Episode 1: REACHing for Vaccine Equity Guest National Kidney Foundation of Michigan

Dr. Yabo Beysolow 00:00

Welcome to Reaching for Vaccine Equity. We are your hosts. My name is Dr. Yabo Beysolow.

Lisa Jacques Carroll 00:09

And I’m Lisa Jacque Carroll. In this limited series podcast, hosted by the iReach team at the nonprofit Association of Immunization Managers, learn how individuals living with chronic health conditions can thrive with the preventative power of getting vaccinated and adopting healthy behaviors, including nutrition, exercise, and smoking cessation.

Dr. Yabo Beysolow 00:33

Meet REACH community leaders who have success stories to share, the challenges they have met, and the health inequities they’re working to overcome in the diverse communities they serve. We’re glad you’re here.

Lisa Jacques Carroll 00:47

In this episode, we will explore the importance of vaccination and healthy behaviors for individuals living with kidney disease.

Kidney disease disproportionately affects people from certain racial and ethnic backgrounds, and individuals with kidney disease are at a higher risk of complications from both flu and COVID disease. I’m happy to welcome our guests, Cynthia Jackson and Teresa Tejada from the National Kidney Foundation of Michigan or NKFM.

I’ve worked with them over the past two and a half years, and I’m excited for them to share the great work they’ve been doing to prevent kidney disease and promote flu and COVID-19 vaccination in their community. Cynthia and Theresa, I’m so glad to have you on the show. Welcome.

Theresa Tejada 01:36

Thank you.

Cynthia Nichols Jackson 01:37

Thank you for having us.

Lisa Jacques Carroll 01:38

Can you please tell our listeners a little bit about your organization and how the National Kidney Foundation of Michigan works to impact the lives of people in your community?

Theresa Tejada 01:48

Sure. So the National Kidney Foundation of Michigan, um, has a mission to improve the quality of life for those who have kidney disease and also to prevent it.

So we have offices in Detroit, Ann Arbor and Grand Rapids, and touch more than 20,000 people a year with our patient services programs and our prevention programs and our information and our communication campaigns as well.

Lisa Jacques Carroll 02:11

Excellent. Thank you so much, Teresa. Tell us a little bit about the community that you work with most.

Cynthia Nichols Jackson 02:17

I work with the, uh, kidney patients. We work with persons with diabetes as well as high blood pressure. We do prevention programs as well as work directly with the patients in the children’s program. It’s all kidney focused or prevention for not becoming a kidney patient.

Lisa Jacques Carroll 02:35

Excellent, thank you.

Theresa Tejada 02:37

And in our REACH project specifically, we have kind of narrowed down a region in Western Wayne County, Michigan.

And that region has, and, and Wayne County, I should say, we have been working with individuals who are mostly African-American and Hispanic individuals, um, who are, as you said before, at a higher risk of chronic kidney disease as well as diabetes and high blood pressure. And those are some of the leading causes of chronic kidney disease.

And so those are some of the populations and why we chose this populations. We’ve been working in those communities a long time.

Lisa Jacques Carroll 03:11

Great. And what are some of the unique cultural aspects of your community that affects your work?

Theresa Tejada 03:14

So, like I had mentioned before, there’s a strong connection between the connections of Hispanics are living in Western Wayne County at Southwest Detroit and they, you know, there’s a very strong connection to the religious community.

We developed a really great connection, a partnership with a church in Western Wayne County in the city of Wayne that has a strong Hispanic ministry there. But there has been some concerns, religious concerns about promoting the COVID-19 vaccine. But they were welcoming to, um, promoting the flu vaccine.

And we also found that there were some, you know, lack of cultural responsive services in Western Wayne County from Hispanic residents. Just not having those bilingual resources, just not having, you know, staff that have, you know, training and cultural competency. And, so therefore, that’s where that connection to Southwest Detroit and why we extend it expanded a little bit of our, of our region.

Cynthia Nichols Jackson 04:06

So as far as the African American community, Detroit is a big population of African Americans as well as even in the Wayne/Westland area. So the population there in Detroit is mostly where, you know, the misinformation was very much, you know, not welcomed and was a big deficit for us as far as trying to get them to agree to it.

Also, we have the history of the poor medical system that caused the syphilis outbreak that happened years ago. Some people historically were misinformed on things, but the population overall took on the vaccine after much more education and trying to extend the information to say it’s more about your health.

