nror/tiPckton 1/Z 1/)n1'7 f r � r � s L 888 e RO . t sa s• F { f S Y j \ t f Y S l a f A+ ;;%'� �t'x;a- �"' x .. �as,,, z t �'rF�°s ��-,��.e rvs�.#•��, y�.��,�y„ t'�.2�r��"c�,' -. 3 Ol► - e - Mini Mv 55HY Resdutocon 2026 o RESOLVED, that the Medical Society of the State of New York call upon the New York State Department of Environmental Conservation and the manufacturers of the gas leaf blowers to develop guidelines that would dramatically reduce the toxic emissions and noise level of gas leaf blowers; and be it further o RESOLVED, that the Medical Society of the State of New York also encourage that New York State and other governmental entities promote the use of non-polluting alternatives to gas leaf blowers; j and be it further o RESOLVED, that a copy of this resolution be transmitted to the American Medical Association for consideration at its House of Delegates - _ Uown cl Loon(C(Dht MA kt Y TD%IN(DFFIGE$ a TOWN OF LINC©LN BOARDOF�aLTx �Y t MIMI=COUNTY 1VUSSACHUSI'I•rS 16 Lincoln Road Lincoln I A 01773 Phone:781-259-2613 Fwc:781-259-8729 cairoEeCa lincolntown.org Frederick L_Mansfield-M.D--Chairman Herbert:A.Haessler:M.D. Steven R.Kanner,M.D. Boaj.-d of Health Statement Exposure to high intensity,episodic or.long duration noise and air particulate and vapor dispersion from leaf blo.yeas represents significant potential health hazards to otir cities_ The Board of Health supports the Toum ofLmooln Leaf Blo%Nw Study Group's efforts.to craft effective and economically sound approaches to mitigate those health risks. I i Fredrick L_Mansfield_MD. Steven R K.-anner,M-D. Herbert A-Haessler,M.D. • • 00 1 * 310 CMR Section 7.09 deals with dust and odor control. o Leaf blowers are identified by DEP as a source of dust. ® 310 CMR Section 7. 10 deals with noise control . o Leaf blower noise far exceeds thresholds. ® MA Boards of Health are authorized to enforce. Sources: http://bloq mass gov/masslowlib/legal-topics/state-and-local-regulation-of-leaf-blowers/ and others i I 4 4 i Jamie Banks, PhD, MS Executive Director ilbcanks@quietcommunities.orq Jeanne Kempthorne, JD Co-Chair Legal Advisory Council 'mkem thorne@ uietcommunities.or � q g r � � s oo�0000 �� • h g � y o Baldauf R. Fortune C, Weinstein J, et al. Air contaminant exposures during the operation of lawn and ' garden equipment. J Expos Sci Environ Epidemiol 2006;16:362-370. o Banks JL, Weinstein L. Landscape Maintenance Equipment Emissions and Children's Health. Presented at the 2017 Children's Environmental Health Network Conference, April 5-7, 2017, Arlington, VA. o Bureau of Labor Statistics. Employed persons by detailed occupation, sex, race, and Hispanic or Latino ethnicity. www.bls.gov/cps/cpsaatl 1 .pdf o Busick J. Hispanic and Latino Workers at Risk; Can You Protect Them? EHS Daily Advisor. BLR. http://ehsdailyadvisor.blr.com/2014/1 0/hispanic-and-latino-workers-at-risk-can-you-protect- them/#sthash.5XMIKOWj.dpuf o Campbell AF. Many Americans Want Work But They Don't Want to Mow Lawns. The Atlantic, July 1 l , 2016 o Hispanic and Latino Workers at Risk. http://ehsdailyadvisor.bir.com/2014/10/hispanic-and-latino- workers-at-risk-can-you-protect-them/ o Iowa State University Environmental Health and Safety. Vibration. https://www.ehs.iastate.edu/occurpational/ergonomics/vibration o Koppel T, Tint P, Karajeva G, et al. Vibration and noise caused by lawn maintenance machines in association with risk to health. Agronomy Research 2012;10(1 ):251-260. o Loh MM, Levy Spengler A S ler JD, et al. Ranking Cancer Risks of Organic Hazardous Air Pollutants in the g United States," Environ Health Perspect 2007; 1 15:1 160-1 168. o NIOSH. Fact Sheet. Fatal Injuries among Landscape Services Workers. DHHS (NIOSH) Publication No. 2008-144, October 2008. o Tovalin H, Valverde M, Morandi M T, et al. DNA damage in outdoor workers occupationally exposed to environmental air pollutants. Occup Environ Med 2006;63:230-236. { O Q • 0 o Boards of health are required to examine into all nuisances, sources of filth and causes of sickness within the city or town . Whenever a board is aware of a nuisance or cause of sickness that may be injurious to the public health, the board is required to remove or destroy the nuisance or cause of sickness, or prevent the nuisance or cause of sickness . M. G. L. c. 1 1 1 , s. 122 S V • Action Options for Salem Board of Health—June 27, 2017 Submitted by Jeanne Kempthorne, 64 Dearborn Street, Salem, and Jamie Banks, Ex. Dir., Quiet Communities We wish, first, to extend our thanks to Chair Paul Kirby for his invitation to address the Board about the significant public health problem related to the use of gas-powered lawn equipment, particularly leaf blowers, in our community, and to Health Agent Larry Ramdin and Clerk Maureen Davis for their assistance. As you know, Mass. Gen. Laws ch. 111, sec. 112 requires the BoH to examine all nuisances and causes of sickness within the municipality, and to adopt regulations to protect public health and safety relative to those nuisances and causes of sickness. The BoH is further empowered to adopt and enforce regulations to control air pollution. Mass. Gen. Laws ch. 111, sec. 31C. Recent actions by the Mass. Medical Society and the Medical Society of the State of New York, as well as statements from other health organizations, including the U.S. Centers for Disease Control, should spur local boards of health to act to curtail harmful emissions and noise. Beyond local health code regulations,there are several possible actions the BoH might consider to address the problems and risks posed by gas-powered lawn equipment. Quiet Communities is available to consult with the City and the BoH on programs and ordinances that have been adopted by other municipalities and is happy to submit a proposal once items of interest are identified. 1. Educational outreach. The BoH should take immediate steps to educate the public, not only residents, but other property owners, businesses, and workers. The goals of the educational outreach effort should be (a)to raise awareness of the health and pollution risks, (b) to support public and private efforts to transition to cleaner, quieter and healthier alternatives, and(c)to create new norms for social and commercial behavior. a. The BoH could issue an advisory to the public about the risks of leaf blowers, including pollutant emissions, dust, and noise, along with recommendations about greener alternatives. The advisory could be distributed online and via printed handouts available at City Hall, the library, the Council on Aging, the CDC, the Farmers' Market, and other outlets available to the City. b. The advisory could also be included in scheduled City-wide mailings, for example, mailings concerning recycling, or with water/sewer bills, property tax bills, census forms, etc. c. The BoH could issue a separate advisory to local landscapers to encourage them to transition to electric and manual options, to advise them on appropriate uses and • limitations on use, such as within x feet of a residence, or a public way, or on unstable or dusty • surfaces, or on roofs or gutters. The advisory should also contain information about worker safety. It should remind landscapers that they are subject to OSHA requirements as well as the City's noise ordinance. 