Dr. Tom Kottke
Appearances
Health Chatter
Preventive Services Task Force Community Guide
Clarence, let me jump in. Well, first of all, just the communityguide.org, and then you start poking around.
Health Chatter
Preventive Services Task Force Community Guide
So Allison is frozen. Stan, do you hear me? Yep, I hear you. Okay. I mean, I'm going to say that when we start on a topic, we turn up thousands of articles and it boils down. And I know being a cardiologist, like nephrology or specialists, I can't read that literature because I'm not a specialist there. And we're not just a team of physicians looking at all this. It's like Allison pointed out.
Health Chatter
Preventive Services Task Force Community Guide
We have many, many different perspectives and expertise. And so we can trust that. And one of the things using the community guide does is saves both time and money. And so if we start off, we think we have a great idea. And we implement it, it doesn't work. We've not only wasted a lot of money, but we've wasted a lot of time. And using the community guide prevents that from happening.
Health Chatter
Preventive Services Task Force Community Guide
Like Alison said, there's one-pagers, there's long papers, there's papers in the American Journal of Preventive Medicine. However you want to use it, it will fit your needs. And you can trust that What the community guide recommends is evidence-based and well-vetted.
Health Chatter
Preventive Services Task Force Community Guide
Yeah, I want to jump in this. So I think most people who come to the guide are passionate about something, okay? So I have my passions around community, around healthy Black pregnancies, around physical activity. And so I'm going to go in there and ask, what can I do to promote my passions for the community in this?
Health Chatter
Preventive Services Task Force Community Guide
I don't think they approach it, the average person says, what are the strong, I'm going to do the strongest. It's what's the, how can I promote a particular thing? Like very immunizations. And so like Amy just said, the strength of evidence frequently is how much research has been done. And so either strong or sufficient, the reader can be,
Health Chatter
Preventive Services Task Force Community Guide
assured that what was examined by the CPSTF was in fact found to be effective.
Health Chatter
Preventive Services Task Force Community Guide
So Clarence, I want to jump in here about this and the value of the evidence gaps section of every finding. And so what I would do is with the program you were discussing is write a letter saying, dear my Senator, there is an evidence gap here. Please ask the NIH or the CDC about funding programs that will help me understand how I can deal with substance use disorders in urban communities.
Health Chatter
Preventive Services Task Force Community Guide
Thank you. First, Dr. Amy Lansky. Amy serves as the director of the Community Guide Program. On your browser, that's thecommunityguide.org. You can sign on and follow as you follow the podcast. The program is at the CDC, the Centers for Disease Control and Prevention, in the Office of Science, Amy's responsibilities include supporting the Community Preventive Services Task Force.
Health Chatter
Preventive Services Task Force Community Guide
And so there's another value there beyond the recommendation. It's the finding of evidence gaps, which is helpful for community activists. Thank you for that.
Health Chatter
Preventive Services Task Force Community Guide
One of the advantages of the community guide is that all of the background papers are cited. And so you can go through, there's nothing here about, oh, this is expert opinion or this or that. You can dive down into exactly what the publications are.
Health Chatter
Preventive Services Task Force Community Guide
And there may be, and I'm sorry, I don't know right off the bat, but there may in fact be some papers that report interventions that were done in urban communities. But the take home is that you can track back the evidence to all of the publications on that website. There's nothing. It's totally transparent.
Health Chatter
Preventive Services Task Force Community Guide
And Dr. Alison Quayar, Alison Evans Quayar is a professor and associate dean of research in the College of Public Health at George Mason University. She's a research associate at the National Bureau of Economic Research. She currently chairs the Community Preventive Services Task Force. Back to you, Stan.
Health Chatter
Preventive Services Task Force Community Guide
Yeah, we had a big discussion at the last meeting about mobile, you know, on your smartphone interventions that change, I mean, almost hour to hour. Right, right. And so, yeah, we look at it. what's been done, potential change. Are there significant updates to systematic reviews? Are there new systematic reviews, et cetera?
Health Chatter
Preventive Services Task Force Community Guide
And sometimes, like I was looking at the community guide the other day and there was a, an announcement about a paper that was published and said, well, this has not been reviewed in a while. Well, it's been archived. And so there is a review and we'll give you a heads up if something is felt to be perhaps not totally up to date.
