To gather perspectives on childhood vaccination and vaccine hesitancy, the Saint Louis County Department of Public Health (DPH) surveyed parents seeking nonmedical exemptions, conducted focus groups of school nurses, and interviewed pediatricians. We distributed exemption forms and voluntary questionnaires to parents in St Louis County who were seeking nonmedical exemptions for their school-aged children at any DPH clinic from August 2019 through December 2022. We conducted and recorded four 75- to 90-minute focus groups of 11 school nurses in groups of 2 or 3 nurses in September 2022. We conducted and recorded interviews of 8 pediatricians in March 2023. We calculated descriptive statistics, transcribed focus group discussions and interviews, and performed qualitative coding. We collected 1871 exemption forms. The median age of children (n = 1854) was 6 years. Of the 10 vaccines included in the exemption list, the percentage of exclusions ranged from 91.2% for meningococcal conjugate to 88.7% for hepatitis A. We identified 4 themes in the focus groups: recent changes in vaccine compliance, hesitancy and barriers, services addressing hesitancy and barriers, and future requests for DPH. Analysis of pediatrician interviews revealed themes relating to vaccine information, community efforts, and physician decision-making. This study highlights the need for a multidisciplinary approach to vaccine hesitancy in St Louis County. Future interventions need to focus on beliefs and behavioral change related to vaccines and not just the economics and accessibility of vaccines.

Revised accreditation criteria from the Council on Education for Public Health (CEPH) in 2016 prompted schools and programs of public health to shift their master of public health (MPH) core curricula. Our objective was to provide data on revisions to MPH core curricula at CEPH-accredited schools and programs of public health and other descriptive statistics on the MPH core curriculum and required courses as of 2023. We analyzed data from 67 accredited schools of public health and 130 accredited public health programs to assess changes from 2016 to 2023 in the MPH core curriculum. We examined the number of courses, the proportion of credit hours in the core curriculum, core curriculum composition, and course types. Almost half (49.2%) of schools, but only 16.9% of programs, made extensive changes to their MPH core curricula, an overall increase of 153.6% from 2020 to 2023. Approximately one-fifth of schools and programs made few to no changes to their core curricula and retained core courses in the 5 former core disciplines. On average, core curriculum credit hours comprised 37.8% of total credit hours for schools and 51.7% for programs. Half (50.0%) of all programs in the sample offered single-concentration MPH degrees. Schools and programs were more likely to continue requiring traditional biostatistics (81.7%) and epidemiology (81.2%) courses in the core curriculum compared with environmental health (69.0%), social and behavioral health (61.9%), and health policy and management (42.1%). Most schools and programs modified their MPH core curricula, reflecting a departure from traditional public health courses toward innovative approaches to ensure knowledge and skill proficiency of graduates. Future research will determine if these curricular changes improve the knowledge and skill proficiency of public health graduates and the workforce.

Migrant and seasonal farmworkers work in rural areas where internet access may be limited. We assessed internet access, cost of access, and devices available to farmworkers through a statewide survey in North Carolina. During the 2023 agricultural season, we surveyed 1034 migrant and seasonal farmworkers during routine outreach visits in partnership with community health workers employed by 8 community health centers or by nonprofit health service agencies serving farmworkers in North Carolina. We surveyed participants aged ≥18 years by using time-venue sampling and surveyed up to 5 farmworkers at migrant housing locations. We weighted participants to the total population of farmworkers living in surveyed housing and calculated frequencies and percentages of internet access, internet speed, internet cost, available internet devices, and awareness and use of the Affordable Connectivity Program-a program that was run from 2021 through May 31, 2024, by the Federal Communications Commission to make internet access more affordable in the United States. We assessed predictors of internet access and ability to use online videos by using regression models. Participants were predominantly Spanish-speaking men who lived in housing provided by farm owners. Among participants, 9.8% had internet connections with a cable or digital subscriber line, and 23.5% did not have consistent internet access. Most participants used cellular network internet (84.9%) and mobile phone devices (93.9%). Even among farmworkers who lived in their housing year-round, few had heard of (34.4%), applied to (4.8%), or used (2.0%) the Affordable Connectivity Program. Interventions are needed to increase internet access and digital inclusion for migrant and seasonal farmworkers in North Carolina. Development of state and county broadband infrastructure should consider farmworker housing.