2. Equipment exchange and purchase programs. The City could devote resources to subsidize an equipment exchange program whereby homeowners turn in gas-powered leaf blowers and receive in exchange discounted or rebated electric blowers. The City could partner with other municipalities to negotiate quantity discounts for the purchase of commercial-grade equipment for its own use. 3. Landscape business registration. The BoH could require commercial landscapers using gas-powered equipment to register with the City and to pay a small registration fee, which could be used to fund the purchase of noise and air quality monitoring equipment for the police and BoH. Landscapers using gas equipment could be required to have their equipment tested for emissions and decibel rating. Registered landscapers could be required to post a notice to passersby with a phone number to call with complaints. Landscapers using only electrical equipment could be exempted from registration, testing, and posting. Registration, testing, and posting requirements would provide a powerful incentive to landscapers to make the transition from gas to electric/manual. • 4. Training. The BOH could sponsor training for commercial landscapers, laborers, and homeowners in the proper use of gas-powered equipment, as well as in the use of protective equipment. The training should make clear that blowers should not be used on public sidewalks or on City streets and must be turned off when there are passersby, children, etc. in the vicinity. 5. City Should Model Appropriate Use of Equipment. The City should model appropriate and safe use of equipment to its citizens. The BoH can work with the City to transition its own equipment to electric, and until they do so, require, if possible, and otherwise instruct the DPW and contractors to the City not to blow dusty sidewalks or within 50 feet of passersby. 6. Publicize Green Alternatives. The BoH could publish a webpage that lists landscapers who pledge to use electric and manual equipment. It could also provide an electronic bulletin board for people (e.g., high school students) who are willing to rake and sweep. 7. Establish Certified AGZA Green Zones. The City could establish"AGZA green zones" —public spaces where only emission-free and quiet equipment are permitted. These "green zones" could be established, first, in school grounds and on the grounds of public elderly housing, and expanded over time to other spaces. 8. Noise-measuring equipment. The BoH should acquire high-quality decibel meters for City use. In addition, the BoH should encourage the public to use widely available apps to measure decibel levels and to document and report inappropriate and unreasonable use of leaf • blowers to appropriate authorities, including the BoH and OSHA. 9. Hotline/Online Complaint Form. The BoH should develop a protocol for responding to noise complaints. It could develop a telephone hotline and email system for notifying the Board of situations where blowers and other equipment are used inappropriately or are too loud, or publish an online complaint form and provide a response system. The BoH can develop a procedure whereby, say, two noise or other complaints against a landscaper would result in a warning accompanied by a requirement that the landscaper notify the BoH that it intends to use gas blowers on a job within the City limits, so that the BoH can check the landscaper's operation, including worker safety,noise, and other emissions. 10. Amendment to Noise Ordinance. The noise ordinance currently states that it is unlawful for any person to "make, continue, or cause to be made or continued any loud, unnecessary or unusual noise or any noise which: (1)Endangers or injures the safety or health of humans or animals; (2) Annoys or disturbs a reasonable person of normal sensitivities; or(3) Endangers or injures personal or real property, which noise shall be termed a"noise disturbance" for the purposes of this chapter."The ordinance enumerates various sources of noise, which, among others, are declared to be loud, disturbing and unnecessary noises. The ordinance should be reviewed to determine whether lawn maintenance equipment should be an enumerated source of noise. It should also be reviewed to determine whether more specific regulation is appropriate or necessary, including limitations on the number of units that may be used simultaneously, the minimum distance from neighboring residences, maximum duration, and maximum decibel level. Currently, the sanctions for violations are outdated and far • too lenient. Many communities are proceeding with seasonal and other sorts of bans. While we do recommend that the BoH consider setting much clearer regulations for appropriate use, we are of two minds when it comes to outright bans. The benefits of a ban are that it clarifies what is acceptable, it can accelerate the delivery of the message to the public, and it empowers citizens to complain and the police to respond relatively easily. The problems with outright or seasonal bans relate to enforceability and public acceptance. We think other methods of regulation and enforcement may be more acceptable to the public, while also delivering a clear public health message. Again, we thank you for the opportunity to address the Board. • CITY OF SALEM, MASSACHUSETTS BOARD OF HF.ILTH PaNcEWNh 120 WAMINGTON STREET,4T"FLOOR r r."t.Remote.Pmtect. KIMBERLEY DRISCOLL TEL (978)741-1800 FAx(978) 745-0343 MAYOR 1ramdinna,sa1em.com LARRY RAMDIN,It,S f 12I'sIIS,C140,cp-ice Hl:. 1Xl-1 AC NT RECEIVED April 18, 2017 APR 2 62017 CITY OF SALEM KvAk Shop Market BOARD OF HEALTH 10 Jefferson Avenue Salem,_MA 01970 . Dear Owner. Kwfk Shop Market is in violation of the Salem Board of Health Regulation Affecting sales to a minor. According to this section,the sale of cigarettes,chewing tobacco,snuff,or any tobacco in any of its forms to any person under the age of twenty-one shall be punished by a fine of$200.00 Hundred Dollars for the second offense plus a 7- day suspension.You will be advised of the dates of the suspension by the Health Agent. On Thursday,March 30,2017 at 4:03pm personnel from the Tobacco Control Program conducted a compliance check.During that compliance check,a 17-year-old female,a minor,was sold flavored tobacco from a dark In your store,which is also a violation of the flavor ban effective March 1,2017. Documentation is now on file at the Board of Health regarding that sale. FOLLOWING THE THIRD(31w)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. Therefore,you are ordered to pay a fine of$200.00 for the violations.A check or money order payable to the City of Salem must be at the Board of Health office,120 Washington Street,4"'floor,within ten days of receipt of this notice. Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven(7)days of -re-W -of-this.Order. X- said hesringL�ou will,begiven the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be y represented`b}r an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports,orders,and other documentary information in the possession of this Board,and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification,please call me at 978-741-1800. Sincerely yours, Larry Ramdin Health Agent LR/md CERTIFIED MAIL:70121640 0002 33131451 cc: North Shore/Cape Arm Tobacco and Alcohol Policy Program Paul IGrby,Board of Health Chair and Members s S North Shore/Cape Ann Tobacco Policy Program 3 City Hall Square Room#ion Lynn,MA o1goi March 31,2017 Dear Tobacco Permit Holder A tobacco compliance check was conducted at your establishment on,3/31/17,see attached violation notice. The City of Salem Board of Health will be in contact with you if further action is required. If you have any question contact me at 781-586-6821 Peter T.King,Inspector % � s s Memo RECEIVED Date: April 6,2017 APR 13 2017 To: Larry Ramdin,Health Agent CITY OF SALEM From: Joyce Redford,Director 80ARD OF HEALTH RE: Salem Tobacco Compliance Checks On Thursday March 30,2017,the North Shore/Cape Ann Tobacco Alcohol Policy Program conducted compliance checks in the City of Salem. In addition to Peter King,Inspector and two(2)under aged youth participated in these checks. Although additional checks will be conducted three(3)sales occurred and are listed below. Violations occurred in the following establishments: Establishment: Address: Offense: Fine: Salem l iquor's .�f 125 Canal St ist $100.00 Kwik Shop Market J io Jefferson Ave end $200.00 +7-day suspension V/ AL Prime V 1.75 Lafayette St end $200.00+7-day suspension j *It is Noteworthy to mention that in addition to Kwik Shop Market having a violation of a sale of tobacco product to a minor,the product sold to the youth was Dutch Master cigarillos vanilla. Enclosed you will find a copy of the violation notices that were issued to each establishment at the time of the compliance check Should you have any questions regarding these checks please do not hesitate to contact me at 781-586-6821 The Commonwealth of Massachusetts RECEIVED Executive Office of Health and Human Services MAY 17 2011 T Department of Public Health OF 0 250 Washington Street,. Boston, MA 02108-4619 BOARD OF HEA N CHARLES D.BAKER MARYLOU SUDDERS Governor Secretary KARYN E.POLITO MONICA BHAREL,MD,MPH Lieutenant Governor Commissioner Tel:617-624-6000 www.mass.gov/dph, TO: Boards of Health FROM: Susan T. Gershman,MPH,PhD, CTR Director Massachusetts Cancer Registry DATE: May 15, 2017 RE: Cancer Incidence in Massachusetts, 2009-2013, City and Town Supplement I am writing to inform you that the Massachusetts Cancer Registry(MCR) of the Massachusetts Department of Public Health(MDPH)is releasing its report Cancer Incidence in Massachusetts, 2009-2013, City and Town Supplement. Please note that this report will be published in an electronic version only and will be posted on the Department of Public Health's web site at www.mass.ggy/dRh/mer.on May 24,2017. If you are interested in further supplement data prior to the posting,please contact the registry directly at the telephone number listed below. Please note that there is no embargo on these data and they may be released prior to the web posting date. The 2009-2013 City and Town Supplement updates the 2008-2012 City and Town Supplement. For each city and town,this report provides expected case counts, observed case counts, standardized incidence ratios, and confidence intervals for 23 types of cancer and for all cancers combined. The confidence intervals indicate if there is a statistically significant difference (excess or deficit)between the observed and expected counts. We are providing you with the following pieces of information in advance of the report's Internet release. 1. The introduction to the report,including an explanation of standardized incidence ratios. 2. The cancer incidence data for your town(i.e. for 23 cancer types and all cancers combined). 3. Appendix II includes selected resources for information on cancer. 4. Appendix III-includes MDPH Cancer Prevention and Control Initiatives. 5. For cancer risk factors,.please check the following websites: American Cancer Society: www.cancer.orll;National Cancer Institute: www.cancer.gov. over 9 bo'miplbte Internet version will be available at: www.mass.gpX/dph/mcr The following reports have also been recently posted on the above website: Data Brief. Cancer Incidence in Massachusetts 2010-2014—Preliminary Data Cancer Incidence.and Mortality in Massachusetts 2009-2013: Statewide Report If you have any trouble accessing this web site,please contact the MCR at(617) 624-5642. For further information,please contact the following at MDPH: Massachusetts Cancer Registry (617) 624-5642 Bureau of Environmental Health (617) 624-5757 Massachusetts Comprehensive Cancer Prevention and Control Program(617) 624-5484 INTRODUCTION Content • The purpose of this report is to provide an estimate of cancer incidence for each of the 351 cities and towns of Massachusetts for the five-year time period 2009 through 2013. For each city and town, Standardized Incidence Ratios(SIRS)are presented for twenty-three types of invasive cancer and for all invasive cancer types combined. These ratios compare the cancer incidence experience.of each city or town with the cancer experience of the state as a whole. The method involves comparing the number of cases that were observed for a city or town to the number of cases that would be expected if the city or town had the same cancer rates as the state as whole. The report is organized into the following sections: METHODS provides a detailed explanation of the data collection, data processing,and statistical techniques employed in this report. TABLES present data for selected types of cancer by city/town and sex. APPENDIX I provides a listing of International Classification of Diseases for Oncology codes, used in the preparation of this report. APPENDIX H provides selected resources for information on cancer. APPENDIX III describes the Massachusetts Department of Public Health's current cancer control initiatives,and provides links to bureaus within the department that address some aspect of cancer. Links to resources for publications are also provided. • Comparison with Previous Reports This report updates previous annual reports publishedby the Massachusetts Cancer Registry(MCR). It is available on line at httg://www.mass.g_py/dph/mcr. For questions about the report,contact the MCR at: Massachusetts.Cancer Registry - Office of Data Management and Outcomes,Assessment Massachusetts Department of Public Health 250 Washington Street, Eth floor- Boston,MA 02108-4619 telephone 617-624-5642;fax 617-624-5695 The preceding report Cancer Incidence in Massachusetts 2008.2012: City and Town,supplement, included data for diagnosis years 2008 through 2012. This report contains data for the diagnosis years 2009 through-2013. There have been no changes in this report's format from the previous report. METHODS Data Sources Cancer Incidence i The MCR collects reports of