Good afternoon. I'm Katrina Rhodes, chair of the American College of Preventive Medicine 2021 Annual Conference here with Dr. Richard Bruno, our highly regarded vice chair. On behalf of ACPM leadership and planning conference committee, we have the honor to welcome you to PM21 Building Resilience, Preventing Pandemics, Health Inequity, and Climate Change. We are so excited to have you with us today and share with you some of the highlights of this year's conference and today's events. Now while COVID precludes us from meeting in person, we're pleased to offer you an all virtual conference. Our conference theme is building resilience and sub themes include climate change and human health, social justice and health equity, and COVID-19 pandemic preparedness. Our conference tracks with sessions that run throughout the conference include population health management and health technology, public health innovation and community medicine, research, evidence and policy, clinical preventive medicine and lifestyle medicine, global health and environmental medicine, and the future of preventive medicine training and advocacy. Our oral concurrent sessions include updates from the U.S. Preventive Services Task Force, the Community Preventive Services Task Force, and the American Board of Preventive Medicine. Plenary sessions throughout the conference will highlight our conference theme and sub themes, including building resilience during the COVID pandemic, climate resilience and environmental justice, building vaccine confidence with outreach efforts and U.S. regulatory safety practices, social justice and health equity, and building public health resilience, featuring health officials on the front lines and legislative efforts behind the scenes. Keynote speakers include Allison Cassidy from the EPA, Chelsea Clinton from the Clinton Foundation, Peter Marks from FDA's CBER, Amanda Cohn from the CDC and ACIP, Wayne Frederick from Howard University, Anand Parekh from the Bipartisan Policy Center, Reuben Warren from Tuskegee University, Ursula Bauer from the Office of Surgeon General, Wilma Wooten from the San Diego Health Department, and Clarence Lamb from the Maryland State Senate. The conference also includes scientific poster presentations on a variety of public health and preventive medicine topics, and an opportunity to earn more than 25 CME hours to support your maintenance for certification and recertification. Our professional development events include a Young Career Lecture, an advocacy training workshop, and there will also be networking opportunities during our conversation cafes, our Congressional Hill visits, and social events, including a virtual museum tour. Our conference will close with our annual ACPM Awards, recognizing outstanding member contributions to our college and profession, and remarks from our President-Elect, Dr. Tenet Castle-Wood. Be sure to create a profile and participate in the PM21 Networking Challenge, interacting with your colleagues, attending events and sessions, and earning points to be entered into a drawing to win a complimentary PM22 conference registration. We'll be starting conference events today with the State of the College with our CEO, Donna Grande, ACPM President, Stephanie Zaza, ACPM Treasurer, Joni Shen, and ACPM Secretary, Sandra Guerra. This will be followed by our KBS lecture featuring Dr. Aletha Maybank, the Chief Health Equity Officer and Senior Vice President of the American Medical Association. Dr. Maybank will also be featured in a plenary panel on building social justice and health equity on Tuesday afternoon. Remember to join us on social media and use hashtag PM2021. Concurrent sessions for today include a patient safety course, partnerships in public health, and managing stress and weight during COVID. And please join us this evening for the grand opening of our Partner Corner, the poster exhibits, and our virtual tour of the Smithsonian Museum of Natural History with our guide, Dr. Steve Rockauer. We're so glad you're here and hope you enjoy PM21. Good afternoon. I'm Katrina Rhodes, Chair of the American College of Preventive Medicine 2021 Annual Conference. Here with Dr. Richard Bruno, our highly regarded Vice Chair. On behalf of ACPM Leadership and Planning Conference Committee, we have the honor to welcome you to PM21, Building Resilience, Preventing Pandemics, Health Inequity, and Climate Change. We are so excited to have you with us today and share with you some of the highlights of this year's conference and today's events. Now while COVID precludes us from meeting in person, we're pleased to offer you an all virtual conference. Our conference theme is Building Resilience and sub themes include climate change and human health, social justice and health equity, and COVID-19 pandemic preparedness. Our conference tracks with sessions that run throughout the conference include population health management and health technology, public health practice innovation, and community medicine, research, evidence, and policy, clinical preventive medicine and lifestyle medicine, global health and environmental medicine, and the future of preventive medicine training and advocacy. Our oral concurrent sessions include updates from the US Preventive Services Task Force, the Community Preventive Services Task Force, and the American Board of Preventive Medicine. Seminary sessions throughout the conference will highlight our conference theme and sub themes, including Building Resilience During the COVID Pandemic, Climate Resilience and Environmental Justice, Building Vaccine Confidence with Outreach Efforts and US Regulatory Safety Practices, Social Justice and Health Equity, and Building Public Health Resilience, featuring health officials on the front lines and legislative efforts behind the scenes. Keynote speakers include Allison Cassidy from the EPA, Chelsea Clinton from the Clinton Foundation, Peter Marks from FDA's CBER, Amanda Cohn from the CDC and ACIP, Wayne Frederick from Howard University, Anand Parekh from the Bipartisan Policy Center, Reuben Warren from Tuskegee University, Ursula Bauer from the Office of Surgeon General, Wilma Wooten from the San Diego Health Department, and Clarence Lamb from the Maryland State Senate. The conference also includes scientific poster presentations on a variety of public health and preventive medicine topics, and an opportunity to earn more than 25 CME hours to support your maintenance for certification and recertification. Our professional development events include a Young Career Lecture, an Advocacy Training Workshop, and there will also be networking opportunities during our Conversation Cafes, our Congressional Hill Visits, and social events, including a virtual museum tour. Our conference will close with our annual ACPM Awards, recognizing outstanding member contributions to our college and profession, and remarks from our President-Elect, Dr. Tenette Russell-Wood. Be sure to create a profile and participate in the PM21 Networking Challenge, interacting with your