And after the, after the information was given, then the vaccine was accepted more.

Lisa Jacques Carroll 05:02

Great.

Theresa Tejada 05:03

Just to add one more cultural, you know, connection, uh, in the city of Inkster, which also has a very high, it’s a, uh, majority African-American community from historical backgrounds to that the, they don’t have a public school system within the city of Inskter because of some rules of financial management and everything like that.

So that has also bred some distrust into, you know, public institutions and, you know, sometimes there’s, you know, people just different groups, uh, stakeholders, political groups just don’t get along. So, that can also kind of contribute to a lack of, of distrust. And so there also was really throughout our community these assessments and stuff and expressed an interest then in some of like natural and alternative therapies and making sure that those types of therapies and topics also get the type of attention along with like Big Pharma.

Lisa Jacques Carroll 05:52

Great. Thank you so much. Cynthia, I understand that you have experience with kidney disease yourself. Can you talk a bit about how the COVID-9 pandemic affected you and the people you work with who have kidney disease?

Cynthia Nichols Jackson 06:04

Yes. I am a kidney patient myself of 36 years, and I am a transplant twice, and so the virus became more a problem with myself because I was a new transplant

So I was a dialysis patient prior. I was immunosuppressed based on the medications I took before the transplant. But then, after the transplant, became really confused about how efficient or was this vaccine good for the transplant patients or persons because there was no research done on the vaccine for organ transplants.

And so I guess I was in the distrust too, cause no one talked about me, you know, in my, uh, situation. And so that became a big group discussion among transplants, both or any kind of a organ. It took quite a few times. We had the Johnson and Johnson, we had the Moderna, and the Pfizer, but it was still going through the first phases and no one wanted to take the vaccine.

But eventually we had to because we knew that we were still immunosuppressed. So it became a big topic. So that didn’t even have to do so much with culture as much as it needed to do with disease, if I could say it that way. And then when I got COVID later in the two year process, I had the boosters. They gave us more boosters because they told us that the transplant population was not covered by the vaccines originally.

So, we had to take more boosters than most. And if you did get COVID, they immediately treated you with the antivirals. That was good, but it was like after yet so many boosters. So that’s how it affected the transplant.

Lisa Jacques Carroll 08:00

Thank you for sharing your experience, Cynthia. What are the biggest challenges in your community in helping individuals from different racial and ethnic minority backgrounds manage their kidney disease?

Cynthia Nichols Jackson 08:10

The biggest barrier is lack of information and awareness, so lack of educating about their bodies as far as what the functions are of the kidney, and how important they are to you and how to know that diseases such as diabetes and uh, high blood pressure are huge diseases that are in African American as well as Hispanic population.

And so, the lack of even knowing once you’ve been diagnosed that in those two disease populations, that the kidney is so vulnerable to be attacked because of lack of control of either diabetes and high blood pressure, and then it will cause the decline of the kidney function over time. So, to get them the education, to get them the awareness has been the barrier.

They continue to say once they find out, and it may be late when they’re on dialysis or even in transplant, they always say, why didn’t I find out earlier?

Theresa Tejada 09:16

And for individuals who are on dialysis, you know, dialysis is extremely disruptive. It’s very expensive. And, you know, with that it will disrupt your, you know, job opportunities, your abilities within your family, puts a lot of stress on the entire family, and there’s more people who are on the transplant list than there are available kidney donations. And speaking of, you know, racial ethnic minorities, that there are more people of color, disproportionately more people of color, that are on waiting for one of those lifesaving organs.

People are scared to go on dialysis, but also scared to…think transplantation is too expensive. And just kind of like Cynthia was saying, that just unaware of some of those resources available for transplantation as well.

Lisa Jacques Carroll 09:58

Do you also find that your communities have less access to routine healthcare? Do you think that’s also a barrier?

Theresa Tejada 10:06

Yes, absolutely. For sure, especially in the prevention side and then especially for Hispanic populations, there is a lack of dialysis facilities in Southwest Detroit that are, you know, again, like culturally appropriate and speak, that are bilingual. So yes, you know, routine healthcare and then dialysis centers too is the thing.

Cynthia Nichols Jackson 10:26

Right. And African American is basically the health disparities because of lack of access. I mean, you know, some of lack of insurance and clinics that are overcrowded or persons who are, like the elderly, some of them now are Medicare places are not even taking them. They’ll say, you know, if you are Medicare or Medicaid, they won’t take some individuals.