newly diagnosed cancer cases from health care facilities and practitioners throughout Massachusetts..Facilities that reported the.2009-2013 diagnoses that comprise this report include 69 Massachusetts acute care hospitals, 18 independent laboratories, 10 surgical centers, 5 radiation/oncology.centers, 5 medical practice associations, 4 endoscopy centers, and approximately 500 private practice physicians.The MCR signed the modified National Data Exchange Agreement on March 28; 2013. This is a single agreement that allows participating states to exchange data on cases diagnosed or treated in other areas. Together with states participating in the agreement, and states with individual agreements,the MCR now has reciprocal reporting agreements with 43 states and with Puerto Rico and Guam to obtain data on Massachusetts residents diagnosed out of state. Currently the MCR collects information on in situ and invasive cancers and benign tumors of the brain and associated tissues. The MCR does not collect information on basal and squamous cell carcinomas of the skin. The MCR also collects information from reporting hospitals on cases diagnosed'and treated in staff physician offices when this information is available. Not all hospitals report this type of case, however, some hospitals report such cases.as if the patients had been diagnosed and treated by the hospital directly. Collecting these types of data makes the MCR's overall case ascertainment more complete. Some cancer types that maybe reported to the MCR in this manner are melanoma,prostate, colon/rectum,and oral cancers. In addition,the MCR identifies previously unreported cancer cases through review of death certificate data to further improve case completeness.This-process is referred to as death clearance and identifies cancers mentioned on death certificates.that were not previously reported to the MCR. In some S instances, the MCR obtains additional information on these cases through follow-up activities with hospitals, nursing homes, hospice residences, and physicians'.offices. In other instances, a cancer- related cause of death recorded on a Massachusetts death certificate is the only source of information for a cancer case. Thus these "death certificate onnV' cancer diagnoses are poorly documented and have not been confirmed by review of clinical and pathological information. Such cases aie included 0 in this re o but the comp ri a less than 3/o o all cancer cases. p rt, Y P s f All case reports that provided the basis for this report were coded following the International Classcation of Diseases for Oncology,.Third Edition (ICD-0-3), which was implemented in North America with cases diagnosed as of Jan 1 2001. 1 Please see Appendix A for the classification � �Y � ( ) PP of cancers by ICD-03 codes.. Each year, the.North American Association.of Central Cancer Registries (NAACCR) reviews cancer registry data for quality,completeness, and timeliness. For 2009-2013,the MCR's annual case count was estimated by NAACCR to be more than 95% complete for each year. The MCR has achieved the' gold standard for this certification element as well as.for six other certification elements for each case year since 1997. The Massachusetts cancer cases presented in this report are primary cases•of cancer diagnosed among Massachusetts residents during 2009-2013 and reported to the MCR as of December 1,2016. These data include some additional cases diagnosed in 2008-2012 that were not counted in the previous report, Cancer Incidence in Massachusetts 2008 20I2: 'City and Town Supplement. The lag time between this report and the annual statewide report of 2009-2013 cancer cases is due to the fact that data for this city and town report needed to be cleaned for accuracy of residence within Massachusetts. The statewide report presented data at the state level and did not require such accuracy of city and 2 town.of residence. The numbers presented in this report may change slightly in future reports, reflecting late reported cases or corrections based on'subsequent details from the reporting facilities. Such changes might result in slight differences iri numbers and rates in future reports of MCR data, reflecting the nature of population-based cancer registries that receive case reports on an ongoing • basis. Massachusetts cancer cases presented in this report are primary cases of cancer diagnosed among Massachusetts residents during 2009-2013.' The Massachusetts data presented include invasive cancers only(except cancer of the urinary bladder,where in situ cancers are also included). Invasive cancers have spread beyond the layer of cells where they started and have the potential to spread to other parts of the body. In situ cancers are neoplasms diagnosed at the earliest stage,before they have spread,when they are limited to a small number of cells and have not invaded the organ itself.. Typically,published incidence rates do not combine invasive and in situ cancers due to differences in the biologic significance,survival prognosis and types of treatment of the tumors. Cancer of the urinary bladder is the only exception, due to the specific nature of the diagnostic.techniques and treatment patterns. Presentation of Data 'Each city and town in Massachusetts is listed alphabetically in the TABLES section. The observed number of cases,the expected number of cases,the standardized incidence ratios,and 95%confidence intervals are presented for twenty-three main types of cancer and for all cancer types combined. The "all cancers combined"category includes the twenty-three main types presented in this report and other malignant neoplasms. This category is meant to provide.a.summary of the total cancer, experience in a community. As different cancers have different causes,this.category does not reflect • any specific risk factor that may be important for this community. Observed and Expected Case Counts The observed case count(Obs)for a particular type of cancer in a cityltown is the actual number of newly diagnosed cases among residents of-that city/town for a given time period. A city/town's expected case count(Ezp)for a certain type of cancer for this time period is a calculated number based on that city/town's population distribution(by sex and among eighteen age,groups)for the time period 2009-2013, and the corresponding statewide average annual age-specific incidence rates. The source of the city and town population data for the 2009-2013 period was the US Census American Community Survey(ACS), an ongoing national survey that provides demographic estimates on-a yearly basis? Standardized Incidence Ratios A Standardized Incidence Ratio (SIR)is an indirect method of adjustment for age and sex that describes in numerical terms how a city/town's cancer experience in a given time period compares . with that of the state as a whole. • An SIR of exactly 100 indicates that a city/town's incidence of a certain type of cancer is equal to that expected based on statewide average age-specific incidence rates. • .An SIR of more than 100 indicates that a city/town's incidence of a certain type of cancer is • higher than'expected for that type of cancer based on statewide average annual age-specific incidence rates. For example,an SIR of 105 indicates that a city/town's cancer incidence is 5% higher than expected based on statewide average annual age-specific incidence rates. 