colleagues, attending events and sessions, and earning points to be entered into a drawing to win a complimentary PM22 conference registration. We'll be starting conference events today with the State of the College with our CEO, Donna Grande, ACPM President, Stephanie Zaza, ACPM Treasurer, Joni Shen, and ACPM Secretary, Sandra Guerra. This will be followed by our KBS Lecture featuring Dr. Aletha Maybank, the Chief Health Equity Officer and Senior Vice President of the American Medical Association. Dr. Maybank will also be featured in a plenary panel on Building Social Justice and Health Equity on Tuesday afternoon. Remember to join us on social media and use hashtag PM2021. Concurrent sessions for today include a Patient Safety Course, Partnerships in Public Health, and Managing Stress and Weight During COVID. And please join us this evening for the grand opening of our Partner Corner, the poster exhibits. Hi, good afternoon. I'm Jon Webb. I'm a Preventive Medicine and Public Health resident at Rutgers New Jersey Medical School. And today I'm going to be presenting and reviewing a critical role of preventive medicine physicians in supporting a multidisciplinary homeless commission in New Jersey during the COVID-19 pandemic. Our objectives today will be to demonstrate our effective integration of preventive medicine expertise into a community organization's public health strategy for homeless citizens during the SARS-CoV-2 pandemic, illustrate examples of our team's valuable contributions and work product, highlight the wide-ranging benefits preventive medicine physicians offer organizations, and to stimulate conversations and motivate preventive medicine physicians to seek more proactive roles at a local, state, and national levels. Questions I'd like for us to ask ourselves during this demonstration today is do we believe that we can make a positive difference and be in part of our groups and our communities? And if so, how many of us are actually taking an active role in seeking out opportunities to represent public health and preventive medicine on organizational boards or other decision-making groups? As a background, in late 2018, the mayor of Newark, New Jersey appointed Denise Rogers to chair a homelessness commission that the city had previously put in place to address the sheltering of homeless persons within the city of Newark. Mark Wade, who is the director of the health department, partnered with 15 public and private members to help in this initiative to combat homelessness within the city. The commission's purpose was to find permanent housing and to ensure necessary support systems to create healthy housing options with wraparound services that support the city's residents without addresses as they like to refer to them as. So if we fast forward to 2020 and the COVID-19 pandemic, the first case was identified in the city of Newark on March 14th, 2020. Dr. Rogers suggested that they form a COVID task force to specifically address the health and safety of this vulnerable population. And so therefore, the COVID-19 task force of Newark Homelessness Commission started convening once a week with virtual meetings. In May of 2020, the preventive medicine residency program director at Rutgers was invited to join this task force and the residents and a first year medical school student joined in the effort. At that time, the Newark Department of Health estimated there were 2,200 residents without addresses in the city, with more than 1,800 of them being sheltered throughout the city in their 28 existing shelters. And that was in May of 2020 as the numbers of COVID-19 cases began to rise. So if we look at this multidisciplinary task force that was put together by Dr. Rogers, we'll see how truly multidisciplinary it was. Within this task force, we had multiple government agencies. So we had the city health department, we had the mayor's office at the city of Newark, which had multiple departments within their offices, including the Homelessness Czar. The New Jersey State Health Department also plays a role within this task force. And then the Division of Community Action, which are a group of people within the city that help with applications and housing throughout the city, along with other social work functions. The housing addiction and long-term care agencies that were involved was the Mental Health Association of Essex and Morris County, the Newark Housing Authority, which is the largest housing authority in the area, Broadway Health and Integrity Health, both of them which offer addiction services as well as long-term care services to persons within the city, and of course the New Jersey Center of Excellence in Medication Assisted Treatment, which helps with addiction services as well. Many of the community and church religious organizations also play a vital role, the YMCA, the Salvation Army, Catholic Charities, and then Bridges Outreach, which also provides a lot of services for the homeless population within the city. And then locally, the academic institutions involved with this initiative was the Rutgers New Jersey Medical School and the Rutgers Biomedical and Health Sciences. So initially, the city had a very fast response to the COVID-19 pandemic. The city quickly secured a local hotel to house individuals who had been exposed to COVID for quarantine and isolation purposes. Within two months, they also secured a second site, which was another hotel that was there to give people individual housing to reduce the number of congregate housing situations in the city to reduce the spread. Testing for COVID-19 was offered at all the sites and at local shelters as well as soup kitchens, and they provided education to all the residents without addresses on reducing transmission within their populations. Also, the city very quickly made alliances with safety nets hospitals, which was University Hospital in Newark, and as well with mental health and addiction services in the local area. And this is where the Preventive Medicine Team came in. So the Preventive Medicine Team performed a plethora of tasks. In the beginning, there was a, we reviewed federal and state housing policies on mitigating communicable diseases in emergency shelters. This is reviewing the CARES Act. We were looking at HUD funding and HUD regulations to ensure that everything was properly set up under the current rules and emergency funding. We also looked at primary research on congregate housing and best practices in testing, masking, hand hygiene, life expectancy and mortality rates in this population. And we really leaned heavily on Boston and San Francisco with their infrastructure within the homeless population with healthcare. And we reached out to lots of organizations to see what they had been successful with so we could see what parts of that we could use in Newark. We also provided ongoing updates on pandemic statistics, vaccination strategies, management of the vaccine-associated anaphylaxis, transmission rates and all the other emerging issues including adverse events, variant