Although studies have addressed food insecurity among veterans, few have focused on active-duty soldiers or on variables associated with the military occupational context. We examined the link between marginal food insecurity (defined as anxiety over food sufficiency or shortage of food in the house) among US soldiers and demographic, behavioral health, and unit-related factors. We analyzed survey data from 6343 active-duty soldiers using χ2 tests, generalized linear mixed-effect models, and adjusted odds ratios (AORs) to identify significant differences between soldiers categorized as marginally food insecure versus those who were not. In a fully adjusted model taking unit into account, marginal food insecurity was associated with preferring not to report gender (vs reporting being male) (AOR = 1.39; 95% CI, 1.08-1.78), being married/in a relationship (vs being single) (AOR = 1.22; 95% CI, 1.06-1.40), junior enlisted rank (vs noncommissioned officer: AOR = 0.45; 95% CI, 0.37-0.54; and vs officer: AOR = 0.13; 95% CI, 0.09-0.19), less time in unit (vs more time) (AOR = 0.99; 95% CI, 0.99-1.00), screening positive for depression (vs not) (AOR = 2.67; 95% CI, 2.30-3.11), screening positive for hazardous drinking (vs not) (AOR = 1.34; 95% CI, 1.11-1.63), and lack of reported unit-related social support (vs support) (AOR = 0.52; 95% CI, 0.45-0.59). In this sample, more than 1 in 5 US soldiers reported marginal food insecurity. In addition to supporting households with financial and food assistance and targeting junior enlisted personnel, policy makers and leaders should prioritize soldiers who are married or in a relationship, who are new to their unit, and who screen positive for depression and hazardous drinking, and they should encourage units to take care of unit members who need support. Policy makers and leaders can use these study results to direct prevention and early intervention initiatives.

A lack of infection prevention and control protections for essential industries in the United States led to increased risk and incidence of COVID-19 among essential workers during the COVID-19 pandemic. When the nation deems an industry essential during a disease outbreak, an ethical obligation exists to safeguard the health of workers who are at increased risk of being exposed to disease. The Global Center for Health Security at the University of Nebraska Medical Center began work to rapidly develop and disseminate infection prevention and control guidance for essential industries, such as meat processing. The Global Center for Health Security established an ethics advisory committee to support COVID-19 response efforts. The ethics advisory committee supported the development of guidance on infection prevention and control to promote justice, reciprocity, health, safety, and equity for workers in the meat processing industry. Our experience highlighted the fundamental role of ethical analysis in public health response efforts, but ethical analysis in this case required an interdisciplinary approach, including the need for effective community-relevant solutions. The integration of an ethics committee into public health emergency response efforts can address ethical concerns for workers in industries that must remain operational during public health emergencies.

Intimate partner violence (IPV) has short- and long-term health effects, including physical injuries and traumatic brain injury, as well as sexual, reproductive, and mental health issues. However, accessing necessary health care is often challenging for IPV survivors and became even more difficult during the COVID-19 pandemic. We examined access to health care among those affected by IPV during the COVID-19 pandemic to better connect survivors to health and social support services. The Health Resources and Services Administration's Office of Women's Health partnered with its Bureau of Primary Health Care, the Administration for Children and Families' Office of Family Violence Prevention and Services, and the National Domestic Violence Hotline (Hotline) on the 2-year Survivor Health Connection Project. The Hotline administered 2 surveys to its contacts: a 2-question postinteraction survey from March 29, 2021, through September 30, 2022, and a longer focused survey in 2021 and 2022 that measured barriers and restrictions to accessing health care, telehealth safety, and interactions with health care providers. Of 9918 respondents to the postinteraction survey, 6173 (62.2%) reported current health needs related to their abusive experience. Nearly half of 242 respondents to the 2021 survey (n = 106, 43.8%) indicated that the frequency or intensity of abuse increased during the COVID-19 pandemic, and 157 of 338 respondents to the 2022 survey (46.4%) reported that their partner had controlled and/or restricted their access to health care. Participants described barriers to accessing health care, including finances, health insurance coverage, and transportation. Findings illuminate opportunities to further support the health and social needs of those experiencing IPV, including continued coordination of efforts across health care and social service delivery partners.