3 • An SIR of less than 100 indicates that a city/town's incidence of a certain type of cancer is lower than expected based on statewide average age-specific,incidence rates. For example,an SIR of 85 indicates that a city/town's cancer incidence is 15%lower than expected based on statewide average annual age-specific incidence rates. Statistical Significance and Interpretation of SIRS The interpretation of the SIR depends on both how large it is and how stable it is. Stability in this context refers to how much the SIR changes when there are small increases or decreases in the observed or expected number of cases. Two SIRS may have the same size but not the same stability. For example, an SIR of 150 may represent 6 observed cases and 4 expected cases,or 600 observed . cases and 400-expected cases. Both represent a 50 percent excess of observed cases. However,in the first instance;one or two fewer cases would change the SIR a great deal,whereas in the second instance;even if there were several fewer cases,the SJR would only change minimally: When the observed and expected numbers of cases.are relatively small,their ratio.is easily affected by one or two cases. Conversely,when the observed and expected numbers of cases are relatively large,the value of the'SIk is stable. A 95 percent confidence interval.(CI)has been presented for each SIR in this report-(when the observed number of cases is at least 5),to indicate if the observed number of cases is significantly different from the expected number, or if the difference is most likely due to chance. A confidence interval is a range of values around a measurement that indicates the precision of the measurement. In this report,the 95%confidence interval is the range of estimated SIR values that has a 95%probability of including the true SIR for a specific city of town. If the 95%confidence interval range does not include the value 100.0,then the number of observed cases is significantly different from the expected number of cases. "Significantly different"means there*is at most a 5%chance that the difference between the number of observed and expected cancer cases is due solely to chance alone. If the • confidence interval does contain the value 100,there is no significant difference between the observed and expected.numbers. Statistically,the width of the interval reflects the size of the population and the number of events;smaller populations and smaller observed numbers of cases yield less precise estimates that have wider confidence intervals. Wide confidence intervals indicate instability, meaning that small changes in the observed or expected number of cases would change the SIR a.great deal. Examples: • SIR= 137.0; 95%CI(101.6- 180.6)—the confidence interval does not include 100.0 and the interval is above 100.0,indicating that the number of observed cases is statistically significantly higher than the expected number. • SIR=71.0;95%•CI(56.2—88.4)—the confidence interval does not include 100.0 and the interval is below 100.0,indicating that the number of observed cases is statistically significantly lower than the expected number. • SIR= 108.8 95%CI(71.0-159.4)—the confidence interval DOES include 100.0 indicating that the number of observed cases is NOT statistically signiftcantly different from what-is expected, and the difference is likely due to chance. When the interval includes 100.0,then the true SIR may be 100.0. 4 Example of Calculation of an SIR and Its Significance OBSERVED CASES SIR_ X 100 EXPECTED CASES The following example illustrates the method of calculation for a hypothetical town for one type of cancer and one sex for the years 2007-2011: Town X State Town X Town X Age Age-Specific Expected Observed Group Population Incidence Rate Cases Cases (A) (B) (C)_(A)x(B) (D). 00-04 74,657 0.0001 7.47 11 - 05-09 -134,957 0.0002 26.99 25 1044 54,463 0.0005 27.23 30 15-19 25,136 0.0015 37.70 40 20-24 17,012 0.0018 30.62 30 UP TO 85+ 6,337- 0.001.0 6.34 8 Total: 136.35 144 Observed Cases (column D total) 144 SIR= X 100= X 100= � X 100 106 Expected Cases (column C total) 136.35 Thus the SIR for this type of cancer in Town X is 106,indicating that the incidence of this cancer.in Town X is 6%higher than the corresponding statewide average incidence for this cancer. However, the range for the 95%confidence interval.(89.1-124.3).(calculation not shown)indicates that the true value may be as low as 89.1 or as high as 124.3 Also, since the range includes the value 100,it means that the observed number of cases is not statistically signicantly higher or lower than what is expected. Whenever the number of observed cases is less than five,the corresponding SIR is neither calculated nor tested for statistical significance.This is indicated with an(nc)("not calculated"). However,the number of observed and expected cases is shown in these circumstances. Notes about Data Interpretation The SIR is a useful indication of the disease categories that have relatively high or low rates for.a given community, These statistics,however,should be used with care. Such statistics provide a starting point for further research and investigation into a possible-health problem,but they do not by themselves confirm or deny the existence of a particular health problem. Many factors unrelated to disease causation may contribute to'au elevated S1R,including demographic factors,changes in diagnostic techniques,and changes in data collection or recording methods over time, as well as the natural variation in disease occurrence. 5 When reviewing the data tables,it is important to keep in mind that an SIR compares the observed cancer incidence in a particular community with the expected incidence based on statewide average annual age-specific incidence rates. This means that valid comparisons can only be made between a community and the state as a whole. SIRS for different cities and towns CANNOT and SHOULD NOT be • compared to each other. (Comparisons between two communities would be valid only if there were no differences in the age and sex distributions.of the two communities'populations.) Another point to keep in mind when reviewing these data is the large number of statistical tests being performed in this report. For each of the 351 cities and towns,we evaluate 18 types of cancer that can. occur in both males and females,3 types that occur only in females and 2 types that occur only in males,resulting in 41 gender/cancer categories. This results in 14,391 possible calculations(351 cities and towns x 41 gender cancer categories). Note that gender/cancer categories with less than 5 observed cases are not evaluated for statistical significance,so the actual numbers of tests is slightly lower than 14,391.This is important for the reader because when multiple significance tests are performed, some will result in a-significant finding due to chance alone.Based on the number of calculations in this report,we expect 720 significant findings to be due to chance alone. Half of these. would'be significant excesses(360)and half would be significant deficits(360). There are statistical techniques that can be used to reduce this number,however use of these techniques leads to the opposite problem—true significant differences that may be missed. We choose to err on the.side of caution and identify more significant results,knowing that some will.be due to chance alone. Data Limitations It should be.emphasized that apparent increases.