So again, more health disparities, even though the insurance should go everywhere, but it’s when you wanna find a place that you wanna go and they don’t wanna take that. So health disparities for the clinics, just common, basic health is very, very poor in areas.

Lisa Jacques Carroll 11:08

Sounds like there’s a lot of challenges to overcome.

Theresa Tejada 11:10

I also know too that it’s the social determinants of health and the access to quality healthy foods and that are affordable access to safe places, to be, you know, active are also limited in the communities too.

Lisa Jacques Carroll 11:23

Thank you so much. In working with you, I’ve been inspired by your organization’s work to help meet your community’s needs.  How did you build relationships and foster partnerships in your community to promote flu and COVID vaccination?

Theresa Tejada 11:39

So luckily, you know, we’ve been able to have relationships with some of these organizations in these communities for a long time. So, we leverage those existing partnerships with the individuals and organizations, faith-based communities, education, healthcare partners, and even some of our employer, um, partners that are, uh, supporters of the National Kidney Foundation of Michigan, but are also major employers of the populations that we’re trying to serve. So, we work with them to develop our strategies and get the word out about vaccination. But then we also created new partnerships with vaccine providers, particularly. We’re not a vaccine provider and we’re not a health department, so we really needed to make some new relationships with some vaccine providers and some other community organizations to reach those key target audiences that when we did our needs assessment that we heard about, who still has questions about the vaccine? Who do people look towards to get reliable information about their health? So, we created some partnerships with community organizations, particularly among like young adults who had a low uptake of vaccination. And so it was, you know, a challenge at first to establish some new partnerships.

And we needed to tailor each strategy, each campaign, each outreach activity specifically to those target needs. And, so like our bilingual team, you know, they provided free flu vaccines with some of our partners and health screenings and education information to a church. Like I said before, that they don’t really have access and have some hesitancy around COVID-19, but were, you know, willing to open the door for flu. So how can we still get some of that message out there? They typically still don’t have access to those services so let’s take the opportunity where we can to develop those trust-based relationships and so that over time we can, hopefully, you know, open some doors for conversations down the line and new opportunities down the line to do other things. So while it took some time to develop those relationships and those goals might be a little bit different from what our specific goals would be, you know, it paid off eventually because we were able to seek the best for their congregation and make some opportunities where they weren’t there before.

And also, you know, using trusted messengers. You know. Cindy, do you wanna talk a little bit about some, some trusted messengers?

Cynthia Nichols Jackson 13:43

The trusted messengers we used were the peer mentors because they had the kidney disease. They’re either dialysis, just keep CKD patients or chronic kidney disease persons and transplants.

We formed a small group that came together that would go to their individual communities and be able to spread the word. We had, even those who had difficulties with transportation, that was provided so they could get the COVID vaccine to different locations, but the trusted messengers within keep the conversation going, keeping the communication open.

They were talking in various different communities of their own personal as well. And then, we came together with that and made what we call now Vax Facts, which is a video session that we put together that they would have. We were doing it monthly, first, twice monthly and then monthly, in order to get more of the information out there that was accurate, that was updated, that was live, that was open for FAQs so that persons could be able to get right involved, you know, any questions they had or the new information was coming out, or what is a variant, why do we have to keep doing all these boosters, all of that. But the trusted messengers were also out here on the streets and saying, you know, you need to get the vaccine.

You know, we are kidney patients, you’re immunosuppressed, you are dialysis, you are having these issues and we live the same kind of life you did. So we’re telling you that we received them so that you do, we’re encouraging you to also so that you can have a better life and help. So, that’s how the trusted messengers were and still consisted, continued to be involved.

Theresa Tejada 15:38

Yeah, we found that as important it was to have the trusted messengers of people who were like doctors and pastors and stuff like that, we found through our needs assessment that peers, um, you know, people’s friends, family members, you know, people that they talk with on a normal basis, are also very important to connect with in terms of the trusted messengers.

And that’s where we kind of really also, you know, targeted some of our approaches. Really. How can we connect with, with just everyday people who are really connected within their own populations?

Lisa Jacques Carroll 16:04

Great. Thank you so much. Those sound like some excellent initiatives that you all introduced for your community. How would you say that the flu and COVID vaccines have been accepted in your community?