Health Chatter
Preventive Services Task Force Community Guide
Yeah, that's an excellent point of when there's money on the table or you're going to the legislature, what it helps focus on things that are effective versus bright and shiny objects.
Health Chatter
Preventive Services Task Force Community Guide
Yeah, well, thank you for having us on. I just consider myself a foot soldier in public health. And yeah, the process is totally transparent. It's where to go. It's like Clarence says, it's where to go when you want to know what works in community preventive services. Absolutely.
Health Chatter
Preventive Services Task Force Community Guide
Yeah, thanks for asking, Stan. I'm gonna talk about parks and trails, greenways with additional support. Okay, so we in St. Paul, I live in St. Paul, Minnesota, and the mayor proposed a little pittance of a sales tax to improve our parks and trails. And so I was able to write a letter to the editor
Health Chatter
Preventive Services Task Force Community Guide
and say and write that the rigorous evidence shows that parks and trails with additional support increase physical activity. And we all know that physical activity prevents multiple diseases, diabetes, heart disease, cancer, et cetera, et cetera, obesity. And so that let me do that. The other example I'm going to give is community health workers. I'm working with a group from Rondo.
Health Chatter
Preventive Services Task Force Community Guide
Rondo is a historically Black neighborhood that was transected by the interstate, and we're trying to reestablish it. But the evidence is clear that community health workers improve control of blood pressure, cholesterol, et cetera, et cetera.
Health Chatter
Preventive Services Task Force Community Guide
And also community health workers are an entry-level position in healthcare for somebody who thinks they might be interested in adopting some sort of healthcare profession. And it doesn't cost the hundreds of thousands of dollars in tens of years of becoming a physician. So there are two examples that are just very clear and based in the community.
Health Chatter
Preventive Services Task Force Community Guide
So if I jump in, you know, if we were traveling, I'd say healthy people is where we want to be. And the community guide is effective ways of getting there. So they complement each other. Study both. Yeah.
Health Chatter
Unintentional Firearm Deaths
Yeah. Yeah. That's a great question, Anthony. And what we're learning from the docs is that you don't ask, do you have guns? You start out by asking, are your guns stored safely? And so that gets around the Second Amendment thing or the, you know, like, why are you asking me if I have guns? It's, are your guns stored safely? And I think, you know, folks in the military, I...
Health Chatter
Unintentional Firearm Deaths
um or ex-military may i mean they've they've had some training and and i'm going to offer something i think I had gun safety training when I was in Boy Scouts. We used to hunt with a classmate of my father's who had been in the military in World War II. He was a stickler for safety. I was talking to one of the chaps who was in the St. Paul violence interrupters. He said,
Health Chatter
Unintentional Firearm Deaths
The way I learned how to shoot a gun was on Nintendo. So there's no real, the reality of what happens when somebody struck by a bullet is not known. So I would suggest sending, as your child, if they're not in Boy Scouts or, you know, sending them to gun safety, program. Now, Outstate, the Department of Natural Resources hosts these.
Health Chatter
Unintentional Firearm Deaths
Here in the Twin Cities, there's a chap, he operates a company called Protection Far Left of Center, and I haven't been there, but if you look at his website, what he talks about is very realistic. He's not a carry and kill guy, but he's teaches respect for guns. The other the other opportunity, if you want, is have your child participate in the Minnesota Clay Target Association.
Health Chatter
Unintentional Firearm Deaths
I mean, you know, competitive trap shooting and because their first their first order is safety and respecting what you know, what that firearm can do.
Health Chatter
Unintentional Firearm Deaths
Absolutely. I would absolutely not buy a kid a replica gun, you know, like a like, you know, one that shoots ping pong balls. Fine. You know, nobody's going to mistake that. But a replica gun can get your child killed.
Health Chatter
Unintentional Firearm Deaths
because um they pull it up and it happened and i think cincinnati it was cleveland or cincinnati kids on a swing has a replica gun the sheriff or a police officer comes roaring up uh says drop it in three six you know three seconds later or 10 seconds later fills them full of uh uh lead and yeah you know and and so i think you know and and that's the other thing you
Health Chatter
Unintentional Firearm Deaths
I would not carry myself personally a gun because you read the newspaper and all the dumb things people do with their guns in the heat of the moment. Anthony, do you have an opinion about that?