-or decreases in cancer incidence over time might reflect changes in diagnostic methods or case reporting rather than true changes in cancer incidence. Your other limitations must be considered when interpreting cancer incidence data for Massachusetts cities and towns: under-reporting in areas close to neighboring states;under reporting for cancers that may not be diagnosed in hospitals; cases being assigned to incorrect cities/towns;and standardized incidence ratios based on small numbers of cases. Border Areas-and Neighboring States Some areas of Massachusetts appear to have low cancer incidence,but this may be due to loss of Massachusetts resident cases who are diagnosed in neighboring or other states and not reported to the MCR.The MCR has reciprocal reporting agreements with 29 states and with Puerto Rico. Cases Diagnosed in Non Hospital Settings During the time period covered by this report,the MCWs primary information source for most newly diagnosed cases of cancer was hospitals. In addition the MCR collected information from-reporting hospitals on cases .diagnosed and treated' in staff physician offices, when this information was available. Other reporting, sources include dermatologists and dermatopathology laboratories, urologists' offices and a general laboratory. Some types of cancer in this report may be under-reported because they are diagnosed primarily by private•physicians, private laboratories, health maintenance. organizations, radiotherapy centers that escape identification systems used by hospitals. The most common types of cancer diagnosed or treated outside of the hospital include melanoma and prostate cancer. The exact extent of this under-reporting has not been determined, but cases included in this report represent the great majority of cases statewide and provide an essential basis for evaluating statewide cancer incidence patterns. 6 • City/Town Misassignment In accordance with standard central cancer registry procedures,each case reported to the MCR ideally should be assigned to the city/town in which the patient lived at the time of diagnosis,based on the • address provided by the reporting hospital. In practice,however,a patient may provide the hospital with his/her mailing address(e.g.,a post office box located outside the patient's city/town of residence); a business address; a temporary address(e.g.,the patient is staying with a relative while receiving treatment and reports the relative's address*as his/her own); or a locality or post office name (e.g.,"Chestnut Hill"rather than`Boston,"`Brookline,"or"Newton"). In addition,if a patient has moved since being diagnosed,the hospital may report the patient's current address. Because of the large number of cases reported to the MCR,and because data are reported to the MCR via electronic media,most city/town case assignments are performed by an automated computer process. This simplified matching process may misassign some cases based on the reported locality name. When MCR staff become aware of such misassignments,they manually correct the errors. Furthermore, in order to minimize such.errors,cases from fifty geographic localities prone to city/town misassignment are reviewed manually. Small Numbers of Cases Standardized incidence ratios based on small numbers of cases result in estimates that are very unstable. This situation is common when the population of a city or town is small or if the particular- cancer type is rare. SIRS and statistical significance are not calculated when the number of observed cases for a specific category is less than five. In these instances,the observed and expected cases are- presented in the tables or,qualitative comparison only. 7 Salem Observed and Expected Case Counts,with Standardized Incidence Ratios,2009-2013 Obs Exv SIR 95%CI Obs Exp SIR 95%Cl •Bladder,Urinary Melanoma of Skin Male 39 34.8 112.0 (79.6-153.1) Male 25 23.4 106.6 (69.0-157.4) Female 10 15.9 62.9 (30.1-115.7) Female 26 23.5 110.7 (72.3-162.2) Brain and Other Nervous System Multiple Myeloma Male 12 7.5 159.8 (82.5-279.1) Male 4 7.2 nc (nc-nc) Female 5 7.2 69.2 (22.3-161.4) Female 12 7.2 166.6 (86.0-291.0) Breast Non-Hodgkin Lymphoma Male 2 1.2 nc (nc-nc) Male 36 21.2 1Z62 (119.2-235.6) Female 188 177.2 106.1 (91.4-122.4) Female 25 22.5 111.2 (71.9-164.2) Cervix Uteri Oral Cavity&Pharynx Male 17 17.2 98.6 (57.4-157.9) Female 3 6.2 nc (nc-nc) Female 12 9.5 125.9 (65.0-220.0) Colon/Rectum Ovary Male 42 39.3 106.8 (77.0-144.4) Female 40 48.4 82.7 (59.0-112.6) Female 10 16.0 62.3 (29.8-114.7) Esophagus Pancreas Male 18 9.4 191.8 (113.6-303.2) Male 11 12.5 88.2 (44.0-157.8) Female 4 3.1 nc (nc-nc) Female 17 16.0 106.2 (61.8-170.0) Hodgkin Lymphoma Prostate Male 4 3.4 nc (nc-nc) Male 151 120.4 125.4 (106.2-147.1) Female 7 3.2 215.6 (86.4-444.1) Kidney&Renal Pelvis Stomach' • Male 23 20.2 114.1 (72.3-171.3) Male 13 8.4 155.4 (82.7-265.7) Female 17 14.0 121.5 (70.7-194.5) Female 3 6.2 nc (nc-nc) Larynx Testis Male 5 5.5 90.8 (29.3-212.0) Male 6 6.8 88.5 (32.3-192.7) Female 4 2.1 nc (nc-nc) Leukemia Thyroid Male 16 14.8 108.2 (61.8-175.6) Male 11 10.0 110.2 (54.9-197.1) Female 16 13.2 121.0 (69.1-196.5) Female 37 34.7 106.5 (75.0-146.8) Liver and Intrahepatic Bile Ducts Uteri Corpus and Uterus,NOS Male 16 12.6 126.5 (72.3-205.5) Female 5 5.1 97.8 (31.5-228.2) Female 45 40.8 110.4 (80.5-147.8) Lung and Bronchus All Sites 1 Types Male 73 62.1 117.6 (92.2-147.8) Male 571 475.0 120.2 (110.67130.5) Female 90 82.5 109.0 (87.7-134.0) Female 624 603.2 103.5 (95.5-111.9) • Obs=observed case count;Exp=expected case count; • SIR=standardized incidence ratio((Obs/Exp)X 100); • 95%Cl=95%confidence intervals,a measure of the statistical significance of the SIR; • Shading indicates the statistical significance of the SIR at 95%level of probability; • nc=The SIR and 95%Cl were not calculated when Obs<5; 267 APPENDIX H: SELECTED RESOURCES FOR INFORMATION ON CANCER • This Appendix contains a listing of selected resources for additional information on cancer. Cancers are complex diseases,many of which have multiple factors that may contribute to their development. For information on cancer risk factors or prevention,you may wish to contact the following: . Cancer Information Service(National Cancer Institute):1-800-4-CANCER(1-800-42276237) Cancer Response Line(American Cancer Society): 1-800-ACS-2345 (1-800-227-2345) In addition,the following selected Internet websites provide information on cancer. Many of these also provide links to other sites(not listed)which may be of interest. Massachusetts Department of Public Health: http://www.mass.gov/dph American Cancer Society: http://www.cancer.org Centers for Disease Control and Prevention Home Page: hqp://www.cdc.gov Cancer Prevention-and Control Program: http://www.cdc.gov/cancer Fruits and Veggies More MattersTM Campaign(nutrition—formerly 5-A-Day Program): http://www.fruitsandveggiesmorematters.org// National Cancer Institute • Information: http://www.cancer.gov Cancer Literature in PubMed: https://www.nebi.nlm.nih.g—oy/pubmed?cmd current--Limits&pmfilter Subsets=Cancer Surveillance,Epidemiology,and End Results.