Theresa Tejada 16:15

I would say that our communities, that like other communities, you know that there are very much, you know, people who are on top of it, who are getting it right away. Then there’s the people who you might need to remind like, hey, did you get your shot?

And that’s why I think it’s really important for us having, where we had our mobile clinics and to be able to reduce those barriers that like locating right where you are, you’re here right now, get it now. I’m like, okay, well sure, yeah, since I’m here, I’ll get it now. And then, you know, some people who still have, have not gotten their primary series and still have some concerns, but we continue to do our outreach and education to not only just know play to see for future consideration, but just to be able to help build that trust within the healthcare system as a whole too. So we continue to see, see a whole spectrum of opinions and concerns and thoughts about the vaccine.

Cynthia Nichols Jackson 17:09

Yeah. And in my case it was like still getting calls and talking to people about their health and saying, you know, you are a dialysis patient. Have you gotten it? No?

Well, I had a example of one woman who was a new transplant and had not had the primary series and, and told me that, no, don’t believe, don’t want it. And so I, I spoke with her at length and sharing that you have been gifted with a second organ. I mean, you know, yours failed and you’ve been gifted, and why not give the best to the gift?

It’s something that is just like you take the transplant medications to keep from rejecting, why not think of it as it is the same importance that, again, this is a gift to you. And by the time I finished my conversation, she actually said yes, I believe you. You know, I didn’t think about it like, And actually received her primary series.

So I was glad to see that. But knowing that you know this out here on social media, you know, putting the chip in the vaccine and you know, again, with all the historical problems of health, more of the persons that were having the issues were more from the inaccurate or poorly reported information that was from the government that was just saying, you know, different things and then later come back, oh, nope, that’s not it.

So when you have a population of people that you’re trying to drive this way, you gotta keep the story straight. It’s harder for all of us to figure out what to tell them, to keep them on the straight and narrow.

Lisa Jacques Carroll 18:59

Absolutely. I, I agree, Cynthia. It was very challenging to have things changing so rapidly throughout the pandemic and always having to pivot and learn what was the newest recommendations so, but I love the idea of, you know, treating your organ transplant as a gift and, and taking care of it, and I’m glad that that message resonated with that person that agreed to get vaccinated. So that was great.

Cynthia Nichols Jackson 19:20

Yeah.

Lisa Jacques Carroll 19:21

What’s a shining moment in your work during the pandemic?

Theresa Tejada 19:24

We were lucky to be able to share something that we can sustain for years to come through our work and through our connections with the community and what we found about COVID-19 and the connection with kidney disease.

Um, we have a new campaign called the 33. Are you part of the 33% campaign? Because 33% of people are at risk of kidney disease and don’t know it. So we have this campaign specifically tied to our, our National Kidney Foundation National Office, but also in Michigan to be able statewide, um, targeting African-American, Hispanic communities.

And so we took some of our lessons from our vaccine outreach to be able to connect the risk factors of COVID-19 also with kidney disease because individuals with kidney disease are at a higher risk of, you know, severe complications from COVID-19, and then additionally, you know, acute kidney injury from COVID-19 diagnosis.

So, we wanted to be able to kind of connect those messaging together. And so that has been really effective and people are still interested in learning about COVID-19 in that way. It has a social media campaign that will lead individuals to a quiz, call Take A Minute For Your Kidneys quiz. Just a couple quick questions to learn about their risk factors, and then be connected to emails and ongoing resources, uh, to be able to connect individuals to resources in their community if they’re at risk for kidney disease. And again, to share some of COVID-19 information. So that is, I think, a really shining moment where we were able to leverage this opportunity and take it on a, a big, you know, statewide scale.

Cynthia Nichols Jackson 21:01

Theresa said it all as far as our new campaign, but my shining moment was to show persons with kidney disease and those who didn’t, look at how our organization is coming right to you, having you as the focus in trying to educate you on your health. I don’t think that people who are have kidney disease, in general, believe about the immunosuppression that they are under. I think to aid them with understanding and more education about their health, but with the emphasis that your health is such, so fragile that you need to get both the flu and the COVID vaccine we’re showing you it can help.

Lisa Jacques Carroll 21:45

Great. Thank you both for sharing. I’d love to hear how your organization has worked on vaccine and health equity in your community. Can you share some examples of vaccine equity initiatives that have worked in your community? And please feel free to share the work of your partners.