strains and breakthrough infections. These were data mined and we were looking at New Jersey Department of Health Information, the CDC, WHO, FDA and constantly continued to help with measures here. One of the main things that we brought to the table as a preventive medicine team was to help keep the task force members who are mostly non-medical people informed on the medical side of the virus, the vaccines and any of the suggested public health measures that were coming out. So some of the examples of things that we were able to provide for this task force was a lot of educational infographics in addition to the data that we brought to the table. So for the shelters and the shelter staff, we presented different information on testing options. This was vitally important for the stakeholders who ran the different shelters, the YMCA and the Catholic Charities that also perform testing. They needed to know what testing options were available, which ones were most efficacious so they could make the best decisions for their organizations. We made information on PPE use which I'll show you in a moment. We also gathered information on vaccine research data for them and guidance on vaccine hesitancy conversations. For the shelter residents, we also gave reminder information on masking, hand hygiene, viral transmission reduction strategies and addressing myths and facts about SARS-CoV-2 which we've seen many of these from other organizations. So to give you a few, this was an initial infographic that we made for our stakeholders in our multidisciplinary task force. And this went through at the time and talked about the different modes of testing. So the molecular PCR testing, the antigen and antibody, which everyone heard in the news, but unless you're in the medical field, these don't make a lot of sense. So we were able to break this down into plain language and we went further and broke these down by vendor and then also by sensitivity, specificity, positive predictive value and negative predictive value. We were able to educate all the members of the task force on what these numbers meant and help guide them on determining which tests were best for their site and which ones in their populations based on pretest probability. The next one was a brochure that we made. And of course, this is using CDC and WHO information on donning and doffing of PPE. So you can see to the right, there's some focus in excerpts from these brochures. And I know we've all seen these from multiple organizations. Initially, some of the Chinese studies showed that a lot of the hospital transmission came from improper PPE use and the donning and doffing procedures. So we wanted to make sure that all of the staff who were giving PPE at the centers knew how to properly don and doff so they could make sure that they reduce any transmission within those facilities. This was a nice little simple infographic that we made for the shelter residents. You know, we see a lot of these when we walk into stores reminding us to wash our hands. One of the concerns that the staff had at the shelters was the sharing of cigarettes and sharing of food. So we wanted to make sure we addressed those, reminded them about coughing or sneezing into their bent elbow, and then of course, wearing a mask and avoiding crowds. And there's a little reminder here about making sure that they report any symptoms immediately. So these were placed in multiple housing situations and shelters on different doors and entrances just to remind the shelter people as much as possible to follow these guidelines. Our team also put together a nice, very simple, very plain language myths and facts concerning the vaccine. So as you see, we took some of the most common questions that were asked about the vaccine and some of those common myths, and just quickly in a short paragraph addressed these, you know, about the ingredients being safe, about the fact that it was not rushed, that it doesn't cause the disease and so on. So this was very good in helping dispel some of the myths and understandings of the vaccine. This infographic here was something that we put together for the staff. It was just some pointers based on positive psychology to help with vaccine hesitancy when talking with residents. So we just reminded them to use positive language, to understand the misunderstanding within the history behind vaccinations. So we just wanted to make sure that the staff understood that there was hesitancy reasons that were valid so that they could speak with the residents about that. We wanted them to avoid negative language and making the residents feel any negative feelings about not wanting to get the vaccine. And then understanding, you know, the one shot versus two shots and any of the symptoms that come after. This last one here was just one that we put together. This is right after the J&J vaccine was approved. This was mainly to the stakeholders again, to the task force members who needed to have high level conversations and high understanding when they were speaking with other members about efficacy and effectiveness. And then we also broke down the data from the different vaccine trials and what that data meant for them. And so that way, when they were talking to their staff members, when they were training new staff members, they could speak, you know, very intelligently about these different factors here. So how do we measure success within our, within this model here? So one of the things we looked at was, as of today, the residents have continued to have safe shelter. The one hotel has around 142 residents who have continued to be sheltered safely. They're getting housing, they have testing on site, they also have vaccinations. As we see here in the second thing, all residents who are homeless, whether they choose to shelter in one of the shelters or in the hotel housing that we have, they continue to have full, no cost access to SARS-CoV-2 testing and they have full, no cost access to vaccinations. It's interesting, the positivity rates of SARS-CoV-2 in this population have actually remained lower than the positivity rate within the general population. So that leads us to believe that our efforts in controlling the virus within this population have been pretty well received. And then also during this time, we've also overseen and helped them with the installation of modular housing for freezing temperatures, which they call code blue events. And even though this is a month ago today, there were 1,200 residents without addresses who were fully vaccinated. So if you remember from earlier, there was an estimated 2,200 homeless individuals within the city last year in May. And as of April 16th, there were 1,200 vaccinated. So over half of the estimated people were already vaccinated as of a month ago. And we've committed an additional $2 million to help build 100 housing sites to help with the homeless population for ongoing care. So when we look at measurements, in public health and preventive medicine, we love our statistics and our