(SEER)Program data: h4://seer.cancer.gov Your Cancer Risk(Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; formerly at Harvard Center for.Cancer Prevention): http://www.yourdiseaserisk.wustl.edu OncoLink(Abramson Cancer Center of the University of Pennsylvania): hLtp://www.oncolink.org Cancerquest(Emory University—Winship Cancer Institute): www.cancerquest.org National Coalition for Cancer Survivorship: http://www.canceradvocga.org • APPENDIX III: MDPH CANCER PREVENTION AND CONTROL INITIATIVES The Massachusetts Department of Public Health is working to reduce the incidence and mortality • of cancer in the Commonwealth. Partnerships between MDPH programs,researchers,healthcare providers and nonprofit organizations collect information about cancer, lead quality improvement P P g projects, coordinate evidenced-based workshops for managing living with chronic disease (including cancer),provide education for health professionals and bring shared messages to the public. Our collaborated efforts focus on reducing cancer risk, incidence and mortality through healthy lifestyles,early diagnosis, and increased access to care.The Department's programs address the impact of tobacco,alcohol,nutrition,and physical activity on cancer prevention, along with environmental and occupational hazards for cancer.Throughout all of our efforts there is an emphasis on reducing disparate health outcomes and unequal access to cancer care. MDPH Bureaus and Programs: Bureau of Environmental Health,www.mass.goy/dph/environmental health Bureau of Substance Abuse Services,www.mass.gov/dpb&sas Comprehensive Cancer Prevention and Control Program,www.mass. ovg_ /compcancer Men's Health/Women's Health/Care Coordination Program Tobacco Cessation and Prevention Program,www.mass.gov/dph/mtgp Occupational Health Surveillance Program,www.mass.goy/dph/ohsp Office of Elder Affairs www.mass.gov/elders/ Oral Health Program,www.mass.gov/dph/oralhealth Division of Prevention and Wellness www.mass.gov/dph/healthpromotion MDPH publications on cancer prevention and screening are available at the Massachusetts.Health Promotion Clearinghouse,www.maclearinghouse.com. Massachusetts Cancer Registry Publications are available through the Massachusetts Cancer • Registry,telephone: 617-624-5642 and on the web at www.mas§.goy/dph/mer. 1 Larry Ramdin • From: Wendy Kent <wkent@bridgewell.org> Sent: Tuesday, February 14, 2017 4:11 PM To: Larry Ramdin Subject: Needle exchange I am sending this email to support consideration for accessibility to some type of needle exchange program in Salem. Needle exchange programs have been effective in ensuring access to clean needles and reducing the transmission of diseases and infections including HIV and Hepatitis; it also reduces the risk of blood infections among IV drug users. Most importantly, needle exchange is an important component of harm reduction;while abstinence is preferred, it is not always attainable. Needle exchange provides opportunities to connect with individuals at risk and to establish important conversations about harm reduction and service resources, and to develop trusting relationships that could ultimately result in successful referral for treatment. Wendy Wendy P. Kent, M.A., LADC1, CPS Director of Behavioral Health and Prevention Programs Project COPE,An affiliate of Bridgewell 66 Silsbee St. Lynn, MA 01901 Phone: (781)581-9270,ext 4100 • Direct dial: (781) 776-4100 Fax: (781)581-8413 Email: wkent@bridaewell.org i ' r� y IX Landscape Mah enanc e Noise, Pollution, and Health Presented to: Health Department City of Salem Salem, MA Jamie Banks, PhD, MS a II ;; Jeanne Kempthorne, JD li June 13, 2017 M it ° it i QUiet • i i i o A national 501 c3 organization o Scientific, evidence-based approach ® Four advisory councils o Relevant programs and services o Research c Education and outreach programs o Expert testimony Y o "On the ground " solutions i • • ; � o� o � � �� C�® I! � �� { ''�R''-a � ^. �4 rt.� ei:�t� � ..:^'M�� i. .'� ��, � III ,� a.. '�. �ro'"`Siw ��._7� �� .. a � � � � � � i� w � _ � � 5 �. �, w � �� S s ,. ,. „v , T., _ ,�- �- .s � Z S' ' .� _ _ t �� .t $ u �, + ,. -. a , '�R' a�.- 4# fm 'I ��„ �� ., .. c5i�,..,. _w...; W ., i` �. .� - --. . . � -..{ ..� .k ,� � '�� '� d � �. ! � ? 6� j � � b., ,. '� � �x � r n � ,-.: ,. �. ,5., ,F s� x x - s „ ,. •��; s ; -- �-- I __ ©-Oci iet • - d d f -low low y °s. L Ry i .s • II I • `. ® �� f COMPH(anCe Dust o Don't use for moving dusty materials o Don ' t point in direction of people/pets x p p 13 Use >_ 50 feet away from people Noise -=Mr 13 Run blowers only at RPMs needed f Don ' t use full throttle in residential areas 13 Don't use > 1 blower at a time ' Time Don ' t use late in the evening or early in w A the morning Other P' Don ' t use on unstable surface I p Q - - I ARIZONA W. Hollywood NEW JERSEY Southampton Village Maricopa County COLORADO Highland Park Tarrytown CALIFORNIA Aspen Montclair Thomaston Alameda County Carbondale Woodcliff Lake Tuckahoe Belvedere CONNECTICUT NEW YORK White Plains Berkeley Greenwich Ardsley Yonkers Beverly Hills Norwalk Bronxville OREGON Burlingame Stamford Dobbs Ferry Portland Claremont FLORIDA East Hampton VIRGINIA Dana Point Coral Gables Flower Hill Alexandria Del Mar Naples Great Neck CANADA Foster City Palm Beach Greenburg Toronto Hermosa Beach Tampa Hastings Vancouver Indian WellsKey west Huntington ton ISRAEL Laguna Beach Larchmont Lawndale I v Mamaroneck Town Los Altos Evansto S anston Mamaroneck Village Los Angeles Highland Park Newcastle Malibu Lake Bluff New Rochelle k Pa rk rk a Menlo Park New York City Mill Valley Wilmette North Hempstead o Palo Alto Winnetka MARYLAND Nyack Piedmont Orangetown Sacramento Montgomery Cty. Oyster Bay Santa Barbara MASSACHUSETTS Pelham Village j, Santa Monica Arlington Rye Sonoma (as of 2016) Brookline Scarsdale 4 Sunnyvale Cambridge Sleepy Hollow Newton J. ter-- - _____�_._.