Theresa Tejada 22:00

National Kidney Foundation of Michigan is not a vaccine provider, but we’ve been able to make some great relationships with organizations like Alana’s Foundation, which was created to honor memory of a young girl, Alana, who has to weigh at the age of five from the flu, and provides mobile clinics and financial support for organizations to be able to provide subsidized ,free flu shots for the community for, especially for individuals who are underinsured or uninsured.

And we also partner with the Wayne State University Mobile Health Unit, who have been able to provide screenings and COVID-19 and flu shots as well. So, those organizations being able to provide the free vaccination and go on site to our community partners has been very crucial. We were able to host a vaccination event at one of our early childhood community partners called Brilliant Detroit.

They’re like a hub, a house for all sorts of early childhood resources. And so their staff at their Southwest Detroit location, who are primarily speak Spanish and serve the Hispanic community, really connected with the families who come and attend the programs at Brilliant Detroit. And so we had a co-located Alliance Foundation andWayne State University Mobile Health Clinic vaccination event.

And so we were there, Brilliant Detroit was there to provide our translation support as needed and just, you know, general information. So at that event, we had 31 people who got the flu shot including one person who is this their first time ever getting a flu shot and nine people got a COVID. This was in December too, like this most recent December 2022, so it was a little bit late too in the season.

So people still didn’t know that they could get a flu. COVID shot at the same time. So nine people got a booster shot at the same event, and then people also got blood pressure screens and general health screens too. From that too, we were able to provide some suggestions to both of those organizations to see how can we make their processes a little bit more culturally appropriate for individuals who speak Spanish, and then again, having those free vaccinations, opportunities in a location where they attend regularly. They don’t have to go someplace else. It’s free, providing even some incentives. We’ve had some incentives available. Like, that is incredibly important in terms of health equity.

Lisa Jacques Carroll 24:12

That sounds like a great event. Thank you for sharing. Can you share one of your favorite moments when you feel like you’ve connected with someone to make a difference in the cure of kidney disease?

Cynthia Nichols Jackson 24:12

I, being a patient as well, I do community talks in various churches and different senior residents apartments to give the information of the overall kidney health and then disease and preventions, such as utilizing our programs and services that we offer, but giving just the education and awareness. I go out and do those talks. Patient services. We have health screenings that we do by testing in the health fairs and different organizations that ask for us to come and talk about or actually test people to see whether or not they have early kidney disease so that they can then be educated and get involved.

We also offer the free health clinics. Once we find people who have the diagnosis or the positive testing then offer them to see a provider, but offer them the free health clinics that we have that can be both in the Hispanic as well as African American populations so that they can have access.

Lisa Jacques Carroll 25:26

Excellent. Thank you so much for sharing. Moving into thinking about the future and sustaining the great work that you’ve done during the pandemic, how is your organization planning to sustain the vaccine equity work you’ve done thus far in your community?

Theresa Tejada 25:40

So, you know, in addition to the, the campaign, the Are you the 33% campaign, which we’re continuing to do and will continue to do for some, for some time now, um, that we, you know, that vaccination really has not been a focus of the Kidney Foundation in the past.

So this project has allowed us to really expand our focus and establish new relationships with organizations like LANs Foundation, you know, or the Wayne State Mobile Health Unit. And so as we continue to do our community-based initiatives, you know, we have the ability to connect those vaccination providers into those community will patients.

And that’s, you know, something that we can, you could, will continue to do, you know, for some time and, and use those resources and share the communication materials that we’ve developed every year. We may go so that they, you know, can, can be present and be relevant. And so, you know, share that with the people that we serve, share that with our community partners and be able to continue that as kind of like an ongoing part of things that we do at the Kidney Foundation.

Lisa Jacques Carroll 26:41

What is one message or story that has inspired your own confidence in vaccines?

Cynthia Nichols Jackson 26:45

I was gonna say, one thing that focuses on is life. I’ve actually, I am a transplant, you know, I am a patient of lupus. I am a chronic kidney disease person, and I got COVID and I was just thankful that there’s some type of a treatment that was helping me and did.

And it was the one that was the shiny light was my life was saved. I mean, I have to go to the hospital based on that, they came and gave me the IV uh, medication. I was able to stay home and not be in the hospital. I didn’t have complications from the respiratory nor the kidney failure portion, you know, so life is my shining moment to just say, you know, thank God there was a vaccine.