Health Chatter
Unintentional Firearm Deaths
Oh, absolutely. Yeah. Makes things salient to people. Yeah.
Health Chatter
Unintentional Firearm Deaths
Yeah, I mean, Anthony's absolutely right. And one of the problems is that the NRA, funded by the gun industry, uh manufacturers the firearm manufacturers has uh convinced uh the american public that they're safer with a gun than without one it and that's only that's only about the last 20 years but it is now true and during covid i mean covid was great for um gun sales um and and uh
Health Chatter
Unintentional Firearm Deaths
A pistol for the average American is really, it's more a talisman than a safety device because the data are clear. You have a firearm in your household. The life expectancy of everyone that lives in that household is shorter than if you did not have. It may be
Health Chatter
Unintentional Firearm Deaths
Like a case when I lived in Rochester where the granddaughter came home late, despite the fact that the grandparents said, oh, if somebody tries to break in, we're going to lock ourselves in the bedroom and call the police. They did. They fired through the back door, hitting their granddaughter in the stomach. She lived, but may have ended up with a colostomy for the rest of her life.
Health Chatter
Unintentional Firearm Deaths
Um, I think one of the, you know, we know that volunteerism being a volunteer improves, uh, happiness, eudaimonic wellbeing. And I think for people who have the time to, to, to mentor young men in particular, to give them, uh, uh, both like Anthony talked about his mentor that changed his life. Mentoring changed, uh, having mentors for me changed my life. Um,
Health Chatter
Unintentional Firearm Deaths
and teaching, identifying for young men what they want to do, giving them opportunity, and then also helping them think through what does a fire carrying do for me? Because in many of our subcultures in the States, you have to carry. And like they talked about, it's really an urbanist arms race. Okay, the other guy's got a bump stock, I need a bump stock, that kind of stuff.
Health Chatter
Unintentional Firearm Deaths
They've got a high capacity magazine, I need a high capacity magazine. And it doesn't make anybody safer, it makes everybody unsafer, but it's teaching and it's teaching within the relevance, within the context, and by somebody who is respected by that individual. I think it's creating opportunity. But you're right, it's absolutely a challenge because Americans, as a result of advertising,
Health Chatter
Unintentional Firearm Deaths
Okay, thanks, Dan. Anthony Butler is a colleague of mine. We both serve on the Protect Minnesota board. Anthony's chair of the C3 board. And Protect Minnesota is the only statewide, exclusively Minnesota gun safety organization. Firearms Safety Advocacy Group. We do collaborate with groups like Moms Demand Action, Giffords, et cetera. Anthony was born in Harlem in New York City.
Health Chatter
Unintentional Firearm Deaths
sponsored by the gun industry and through the NRA and others, I have come to believe that having a pistol, having a firearm makes them safer. And they have this image that, oh, I'll just shoot him. But you have to, you know, say I have a friend who's, he carries a pistol in his car because he says, well, maybe I get in a road rage.
Health Chatter
Unintentional Firearm Deaths
well boy you get that pistol out you better be prepared to shoot because if the other guy has a pistol he's going to shoot you and so you have to shoot first but what if what if that what you think is a pistol is a cell phone you know and you shoot him you're you're in deep doo-doo you
Health Chatter
Unintentional Firearm Deaths
Or like in Rochester, last couple of years, a high school coach got in a fender bender with some Somali kids and shot and killed one of them. not a good scenario for that chap. He's going to spend some time reflecting on that with limited freedom. And, you know, even if you shoot somebody by accident or, you know, are you prepared to do that?
Health Chatter
Unintentional Firearm Deaths
And so this whole idea of thinking through, you know, what are the next five steps that are going to happen? if I shoot somebody. And a lot of times you're gonna spend some time in Oak Park Heights.
Health Chatter
Unintentional Firearm Deaths
I think so. Certainly, probably traffic safety, you know, in terms of community burden. Yeah. Traffic safety. Talk about safety. Jogging at night or walking at night. Every...
Health Chatter
Unintentional Firearm Deaths
seems like every every morning i read about somebody who's been killed by walking on a road and my wife and i walk our dogs and people are they're out jogging in black walking but you can't see them you know and this whole belief that if they if i can see them they can see me yeah you're dead wrong and you're going to be dead because you're wrong you know but um
Health Chatter
Unintentional Firearm Deaths
Yeah, I think, you know, we need to practice those conversations about, you know, that it's okay to ask about, you know, are your firearms locked up? It just, you know, assuming, you know, and then if they say, well, we don't have them, that's, you know, I'm glad, you know, then being prepared to do something, but Yeah, having those conversations.