metrics, but sometimes anecdotal evidence also really helps us. So I'd like to just give this one case here. So fortunately in my clinic every week, I see patients in the addiction medicine clinic. And so back in March, I walk into a room and I meet a patient named Jim. And when I lived in the EMR before the visit, he was a 48-year-old African-American male with a history of substance abuse and hypertension. And one of the things that I've done in this pandemic is I've gotten in the habit of asking people how they're holding up. Now, how are you doing during this mess or during this pandemic? Is everything going okay? And it was interesting because Jim looked at me and he said, I'm actually doing pretty well, doc. I haven't used any drugs in months. And I said, wow, that's really good. You know, what's changed? And he said, well, see, I'm homeless. But recently they put me up at this hotel and I had three meals a day and I've been able to stay clean and I finally have some stability in my life. And you know, I've got a job now, I'm saving some money and they've actually put me on a list to get into permanent housing soon. He said, for the first time in years, I feel hopeful like I'm gonna get my life back. And he goes on to tell me that he had lost visitation with his 12-year-old daughter because of his drug use and homelessness. And that he finally felt like he was gonna be able to reestablish a relationship with his daughter. And so when I walked in that room that day, I had no idea he was homeless. I had no idea that the work that we were doing was making such a huge impact on someone like him. And he had no idea that the words that he gave to me that day instilled hope into me and just strengthened my resolve to continue the efforts that we're putting forward. So it really made me realize how big of a problem this is and how much work we have to do and how much work we can do. So what are our next steps? So our preventive medicine team will continue to contribute throughout this pandemic. So we offer our unique training and broad scope of medical and public health expertise to this commission. As this Homelessness Commission moves forward on trying to get more transitional and permanent housing, we want to be there to help implement the services of primary preventative care, mental health and addiction support as well for long-term solutions for the homelessness. And we're gonna continue to advocate for increasing healthcare access, equity and prevention of disease. As we all know, these are vital elements to addressing these pervasive issues such as homelessness. So in closing, one of the things that I'd like for everyone to think about today is I just want everyone to try to imagine, imagine more and dare to dream bigger. You know, homelessness is a huge issue and it's a big thing to take a bite out of. But I think if we dream bigger and we can imagine a day where we don't have homelessness in our country, and I think we should believe in better and exceed the status quo in all we do when it comes to the healthcare of people globally. And then also to know our worth. You know, remember that we are experts in what we do. We have a wide range of skill sets here in preventive medicine and public health and we should always remember that. And then, you know, take no excuses. You know, again, it goes back to the status quo. Let's take responsibility and let's move ourselves forward and move this profession forward. And let's get to work on what we can do to change the world. And, you know, lastly, the simple truth. You know, the inclusion of preventive medicine physicians in a wide range of institutional positions, not only will prevent and mitigate future health crisis, but will address dynamic issues that impact the omnipresent population health concerns. And I think all of us went into preventive medicine and public health to change the world. And, you know, if you only remember one thing, right now we're spending some watershed moment for public health and a critical time for preventive medicine physicians who are uniquely trained and positioned to usher in a major paradigm shift in healthcare in the US. So now is the time to act. And just remember, if we won't change, we are the change. So I just encourage everyone to go out, look at what else we can do, look at organizations that we can proactively get involved with and start making change on a real level. And just want to recognize all the members of the multidisciplinary COVID-19 task force for the Homelessness Commission. And if you have any questions, I'll be glad to take them. So yes, so COVID vaccines for the homeless, so we actually have the Moderna and Johnson and Johnson vaccines now. So all the centers have it, the city health department also has vaccinations, and they're continuing to vaccinate with the choice. So they are not forcing either one. We have both options for the homelessness people, and they're doing it also for the ones who are not in the shelters. So there's outreach vans that are going to the overpasses and to the other places where people decide to shelter themselves. And they've been all for the vaccination. So that's continuing to go forward. And as far as the educational material. So, yes, there was the different agencies did have those materials translated into the common languages in our area. So Haitian Creole and Portuguese are very common in our area. So they were translated. And the great question there, too, about the ongoing work. So the goal right now with the city and the Homelessness Commission is to build sustainable, ongoing housing and insert health care facilities or some kind of health care facility within the housing unit. And so what we're hoping now with we see now with the HUD money and the CARES Act money that was here that we've been able to make a huge impact on the homelessness in this area. So what we're hoping is that will continue. Like I said, the city has put money into it and we're trying to get other large stakeholders. We've got some large agencies and companies within the New York City that are doing it. I know that some of the insurance companies, I think Aetna and Sigma have started some some work as well at providing long term plans for homelessness. So we continue to want to be part of that. And hopefully we can address the health care needs of these people, which a lot of times the addiction and mental health is the reason for their homelessness. So we're hoping to continue with that and we're still working on that plan. Any other questions or concerns? Okay, thank you very much Okay. Well, thank you to Dr. Webb for a great presentation and welcome to our presentation on transforming public health through local academic and military partnerships. We're thrilled to share the successes of our partnership. I am fortunate to be joined by several of our collaborative team. Let me get on to the next slide. Okay. So representing academia is Hannah Prentice Dunn from University of North Carolina Leinberger Cancer Center. Representing local