The Centers for Disease Control and Prevention (CDC) and the US Postal Service (USPS) consider anthrax to be a potential threat to USPS workers. A county health department-owned pharmacy supports local USPS response in the event of an exposure. The pharmacy team identified the need to review and update the local anthrax response plan. A Pharmacy Point-of-Dispensing Toolkit and response plan for initial 10-day post-exposure antibiotic prophylaxis was developed for use by a local health department in the event of a mass anthrax exposure at a US Post Office sorting facility. The pharmacist's role in medical countermeasures planning for anthrax exposure is also discussed to illustrate how pharmacists' medication expertise can be utilized. The CDC's Public Health Preparedness Capabilities: National Standards for State and Local Planning framework and inputs from an interprofessional stakeholder team were used to develop a Medical Countermeasures Response Plan and Implementation Toolkit for mass point-of-dispensing (POD) in the event of an anthrax exposure. Stakeholders attended a USPS Community Partner Training event where additional revisions to the toolkit were made. The toolkit and standing order are now implemented at the local health department to be reviewed and updated on a yearly basis by health department leadership. Pharmacists can use their medication expertise and experience with patient education to design emergency response plans focused on increasing patient safety and medication adherence. Pharmacists should be involved in emergency response and medical countermeasures planning that involve medications.

Data can guide decision-making to improve the health of communities, but potential for use can only be realized if public health professionals have data science skills. However, not enough public health professionals possess the quantitative data skills to meet growing data science needs, including at the Centers for Disease Control and Prevention (CDC). The Data Science Upskilling (DSU) program increases data science literacy among staff and fellows working and training at CDC. The DSU program was established in 2019 as a team-based, project-driven, on-the-job applied upskilling program. Learners, within interdisciplinary teams, use curated learning resources to advance their CDC projects. The program has rapidly expanded from upskilling 13 teams of 31 learners during 2019-2020 to upskilling 36 teams of 143 learners during 2022-2023. All 2022-2023 cohort respondents to the end-of-project survey reported the program increased their data science knowledge. In addition, 90% agreed DSU improved their data science skills, 93% agreed it improved their confidence making data science decisions, and 96% agreed it improved their ability to perform data science work that benefits CDC. DSU is an innovative, inclusive, and successful approach to improving data science literacy at CDC. DSU may serve as an upskilling model for other organizations.

A limitation of the central cancer registries to examine associations between mammography use and cancer diagnosis is their lack of cancer screening history. To fill this measurement gap, Rhode Island Cancer Registry (RICR) breast cancer (BC) records were linked to Rhode Island-all-payer claims database (RI-APCD) to study Rhode Island (RI) women's regular mammography use and identify its predictors. From the linked 2011-2019 data, we identified 4 study cohorts: (1) women who ever received mammography by Women's Cancer Screening Program (WCSP) and were diagnosed with BC ("WCSP-BC" cohort: n = 149), (2) women diagnosed with BC outside of WCSP (BC-control cohort: n = 4304), (3) women with a history of mammography use at WCSP but no BC diagnosis (n = 6513), and (4) general RI women with no BC diagnosis (n = 15 121). Logistic regressions were conducted to identify predictors of regular mammography use. The linkage for RI-APCD and RICR for our study had a high matching rate of 82%. Mammography use prior to BC diagnosis was not different between the WCSP-BC cohort and the BC-control cohort (58% vs 57%). Women in the BC-control cohort who had mammography in 2 years prior to their cancer diagnosis were more likely of being diagnosed at an early-stage disease. Among BC-control group, women with no anxiety/depression or with no preventive examinations were less likely of regular mammography use. Among women with no BC, a lower proportion of women with a history of screening at WCSP had regular mammography use, compared with the general RI women (38% vs 66%). RI-APCD data linkage with RICR provides excellent opportunities to examine regular mammography use among RI women and compare their outcomes to the general women population in the state. We identified opportunities for improving their mammography use. A measurement gap in the central cancer registries can be effectively reduced by utilizing statewide claims database.