This virus is real. People need to know that. And I’m gonna walk a testimony that it works. That if you take it, even if you fail to and you get the virus, it’s like there is an antidote that helps you to continue living. So life, that’s my shiny moment.

Lisa Jacques Carroll 27:52

You’re such a great spokesperson, Cynthia. Thank you. How about you, Teresa?

Theresa Tejada 27:59

Oh, well, I mean, I, I can’t top, I can’t top that story, but yeah. I think Cynthia’s got it.

Lisa Jacques Carroll 28:08

I’ll move on to the next one, but if you think of something, Teresa…Okay. What do you wish everyone knew about people working to manage their kidney disease?

Cynthia Nichols Jackson 28:16

I wish they were educated when they get the diagnosis. We are finding more and more whom feel as though they were not told on the early side of them knowing that they have the disease because there is a point where we can help people to slow or even stop the progression, but it becomes more of the person who’s just alarmed, I mean, shocked that they’ve been diagnosed and was not informed prior so they can’t, they feel vulnerable like, okay, now what? Or they’re angry that they didn’t get it because by the time they’re told, they either show up in ER due to a failure of the total kidney and have to have emergent dialysis to save their lives, but then it becomes more like they don’t hear about National Kidney Foundation until you know they’re having the failure.

But, they don’t have the knowledge either that is going to help them not to become diabetic or having high blood pressure and understanding what’s needed other than someone saying you have high blood pressure and just kind of leaving them there. So, it’s more of the failure of education or awareness.

Your whole entire world crashes. Because you can’t work like you used to as an executive or a professional because you can’t manage the scheduling to sit in a chair for four hours and do dialysis three times a week. So it’s like a education and awareness.

Theresa Tejada 30:05

And well, just to add too, then, uh, in additionally for, you know, awareness, but then also we need to do a better job as a system to be able to make that, oh, you know, awareness within the healthcare system, but then also to be able to make sure that people then have the tools to be able to act on that knowledge too, so that they can be able to make sure they can get help.

Cynthia Nichols Jackson 30:24

Yes.

Lisa Jacques Carroll 30:26

Great. Thanks so much. And this is the last question I’d like to hear from both of you – what is the one thing that keeps you returning to this work every day?

Cynthia Nichols Jackson 30:34

Getting out there, just showing people like, we’re here. National Kidney Foundation is here. If you have a kidney issue, we’re here. Prevention. I wish we could get that out on billboards, but because there’s no drug that actually will counter it or lower it other than going with the diabetes or high blood pressure.

There’s no one that’s just right over on chronic kidney disease, that it’s not out there on the billboards. So that’s our job. That’s why I do community outreach myself. I go to the churches, I’ll go to the places and come to the people and inform and encourage, and as well as, in that it becomes what you need to also protect yourself as far as vaccines that are needed.

No one knew that we was gonna get a crisis of the pandemic like we were, and, and it all happened and that became a huge challenge for our health. Going to the people and being able to say, we’re here. We’re helping you with the normal everyday life of it, but also showing you preventions as well. It’s also like vaccines and just educating you and encouraging you, and like Teresa said, it’s gonna go on for a while, so that’s what I get up for every morning.

Lisa Jacques Carroll 31:48

Well, you two are truly an inspiration. Thank you so much, Cynthia and Theresa. I’ve really enjoyed hearing about all of the incredible work you’re doing in your community to build trust and improve health. It’s been so wonderful chatting with you today.

Theresa Tejada 32:02

Thank you so much, Lisa. Nice to meet you too.

Dr. Yabo Beysolow 32:07

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Visit our website at immunizationmanagers.org to get resources to help your community thrive.

REACH, or Racial and Ethnic Approaches to Community Health, is a national program administered by the Centers for Disease Control and Prevention, or CDC, to reduce racial and ethnic health disparities. AIM has partnered with CDC to engage in support participating REACH organizations in their efforts to address racial and ethnic disparities related to COVID-19 and flu vaccination coverage.

This content was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention grant number six N like Nancy, H like Henry 23. I like India. P like Paul. 9 2 2 5 6 9 dash zero five dash zero three. The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services or HHS. The contents of this resource do not necessarily represent the policy of CDC or HHS and should not be considered an endorsement by the federal government. The views expressed by the guests are their own and do not reflect those of AIM or IREACH. AIM controls all content on this. All episodes were recorded and produced in 2023.