Health Chatter
Unintentional Firearm Deaths
Yeah, so I can tell you the anxiety is out there. So we have a paper in review right now based on three different national surveys about anxiety about gun violence. And we plugged it into the global burden of disease database. condition weights. And anxiety about gun violence is the leading cause of disability-adjusted life years lost in the United States by a factor of about 1.5 over back pain.
Health Chatter
Unintentional Firearm Deaths
And although living with both parents, he was always in trouble as an adolescent. He attended five different high schools in the greater NYC area before dropping out at age 17 and getting his GED. Growing up, Anthony knew the value of hard work.
Health Chatter
Unintentional Firearm Deaths
If you look at medical conditions, back pain, orthopedic problems is the leading cause. But our calculations, it's about 50% higher. So the anxiety is there to have the conversations. And thinking like with Anthony, you may not want your kids to have sex ed classes. but they're gonna learn about sex. And probably from somebody who's two years older than they are.
Health Chatter
Unintentional Firearm Deaths
If it's your daughter and she's 16, she's probably gonna learn it from a 21 year old guy. Really. And so if you live in a gun culture,
Health Chatter
Unintentional Firearm Deaths
Your kid's going to learn about guns, and it's probably going to be that a friend of theirs, it's highly likely that a friend of yours, maybe same age, maybe a year or two older, maybe three years older, they're going to find a pistol and start playing with it and saying, hey, how does this work? look down the barrel and pull the trigger to see if you can see the bullet coming out, you know?
Health Chatter
Unintentional Firearm Deaths
And, and so it's, it, you know, we live in a gun culture. And so the, the safest thing to do is educate the kids about how to deal with it. And one of the advice I'd give is, you know, somebody gets out a gun and you're over at somebody's house playing, call home, get a ride home. Yeah. Leave. Yeah. Yeah. Yeah. Clarence.
Health Chatter
Unintentional Firearm Deaths
So let me say, the Second Amendment guys have gotten us so scared at our place that we don't ask about gun safety on our health assessments. You know, it's just like, whoa, we can't do that. Somebody's going to say, oh, you're asking about gun safety because you want to take away our guns.
Health Chatter
Unintentional Firearm Deaths
The day after his eighth grade graduation, he began working in McDonald's with his father on the weekends and always held a job throughout high school and beyond. In the summer of 2008, I think he was about 20 at the time, he was the victim of a shooting that resulted in his loss of vision. After problems with his family and nowhere else to turn, Anthony moved into a homeless shelter.
Health Chatter
Unintentional Firearm Deaths
And so we've got to, if we're going to have a conversation about gun safety, we need to stay away from the Second Amendment and make it clear we're not talking about taking away your guns. It's not, you know, you can have a gun, that's legal. It's not smart, but it's legal. But we're talking about how can children be safe in a gut culture.
Health Chatter
Unintentional Firearm Deaths
Yeah. So let me jump in, Stan, about other ways to make it safer besides conversation. But thanks to the coalitions, Minnesota now has a red flag law, which says that you can ask a judge to take somebody's firearm away if they are of a threat to themselves or others. We also have universal background checks. And we're going to be working toward getting guns out of the Capitol.
Health Chatter
Unintentional Firearm Deaths
You know, you can have a firearm in the Minnesota Capitol. What's the purpose of a gun during political discourse other than intimidation?
Health Chatter
Unintentional Firearm Deaths
And so, you know, there are other steps too besides conversation to increase safety. And one of them we're going to be working on is getting guns out of the Capitol.
Health Chatter
Unintentional Firearm Deaths
Yeah. For the Second Amendment people, They're more likely to be able to hang on to their guns if there is gun safety. The lesser the threat their firearms are to the rest of the public, the more likely they're going to be able to hang on to them. So that's a thought. The other is the idea of getting out, knowing your neighbor's
Health Chatter
Unintentional Firearm Deaths
While residing in the shelter, Anthony was introduced to a mentor whom he credits with changing the entire trajectory of his life. He enrolled in the New School where he received his Bachelor of Fine Arts before attending New York University and obtaining his Master in Social Work in 2016.