The World Health Organization (WHO) recommends tenofovir disoproxil fumarate (TDF) for pregnant women with hepatitis B virus (HBV) presenting with HBV DNA levels of 106 copies/mL or more to hinder mother-to-child transmission (MTCT). Moreover, it is suggested that neonates of HBV-infected mothers receive an HBV vaccine birth dose within 24 hours of birth to mitigate transmission risk. The study included 661 HBV-infected pregnant women and 316 infants from 3 hospitals in Southern Vietnam between October 2019 and November 2020. Infants were classified on the basis of their mothers' TDF prophylaxis into I-TDF (+) group (107 infants) whose mothers received TDF; I-TDF (-) group (56 infants) whose mothers missed TDF; and I-NTDF group (153 infants) whose mothers did not necessitate TDF. Almost all infants received an HBV vaccine birth dose with HBIG administered on the basis of parents' financial standing. MTCT was found in 2.2% of the cases. The respective MTCT rates for I-TDF (+), I-TDF (-), and I-NTDF groups were 2.8%, 5.4%, and 0.7%. Immune response rates to the HBV vaccination in the total cohort, I-TDF (+), I-TDF (-), and I-NTDF groups, were 88.6%, 87.9%, 85.7%, and 90.2%, respectively. Vaccinated infants exhibited a statistically lower risk of HBV infection postbirth (aRR = 0.1; 95% confidence interval, 0.0-0.6; P = .01). TDF can equate the MTCT risk in pregnant women with HBV DNA levels of 106 copies/mL or more to those with lower levels. Early administration of the HBV vaccine postbirth also effectively curtails MTCT. Thus, expanding TDF prophylaxis and vaccine coverage is pivotal to impede MTCT.

Social determinants of health (SDOH) impact population health. Leveraging community-level strengths related to SDOH through a social infrastructure perspective can optimize health behaviors and health outcomes to promote health equity. Our aims were to develop, validate, and apply the Connected Community Classification (C3) as comprehensive community-level measure of protective SDOH and structural factors in the Four Corners states region of the United States. C3 was developed using an iterative principal component analysis of publicly available data mapped to 5 SDOH domains. Regional clustering of C3 by zip code tabulation area (ZCTA) was identified using spatial autocorrelation methods. In adjusted spatial autoregressive models, we analyzed the association of C3 with high-risk health behaviors and chronic disease prevalence using publicly available data for population-level estimates of fruit and vegetable intake, physical activity, obesity, smoking, alcohol use, coronary heart disease (CHD), diabetes, and cancer. C3 was found to be reliable and valid; a C3 value of 10 indicates communities with greater connection (high), while a value of 1 indicates communities with greater separation (low) to social infrastructure. Lower connection, as measured by C3, was significantly inversely associated with lower fruit and vegetable intake, lower physical activity, and higher rates of obesity, smoking, CHD, diabetes, and cancer. C3 was significantly positively associated with heavy alcohol use. These findings demonstrate that communities connected to social infrastructure have better population health outcomes. C3 captures protective community attributes and can be used in future applications to assist health researchers, practitioners, nonprofits, and policymakers to advance social connection and health equity in geographically diverse underserved regions.

Partnerships are increasingly critical to achieve the mission of public health. We sought to understand the levers and tools that states use to better connect public health and primary care in efforts to strengthen public health. We reviewed literature focused on collaborative or integrative efforts between primary care and public health and examined strategies employed by 4 innovative states: North Carolina, Oregon, Rhode Island, and Washington. Using a purposive convenience sample, we conducted semistructured interviews with 17 state experts from January to March 2023. We asked leaders to describe their approaches to data sharing, communication, and systems change that could be adopted or adapted by other states interested in better connecting primary care and public health systems. We recorded and coded interviews. Seventeen state leaders from North Carolina, Oregon, Rhode Island, and Washington. Key experiences, strategies, policy levers, and lessons for integration or collaboration between primary care and public health sectors, both common and divergent, across the states. State activity can be categorized by 3 actions: (1) endeavors to support relationship building, both formal and informal; (2) efforts to employ coordinating bodies and champions to ensure all necessary actors are included in planning and communications with clear roles; and (3) approaches to identifying and elevating essential system elements and the change levers to support them. The integration is built primarily on the well-resourced medical care system rather than the public health system. States are engaged in creative approaches to collaboration between public health and primary care. Building blocks include backbone organizations, leadership training programs, payment reform spheres, interoperable data platforms, and intentional efforts to build relationships. Collaboration between primary care, public health, and community-based organizations is an opportunity to strengthen public health systems while staying focused on improving the public's health.