public health is Ashley Curtis, who serves as a deputy director of the Cumberland County Department of Public Health. And representing the military is Colonel John Melton, who was the former commander of Womack Army Medical Center, Fort Bragg. And I am former military, having served as the director of Department of Public Health, Fort Bragg, and I'm now in the academic world as of last month. I am going to proceed through the next few slides quite quickly. So here is our disclaimer. our learning objectives. Now, where do each of you work? You don't need to answer this, but I imagine most of you fit within A through D. And because of COVID, many of us are working with new partners, and through this presentation we'll share some examples of ways to collaborate with new partners. And now I'm going to turn the slides over to Colonel John Melton, who will tell you about Fort Bragg and how we began these partnerships. All right. Hey, thanks, Cheryl. So Fort Bragg is the home of airborne special operation forces and serves what we call the nation's power projection platform, meaning that Fort Bragg maintains a high state of readiness where military units are capable of deploying anywhere in the world in less than 24 hours. It's also the largest military installation in the world by population, supported population, over 258,000 people, the vast majority of which do not reside on Fort Bragg and they live in the surrounding communities. Prior to the partnership, Fort Bragg, this large federal military installation, was basically a black hole in the middle of central North Carolina from a state and local health department perspective. Next slide, please, Cheryl. Now, I served as the medical center commander from January 2018 to the end of July 2021. In that role, in essence, I was the chief executive officer responsible for both the Fort Bragg healthcare delivery and public health systems. In January of 2018, my first month, we discovered a cluster of adverse health outcomes for military and family members smoking vape oils that contained unknown substances. The reporting processes itself involved multiple stakeholders with different equities. In working with and learning from Cheryl Bednow, at the time our Fort Bragg Department of Public Health Director, it became very clear that we need to better integrate with our state and local health departments because our supported population was part of those communities. To improve processes, you must manage to a standard, which means you have to have a standard. Cheryl Bednow and I decided back in February of 2018 to pursue national accreditation through the Public Health Accreditation Board. These standards and measures provided a framework to organize our activities over time. The U.S. Army Public Health Command was also instrumental in our journey, and in less than two years, we achieved accreditation, which was awarded in March of 2020, just as we began navigating the start of the COVID-19 pandemic. Next slide. Now, these collaboration goals and activities were informed by and nested with the national accreditation framework. It was essential to define this overall goal for Fort Bragg stakeholders, support military readiness and population health, and to help them understand the value of these partnerships. You know, public health is a science of protecting and improving the health of people in their communities. From the Fort Bragg perspective, we call it force health protection, the readiness and resiliency of the force. You see, the overarching narrative for our Fort Bragg stakeholders are twofold. First, soldier readiness. The most powerful weapon system in our United States Army will always be the American professional soldier, and our team is charged to ensure that every soldier is physically and cognitively ready to fight tonight. And second, Army families and community resiliency. They sustain the readiness of every soldier. Our Army is an expeditionary Army. Our soldiers go where most will not. If you're not right at home, you are not right at work, and no American soldier should ever have to worry about home or when they come home. Next slide. You know, it was also important to demonstrate the feasibility and impact of our partnerships and how it impacts readiness. You know, the way we look at health is evolving in the military. Through our partnerships, we are learning how best to operationalize it. We now take a more holistic view, understanding how environmental factors influence behavior, lifestyle choices. What do I put in my body because of what is convenient? Affects the body's metabolic processes, having a direct impact on performance from cognitive decision-making to physical reaction time to state of mind. And carrying that narrative was very important as we developed these partnerships. I'll go ahead and now hand off to Hannah there. So Colonel Melton just showed you some different health topics that our partnership has worked on, and I'm going to dive into a few of those. Of course, as we were working on these preventive health projects, the COVID-19 pandemic hit. And because we at UNC are affiliated with the UNC Gillings School of Global Public Health, we were able to engage our epidemiologist faculty and students to support Fort Bragg's COVID-19 response. So over the course of the last year, we were able to support Fort Bragg in several ways. The first was with contact tracing. Early in the pandemic, we helped to record a presentation to walk unit leaders through the process of contact tracing on base to hopefully save Colonel Bednow a few phone calls. We had our faculty and students evaluate new apps to assess their utility on Fort Bragg to help with contact tracing. And lastly, we had a student interview five county health directors surrounding base to understand their contact tracing efforts, how they were going, as well as their approaches to school reopening policies. And then through the fall, we shared weekly research briefings. We had a team look through the literature and understand what was going on with COVID-19 transmission. And we also tracked the actual school reopenings during the fall and shared those reports with base. And those reports were shared with garrison leadership to inform decision making on Fort Bragg. Next slide. In terms of assessing the community's needs, our UNC team worked closely with the Fort Bragg leadership and this collaborative to develop and disseminate the Fort Bragg community survey this year. This survey is assessing quality of life needs for Fort Bragg soldiers and families and will inform programs and services on base over the next three to five years. To develop this survey, we had one of our UNC summer practicum students meet with office leads on Fort Bragg from transportation, housing, public health, and other offices, and also with soldiers and beneficiaries to understand their top challenges and information needs. The survey was pilot tested, approved by Fort Bragg leadership, and we opened the survey in April of this year. And I want to tell one story