Health Chatter
Unintentional Firearm Deaths
engaging socially to reduce fear, because the recent political movements have been based on fear, which is unfortunate. So get out, meet people, do things, volunteer, because we know that volunteering increases the well-being, your own well-being, and it increases the well-being of others. And I think that's the path to safety.
Health Chatter
Unintentional Firearm Deaths
Since graduating, he's had a number of positions in the workforce, such as social worker for young men of color at Kings County District Attorney's Office in Brooklyn. He's been a recovery specialist with Community Access. And after leaving that program, he relocated here to Minneapolis with his girlfriend, where he works as a therapist for offenders of sex crimes.
Health Chatter
Unintentional Firearm Deaths
When he's not working, he participates in multi-sport endurance competitions, which has afforded him the opportunity to travel to over six countries and half the United States. As a social worker, Anthony strives to be an advocate for the underserved and help people navigate the many hardships one may endure on a daily basis.
Health Chatter
Unintentional Firearm Deaths
And as I mentioned, I know Anthony because we both sit on the board of Protect Minnesota, where he is the current chair. So thank you very much, Anthony, for that. joining me on this podcast.
Health Chatter
Unintentional Firearm Deaths
Yeah, sure. And I personally have been affected when about 40 years ago when my daughter was a student at JJ Hill, one of her classmates didn't show up for school that day because the three-year-old had found a pistol in the couch And you don't have to complete the sentence. You know what happened.
Health Chatter
Unintentional Firearm Deaths
And then when I was in practice over at Riverside, just around the corner, again, a kid, about three, found a pistol in a wastebasket where it had been, quote, secreted and shot his brother and killed him. And so a couple of take-homes. There's no such thing as a hidden gun.
Health Chatter
Unintentional Firearm Deaths
You may think if you have a firearm in your home, you may think that it's hidden from your kids, but it's more likely to be hidden from you because you've forgotten about it than your kids. Your kids know everything. I mean, if they can find Christmas presents, they know where the guns are. And because 50% of homes have a firearm in them, when your kids go over to play,
Health Chatter
Unintentional Firearm Deaths
there's a fair chance that there's a unlocked, loaded firearm in that house. And so my suggestion is before a play date, you're setting up a play date. Your Timmy is going to go play over at Johnny's. So you call Johnny's mom and say, are the firearms in your home locked and unloaded with ammo, also locked and stored separately? Okay, so Johnny's mom says, well, we don't have firearms.
Health Chatter
Unintentional Firearm Deaths
I said, great, perfect. She says, yeah, they're all locked and put away. So you say, I'm really glad about that. And she says, no, we have one in the bedside table for protection. I say, well, maybe let's have Johnny come over here. I'm very uncomfortable with having my child in a home where there's an unlocked firearm.
Health Chatter
Unintentional Firearm Deaths
okay now um the uh uh some people say well they can't they can't afford a uh a biometric safe well i just looked online you can buy a biometric safe for 70 bucks and so that's what is that 10 cups of coffee at starbucks yeah if you can afford a pistol you can afford a biometric safe and um
Health Chatter
Unintentional Firearm Deaths
I'm going to stop there for a moment and turn it over to Anthony for his reflections, and we can turn back for some other ideas I have about increasing the safety of your children in a gun culture, which is the United States. Anthony?
Health Chatter
Unintentional Firearm Deaths
Well, the data are clear. We're there. We're there. Now, Anthony brought up an excellent point. Of course, I come from a white middle-class background. For decades, $70 has been not very much to me. But firearm locks free. If you live in St. Paul... You can get a free firearm lock from the St. Paul Police Department. Or in Ramsey County, they also have the Gun Safety Initiative website.
Health Chatter
Unintentional Firearm Deaths
And then Minnesota Department of Safety will also provide them. And we're working with doctors' offices to basically have a bowl of gun locks, trigger locks out on the desk next to the bowl of condoms. And you just pick them up. But Anthony is absolutely right that it may have been barter or that I shouldn't assume that $70, particularly in this economy, is sort of optional money.
Health Chatter
Unintentional Firearm Deaths
Yep. California, Colorado, even down in Louisiana, they have campaigns. The docs have campaigns to offer gun locks.