�-___--� - ._- ----• i Noise Emissions Health S . � . A4A • Fuel Solid Waste Toxic Waste A OQLhat,,Cbrnrnun Li k/1 0--V�' i I © Toxic, carcinogenic exhaust and ground sourced particulates a Dangerous noise levels o Harmful vibration o erators ( p ) o Toxic solvents (operators) © Other _ a O Qe — • — , i Mv anWacWrers Know There 's a ProMem 1A The engineexhaust from this product contains chemicals known to the Mate of California to cause cancer, birth defects or other reproductive harm. Emossoons und Gvaund Souvced y. r MM what Dry 7hey G - 0 o Exhaust emissions c Evaporative emissions c Ground-sourced particulates In close proximity to airways - nose, mouth - f ii k o o GLGE EMOSSOOns, US 2011 I � Pollutant TPY VOCs 461,798 NOx 68,517 CO 5,793,164 PM2.5 19,002 CO2 20,382,401 GLGE: Gas-powered Lawn and Garden Equipment; TPY: Tons per year Source: Banks JL, McConnell R. National Emissions from Lawn and Garden Equipment, International Emissions Inventory Conference, San Diego, April 16, 2015. Soon Mv ove PoHufion 4han CaFsOO Wo ott�c�ft fr�c�il o�or o�Qow�b5b�19�� ow�7Br�@� �✓600 @�c�ooc7 f�oB� �c�� 0�0 Gd�o G�a��oao G,�G�o [3o��c��o c QG�Oc� CCao QcJ G�i L3�rc�� D� ({�O�aOD D a�)* ©'Quiet Communities Inca cal 111 U I (ij f tea ►—• (i] f �i� '�"V + f v ter I C�� ` c�] �i) t�� f Head �o unead: Le& Nower vs Truck © 1 Em'O'ss*oons ReSUNS groin can AAA TeS� Lab I +� • VS I Q 6,200-pound, 400+ hp 2011 Hand held, 2-stroke leaf Ford F-150 SVT Raptor blower o Hydrocarbon emissions from 30 minutes of running a 2- stroke leaf blower = 3,900-mile drive in a Ford Raptor. o The 2-stroke leaf blower generates 23x CO and -300x non-methane hydrocarbons vs the Raptor. Details at http://www.insideline.com/features/emissions-test-car-vs-truck- aiLbro rr drwities, Inc. II Photos at: http://www.insideline.com/features/photos/emissions-test-car-vs-truck-vs-leaf-blower- gallery.html. 14 i i ` I � � I VOCSID PD�qn� C(UFC 0 VOCs o O 0 ,I Volatile Organic Compounds g p wound LevM Ozone i i P Source: American Lung Association i i (i p M �o5unaxavdous �o HeaKh, Cancw Caushg s f Most harmful Important Source: International Agency for Research in Cancer, World Health Organization. Air Pollution and Cancer. K Strait A Cohen, J Samet (Eds), Scientific Publication 161 , Lyon Cedex FR:IARC, 2013. Ground Sourced ParNcWa es 0 Animal fecal material o Pesticides, herbicides, fertilizers 4" o Fungal spores, pollen o Bacteria o Diesel soot, brake dust, rubber tire particles o Toxic heavy metals (eg, arsenic, lead) �I Key Sources: A Report to the California Legislature on the Potential Health and Environmental Impacts of Leaf Blowers. California Environmental Protection Agency, Air Resources Board, Mobile Source Control Division, February 2000. a ,. I n ea Kh 09(s(aft Health risks from OZONE POLLUTION PARTtcLE POLLUTION41 �} P t i o �► Source: American Lung Association � - ("� �r ' � y b,'! Q©;Quiet�Communities Inc: Short-term- ex,,p`asvre f Far IC can p p Ozone and particle {� � s ki11. . Deathsi#can occur on pall utron threaten � =� _ �` the eery d6`61 particle. .- :. leve►s are high, or.wrth►n mrllrons o t _ r 4 o n" to ` 4 `two rn o n th s Americans. � �- afterward. fi American Lung Association, State of � the Ar�2014 American Lun,ry Association i l � I MOISSI - �v E ■ Prcfesmcmua' Lardcore h2e�'.vork I Is Our Equipment Noisier Than 85 dB . Yes. Most of it is. Some are more than 1 ,000 times noisier. Click equipment to learn how noisy it is Sound Pressure d gs ENERGY' 130 10,000,000,Ow,000 120 1,000,000,000.000 11,0 100,000,000,CO10 . � 04 1�0 . 1 s 60 i,4tl0,Ot� so av 1a,�oa e 30 - 1,000 20 = 100 t 1�7 3i r. 10 �� k» N,y iiLtNrY O.eusiRr.p/n Wtlr14"A1NQ xe:4�7r+tl;fiGE1 it it Et Meru -English Prev Next f ON - • - I I ' PLANET • ' . 0 Prcfawcna. Lan lcare I�Kvork Can IGetHearing Damage From My Work? Your daily noise exposure determines most of your risk. Two main factors : dBs HRs AGE • Higher noise exposure = more risk F971 • Longer noise exposure = more risk • Risk also increases as you age At age 25, odds of hearing loss , 0 from work at 97 dB for 8-hour day '64 in over 10 years is 64 in 100 (NIOSH) WO or about 2 in every 3 workers dkers. At 82 dB, odds would be only 2 in 100 workers At 76 dB, odds would be 0 in 100 workers Crick a tool to see rdetine risk to sslirotectei worker. i i By age 45, permanent hearing loss/tinnitus is likely for 1 in 4 workers *Exposed for 10 or more years above 90 dB without hearing protection. i un � � o o A a 1 S, ® ® 40 ® -® ® ® r ""` !Z. � ® ® � ® VV r" �s ��'' .e u '., a cc '�`+.�' '^�.r�,..'rxk ,lF# s .y, ; `��4C -3f^x,- k � '�mr� � �,. ,� -e' � +a � x+',°5•e �'��stm'i `t .� d� .. � _ � r .* I I Source: US Centers for Disease Control and Prevention I � Ho*ose Exceeds WHORPA Commun'Ky Randards General outdoor 55 Outdoor living areas 50-55 School, outdoor playground 55 Dwellings, indoors 35-45 Indoor, school 35-45 aM ,I *LAeq is an average decibel value measured over time, eg, 16 hours for daytime,8 hours for night,shorter periods for discrete episodes.Guideline values are the level at which the lowest adverse health effect is experienced(Source: WHO Guidelines for Community Noise) i Source:Guidelines for Community Noise.Berglund B, Lindvall TM,Schwela DH(Eds).Geneva:World Health Organization, 1999.;Information on Levels of Environmental Noise Requisite to Protect Public Health and Welfare with an Adequate Margin of Safety,"EPA/ONAC 550/9-74-004,March, 1974 0 HeuKh Mosks d Moose x� - R pR. • Increased stress hormone o Hearing loss, tinnitus levels --> o Lost productivity/ poorer task • High blood pressure performance • Abnormal glucose o School children: lower test metabolism scores ® Obesity ® Hyperactivity Impaired communication/ o Im ® Stroke, heart disease p socia l I interact ion ® Sleep disruption >20 studies have shown that noise adversely affects children' i s academic performance fl I 1 i I j i Nag @U Unffiflbag @U AOD(�;(&@ag guovw Uu@un @ oz�jog - @U gcw@lTg@ N@gm @ @un@g du@ 0@ UDo&3@ @PW@UU@O fladm(oflog N@@Uo db@gg@ and N@aftg o oc) ,New • • • • • _. - i Ho*pse: K's MW OMy Hearlhg Damage I 0 Health Effect Minimum Decibels Ischemic Heart Disease Hypertension 70 Hearing Impairment 70-75 Performance 70 Sleep disturbances 40-60 Annoyance 42 Source: Passchier-Vermeer, 2000. Key Sources: World Health Organization American Speech-Language-Hearing AssociationAmerican Psychological Association; Babisch W. Noise Health. 2006;8:1-29. Stansfeld S, Crombie R. Noise Health. 201 1;13:229-33. u .� ; Vuh=lr�itraW= �� s . .:j 41_ a w 1 , .• 1 '. • .. r kYt.it � Il ^ O l► - s - i i Concerns are araw'ong • CDC NIOSH • EPA/WHO • American Academy of Pediatrics • American Public Health Association • Children ' s Environmental Health Network o Harvard School of Public Health o State Departments of Environmental Protection p o Massachusetts Medical Society © Medical Society of the State of NY I ' • California Air Resources Board I � i 3 MMS ResaWVO(on, 2017 o Gasoline-powered leaf blowers (GLBs) pose health risks to both workers and the general public. Recommendations to MMS: o Recognize noise pollution as a public health hazard, with respect to hearing loss; supports initiatives to increase awareness of the health risks of loud noise exposure. o Urge maximum feasible reduction of all forms of air pollution, including particulates, gases, toxicants, irritants, smog formers, and other biologically and chemically active pollutants. #� c Acknowledge the increased risk of adverse health consequences to workers and general public from gas- powered leaf blowers including hearing loss and cardiopulmonary disease.