which I think really highlights the collaboration around this project. Our UNC team created a promotional flyer for the survey, which had a QR code embedded in it that linked to the survey. Our Cumberland County partners printed that flyer. They printed hundreds of copies of that flyer, drove it over to Fort Bragg, and Lieutenant Colonel Nicholas Song was coordinating COVID-19 drive-thru vaccine sites on base. He handed out those flyers to cars who were just waiting for 15 minutes under their observation period before they could safely drive away. And we saw a huge uptick in people, soldiers and families, who actually took the survey because they were sitting there for 15 minutes and were sort of a captive audience. So the teamwork around that was amazing, and through this collaboration, we were actually able to double response rates compared to the last community survey. So the survey closed this past Friday with 3,300 responses, and we're looking forward to looking at that data this summer. And next, I'll hand it over to Ashley, who will talk about some of our tobacco control work on base. Thanks, Hannah. So a brief overview of the state of North Carolina. The state of North Carolina is funded through the CDC for tobacco control. There are 10 regional managers. I happened to be one of those regional managers when I started working with Fort Bragg and promoted from there. This year, we got another set of five years to do tobacco control with a twist. They decided to give us a health disparities project, and we thought, what better project than the Military Health and Readiness Initiative? The goal of this project is to reduce the percentage of Fort Bragg soldiers who use tobacco from 26% to 17% by 2025 at the end of the five years. Through that, UNC has worked on a strategy called CAPS, cessation being trying to get cessation services on Fort Bragg to be more consistent and everybody have the right training and referring to the quit line. Availability, that's the location of retailers and what products they have. Pricing, pricing on and off base and what the discrepancies are. They shouldn't be far off from each other if they're near each other. Trying to make sure the prices match. Smoke and tobacco-free policy, we know that going tobacco-free in a community can help make somebody do a quit attempt. We want to try to assess Fort Bragg's policy as well as Cumberland County's. Next slide, please. Briefly, I'll touch on cessation and pass it over to Hannah to touch on the other areas of CAPS. In 2019, when we first started working with Fort Bragg, we had a little bit of funding to play with to do a quitline campaign. At the time, the quitline was only giving one call per soldier. I'm happy to report that now soldiers can get four calls as well as NRT, nicotine replacement therapy, when they call the North Carolina quitline, which wasn't the case before this project started. As you can see, those are two of the ads that we used. We served those ads digitally to the mobile phones, did some geofencing around Fort Bragg within a 40-mile radius in the eight counties that surrounded the Fort Bragg base installation. As you can see, 2,400 people clicked and went to the quitline from our ads. And this year, they're going to relaunch these ads in more of a gift digital form and try to make them a little bit more interactive. And now that they'll get sent to the quitline, they'll have a little bit better services. Pass it to Hannah real quick. Thanks, Ashley. And actually, yeah, there we go. So I can touch base on some of the work that we've done for the tobacco environment. We know that the environment around tobacco is incredibly important in shaping our behavior and tobacco use. So I'm going to touch on the middle of the slide, our tobacco retail density work, and also our tobacco pricing work. So you can see a lot of red dots here on this plot. Those are tobacco retailers in the four county regions surrounding Fort Bragg. And Fort Bragg is the sort of peach-orange blob in the middle of the map. This is data from 2017. And just mapping this out and seeing the incredible density of retailers off the southeastern corner of base made us want to do something. So I know Ashley and her partners in Cumberland County are working with county commissioners over the next few years to try to put some zoning policies in place so that retailers won't be so close to schools. And of course, this cluster that you see is in Fayetteville, which is in Cumberland County, just off of base. And for the tobacco pricing, there is a DOD policy, a memo that was passed in 2016 that states that tobacco prices on installations should be equal to the prevailing price in the local community, including taxes. So we did a very quick pilot study looking at prices on versus off base in the summer of 2019 and did find that prices were lower on base for tobacco products. So this summer, we're gearing up for a big comprehensive study of tobacco pricing on versus off base. We're going to go to all tobacco retailers on base, all 14 shopettes and exchanges, and hopefully visit 60 to 70 retailers off base as well to understand where the prices stand. And our goal with this is simply to bring information to Fort Bragg leaders and support them in making any policy or enforcement changes that they're interested in to improve the tobacco environment and make the healthy choice the easy choice for these soldiers. And next, Ashley will talk about some of our work to improve the healthy food on and off base. Thanks, Hannah. So pre-COVID, we all got together and applied for the Healthiest Cities and Counties Grant through the Aetna Foundation. We received $100,000 over the course of two years to do some food access work. That falls into two buckets, one being the creation of what we believe to be the first ever military county joint food policy council, as well as to do a comprehensive assessment of food retailers and their offerings of healthy food both on and off base. You can see some preliminary mapping there of the different retailers that serve food. And then below that is a map. We're using a system called Google My Maps to send community residents out into the public to assess different shops and what servings and offerings they have for healthy foods. And that will continue to go on through the course of the rest of the grant that ends in June of 2022. And I'm going to pass it, I believe, back to Hannah. Thanks, Ashley. Our colleague, Dr. Jared McGirt at UNC Greensboro, who's helping with that Healthy Food Council, is also working with Fort Bragg to change how people interact with the food environment on base. So Dr. McGirt worked with Fort Bragg to obtain DOD's Advanced Medical Technology Initiative pilot grant, and he's testing out geofencing technology on base. For this project, Dr. McGirt set up a geofencing perimeter around the Womack Army Medical Center, and he put small beacons, Bluetooth beacons, within the Womack Army Medical Center Cafe. He then piloted an app that sends people push notifications when they're in the Womack Army Medical Center Cafe, encouraging them to choose healthy options. So for example, be sure to pick up an apple before you go through the checkout line. That pilot went really well. Lots of soldiers and workers on base accessed it. And now he's working with base leaders to go after a larger pilot project to spread the use of this technology over base. Next slide. So we know that HPV infections are a huge burden in the United States, but they're also a big burden in the military. HPV infections can cause genital warts and cancers in both men and women, and this impacts soldiers' readiness and their ability to be deployed. The HPV vaccine Gardasil is safe and effective for preventing six types of cancers caused by HPV strains. And while the HPV vaccine is recommended for boys and girls aged 11 and 12, there's a huge benefit for adults to receive it at the catch-up age of 18 to 26. Gardasil is not required right now by the military, but it continues to be strongly recommended by the CDC and Defense Health Agency. So this spring, our team, our UNCT team, worked with leaders at the Medical One-Stop Clinic on Fort Bragg to conduct a quality improvement initiative focused on HPV vaccines. And to give you some background, the Medical One-Stop is a clinic on Fort Bragg that sees all soldiers who in-process and out-process to base, or around 50 to 200 soldiers per day. And the clinic provides them with the vaccines that they need for service. Next slide. In our QI initiative, the Medical One-Stop just added the vaccine supplies, the HPV vaccine supplies to their clinic. They didn't have them on hand before. And we also trained clinic staff to follow this process that you can see on the slide here. They assess soldiers for HPV vaccine history, and they assess soldiers for HPV vaccine history. They give a clear provider recommendation to eligible soldiers. Then if the soldier accepts, they deliver the vaccine, they document it in the EHR, and then remind them about the follow-up doses. So we just finished this four-week project, and we're evaluating the data right now. But we do know that the Medical One-Stop was able to deliver 500 vaccines over the four-week QI initiative, and soldiers knew that the vaccine wasn't required, but they were very receptive to it. The most exciting part for us, though, is the Medical One-Stop decided to continue using this process as their standard of care for in-processing soldiers, and they're continuing to recommend the HPV vaccine. Next slide. So as you've probably picked up from this presentation, we've had some incredibly talented students work with us in this public health collaborative. All students at the UNC School of Public Health have to conduct a practicum, a summer practicum with a community partner, and this has just been a perfect match. We've had lots of public health work going on at Fort Bragg, and the next generation of health leaders being trained at UNC. And to give you some context, Fort Bragg and UNC are just a little over an hour drive apart, so we're very close to each other. These students have been able to dig in and move the work of our collaborative forward in a really meaningful way, and they have also been able to learn about the health needs of a really large military community and learn about career opportunities in military health. And we're also excited to welcome two more practicum students this summer who are going to be working with us on our tobacco control work and to help analyze the results from that community survey. And next, I'll hand it over to Cheryl to talk about sustaining our collaboration. Okay, so military personnel transition frequently, making it difficult to maintain collaborative relationships. We used several strategies so that these great partnerships could endure. We established a multitude of agreements. We submitted for grants, as you heard about some of those grants, and we wrote protocols. We met on a very regular basis. We attained and maintained buy-in from senior leaders. And finally, our efforts were tied to our pursuit of national public health accreditation. I think that concludes our presentation, and I will now open it up to any questions. Okay, I see one of the questions about the entity that was accredited, Fort Bragg Health Department or the partnership. So I will start on the accreditation process. So like many county and state departments of public health that pursue national public health accreditation, we were the second military installation to do so. So that was our public health department was the entity that was accredited. And I think our partnership really helped in that effort because North Carolina has a strong history of local public health accreditation. So as we were going through that process, we worked heavily with Cumberland County and other counties to improve our processes so that we could be accredited. Now I'm going to have another question is, so if somebody is interested in expanding their collaboration or including military partners, what suggestions does the group have on kind of expanding their normal array of partners? So what about, I'll start with Colonel John Melton, if you have any ideas about expanding a partnership? Yeah, most definitely. I think the one thing I learned with the team is to be intentional to me. I can tell you on the federal side, on the military side, it may not necessarily be an expectation, but it doesn't preclude the county or other entities to reach out. And really, I think on a military installation, meeting with the medical treatment facility leadership is a good point of entry on that, but just to actually meet, right? Because all the broadening opportunities are outside the gate. That's where the majority of our population reside. And a lot of times, I think, at least on the military side, we get very fixated with just only on the installation. But definitely, I think at least to have those opportunities that you can meet and collaborate. And I see there's a question about the process to start setting up the agreements. And I think the first set of agreements that we did were those in-kind agreements. And I'm going to ask, because that was a process that came from Fort Riley, and I'm going to call on Colonel Melton again to speak to that initial set of agreements. Yeah, I think it also... So what those are are basically, we recognize from the federal government and military level that in order for us to invest time, effort, and intention of federal resources, we had to have a linkage to what would bring value. And those in-kind agreements basically gave us the framework to have those collaborative discussions, to take it beyond then just to talk about it, right? And it also created an expectation. And the way we do agreements on the military side, you actually have to go through for your chain of command and leadership. And there's no resources tied to it other than time, effort, and intention. But another area where we did agreements was to have public health students, MPH and PhD students. And that began because there was interest on the part of an MPH student to work with us, and we realized that there wasn't that agreement. And it set us off talking about what should that agreement look like and who should be on our side involved and on UNC side. So we discussed it, and it actually happened pretty quickly. And that was, I believe, May of 2019, that we began with our first student. But, you know, I'm going to ask Hannah to comment about having kind of that formalized relationship between Fort Bragg and UNC. Sure, yeah. Part of the practicum process is the student sets up an agreement with their preceptor. And so it basically forces us to lay out the scope of work for the projects and think about any supplies or resources that the student will need. And it sounds small, but you have to think about everything that you want to be accomplished over the summer and really set the student up for success. It's a little bit of a way that UNC guarantees that the student won't be just getting coffee for people all summer, they'll actually be doing real work. But it forces us to think about the environment for that student. And that was just the first way that we went about partnering with Fort Bragg on UNC's side. And it helped us to formalize the work. I think another area that really helped expand our partnerships was Fort Bragg's involvement in a regional group of health directors. We joined a group that was represented by maybe nine of the local counties, and we could hear about other things going on in the region, including the tobacco programs. So I mean, that was an existing group that Fort Bragg was left out of, and I think one of the health directors called had a donut and donut hole analogy about that. But I think that really opened us up to different opportunities in the community and to hear about things like the tobacco policy that Ashley was involved in before she became the deputy director. And I don't know, Ashley, if you have any comments about how, when we kind of expanded that involvement, what did that look like from the county's perspective or the region's perspective? So I think with us, it was really informal at first. We just kind of wanted to get in in any way that we could. We had heard in the past that, you know, like our WIC office was embedded on Fort Bragg. But as Cheryl mentioned, the turnover on Fort Bragg, you know, is frequent. So you've got to build in sustainability. And that's something that we were striving for at all times. And then we met John and Cheryl and we were like, yes, this is it. We finally have champions that can help us all come together. And so we have what we call a memorandum of understanding. And so we had to formalize it in that way. And we're currently going through our accreditation process and filling in gaps where Fort Bragg can fit into that process, as well as our community health assessment process. So at all times now, we think, OK, how can we fit Fort Bragg into what we're doing? And let's reach out to our partners and try to get them involved in whatever that piece little thing is and try to keep them moving. And speaking of the community health assessment, you know, previously, that was a process Fort Bragg did on their own, the counties did on their own. But there's a real effort now, especially with the survey, to kind of share information and work on those things together. I don't know, Hannah, do you mind like talking about what the plans are moving forward between Fort Bragg, the county and UNC on the community health assessment? Sure, well, as I mentioned, we got a great response to the community survey and we have a full time summer practicum student from UNC, a graduate student in health behavior, who's going to analyze that data. And essentially, Katie, the new student, is going to take reports from the assessment and meet back out with those offices on Fort Bragg. We're kind of closing the loop. We're going back to the offices who gave us information to help us build the survey and going back to them and sharing what we found from the community and hearing how that resonates with them and doing some problem solving with the leaders. I also know that Cumberland County included some of the questions from the survey in their own community health assessment that's actually, I think, out in the field right now. So we're hoping that our student will be able to analyze data both from Fort Bragg and Cumberland County, since so many soldiers and families live within Cumberland County. We also are excited that the student will be working on Fort Bragg with Lieutenant Colonel Pierce, the new health director, one to two days per week. So she'll be embedded a little bit in the health department this summer. Great, thank you. Now, I think that concludes all of the questions that are available. Just for any last comments, if anybody has anything else to say before we wrap up. I would like to chime in and say that this partnership is really here because of Colonel Melton and Cheryl and their work. They really just opened the doors to local public health and also UNC. So we're really sitting here because of these two folks. So we're really honored to be a part of this group. I appreciate that shout out there. You know, the one thing I'd invite team to look at, you know, from a senior military leader's perspective, the value of these partnerships. You know, our military is an all-volunteer force. It's actually a family business. About 75 percent of those that are on active duty who wear the uniform come from a military family. A lot of places, particularly like a large installation like a Fort Bragg or a Camp Lejeune in North Carolina, that's where we actually recruit and fill our ranks of an all-volunteer force. So if you think about the strategic impact of an integrated public health system that's, you know, population health and personalized health, in essence, a military family member, a child that's born, all the way to the point where they choose to serve in the military. If we don't have an integrated public health system, there's a gap. And the way we organize it around why recreate the wheel, there are competing requirements and there's not enough resources. But to bring a federal organization who is focused on maximizing human potential for what we do and also maximizing survivability, which adds to quality of life. The opportunities are out there. The challenge is we're not as sophisticated as we need to be to bring that integration. But this was a great case study to demonstrate what could be possible. Well, thank you all. I think starting with Dr. Webb's presentation on how to work capital homelessness from a public health standpoint, integrated preventive medicine, to the partnership between local military and academic public health, just new types of partnerships that I think had tremendous successes. So I just want to thank everybody in this group today and hope everybody enjoys the rest of the conference. Thank you.

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