Background: Health Impact Assessment (HIA) is a public health tool to evaluate how choices made outside the health sector can affect health. HIAs are utilized in transportation, housing, planning, and other fields. Since the built environment can impact community health outcomes, including physical activity rates, injuries, and overweight and obesity, an interdisciplinary team composed of public health, planning, transportation, and land use professionals conducted an HIA in Las Vegas, Nevada. Methods: The HIA consisted of (1) screening, (2) scoping, (3) assessment, (4) recommendations, (5) reporting, and (6) monitoring and evaluation. It examined proposed physical improvements to a 0.66 mile stretch of a major arterial roadway in the City of Las Vegas where nearby residents experience many health inequities. Collection and analysis of land use and survey data, analysis of secondary data, and literature reviews were completed to predict potential health effects produced by built environment changes. Stakeholder feedback informed each HIA step. Results: The HIA generated recommendations to improve physical activity, reduce pedestrian and bicyclist injury rates, and decrease obesity and overweight prevalence, by presenting “good,” “better,” and “best” physical infrastructure improvements. The process and resulting recommendations enhanced collaboration among health and nonhealth sectors. Conclusions: Data and analysis revealed that the proposed changes could improve walkability and bikeability and reduce pedestrian and bicyclist injury. By encouraging active transportation through bicycling and walking, the plan could, over time, contribute to reduced overweight and obesity. The HIA facilitated inter-sector cross collaboration and the integration of health into future decision-making.

This chapter addresses the approach for leveraging public and private partnerships between local, state, tribal, and federal agencies to respond to the COVID-19 pandemic in the greater Las Vegas metropolitan area. These team-oriented efforts led to enhanced communications, improved operational coordination, trust among the responders involved, and better access by the public to much-needed public health resources and services. COVID-19 surge capacity planning required active participation by diverse community sectors with a shared mission to protect the public’s health, to minimize negative impacts caused during the pandemic, and to support ongoing recovery in the city and surrounding areas.

To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥1 follow-up exam after 14 days of age or with ≥1 visit with development reported, respectively. Among 2248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1881 children ≥1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families. We characterize pregnancy and infant outcomes and describe neurodevelopmental abnormalities up to 36 months of age by presence of Zika associated birth defects (ZBD). Neurologic sequelae and developmental delays were common among children with ZBD. Children with ZBD had increased frequency of neurologic sequelae and developmental delay compared to children without ZBD. Longitudinal follow-up of infants with Zika virus exposure in utero is important to characterize neurodevelopmental delay not apparent in early infancy, but logistically challenging in surveillance models.

Eight focus groups were conducted with 48 retail food establishment workers and managers in Clark County, Nevada on their lived experience of food safety culture. Eight focus group questions were created based on existing food safety culture literature. Interview data underwent thematic analysis in which two major themes emerged: the explicit expression of food safety culture, which includes elements of training and oversight, and the implicit expression of food safety culture which includes elements of communication, space, staffing, and appreciation. Participants reported a reluctance of staff to communicate with leadership, a lack of equipment and materials, and short staffing as obstacles to good food safety culture. Participants reported promotors of good food safety culture to be ongoing, applied training, routine two-way communication, engaged oversight, and appreciation.

Abstract Background: To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. Methods: From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥ 1 follow-up exam after 14 days of age or with ≥ 1 visit with development reported, respectively. Results: Among 2,248 infants, 10.1% were born preterm, and 10.5% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1,881 children ≥ 1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥ 1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. Conclusion: Understanding the prevalence of developmental delays and healthcare needs of children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families.

Accessing healthy food is a challenge for many. Healthy corner store initiatives have proven successful at promoting healthy food access nationwide. Recent data suggest that 11.8% of Clark County residents and 17.1% of Henderson, Nevada, residents experienced food insecurity. It is crucial to assess the current perceptions and practices of the community before pursuing policy change to ensure that pilot programs reflect its members' needs. This study aimed to identify which healthy foods consumers would like to see offered in convenience stores, assess purchasing behaviors, and explore barriers preventing store owners from carrying healthy foods. In doing so, this study aimed to ensure that the needs of owners and consumers are reflected in local policy changes. Project staff collected data through two approaches: (a) convenience store owner interviews (n = 2; who represented eight stores total) and (b) consumer intercept surveys (n = 88) within low-income census tracts of Henderson, Nevada. The cost of healthy foods-for storeowners and consumers-was a major factor when selecting items to stock. Storeowners also described key contextual barriers such as minimum purchasing requirements, city regulations limiting promotions, and healthy, fresh food not being in high enough demand for the many transient customers passing through. Survey respondents' most commonly reported barrier to accessing healthy food was their lack of availability in convenience stores, suggesting it would be beneficial if stores offered healthier options to increase access. The results of this study will inform the community's next steps to increase access to healthy foods, including implementing a pilot healthy corner store project and a City-sponsored marketing campaign. Our methods and lessons learned may be useful for other municipalities considering health corner and convenience store initiatives.

The first three SARS-CoV-2 phylogenetic lineages classified as variants of concern (VOCs) in the United States (U.S.) from December 15, 2020 to February 28, 2021, Alpha (B.1.1.7), Beta (B.1.351), and Gamma (P.1) lineages, were initially detected internationally. This investigation examined available travel history of coronavirus disease 2019 (COVID-19) cases reported in the U.S. in whom laboratory testing showed one of these initial VOCs. Travel history, demographics, and health outcomes for a convenience sample of persons infected with a SARS-CoV-2 VOC from December 15, 2020 through February 28, 2021 were provided by 35 state and city health departments, and proportion reporting travel was calculated. Of 1,761 confirmed VOC cases analyzed, 1,368 had available data on travel history. Of those with data on travel history, 1,168 (85%) reported no travel preceding laboratory confirmation of SARS-CoV-2 and only 105 (8%) reported international travel during the 30 days preceding a positive SARS-CoV-2 test or symptom onset. International travel was reported by 92/1,304 (7%) of persons infected with the Alpha variant, 7/55 (22%) with Beta, and 5/9 (56%) with Gamma. Of the first three SARS-CoV-2 lineages designated as VOCs in the U.S., international travel was common only among the few Gamma cases. Most persons infected with Alpha and Beta variant reported no travel history, therefore, community transmission of these VOCs was likely common in the U.S. by March 2021. These findings underscore the importance of global surveillance using whole genome sequencing to detect and inform mitigation strategies for emerging SARS-CoV-2 VOCs.

A poor food safety culture has been described as an emerging risk factor for foodborne illness outbreaks, yet there has been little research on this topic in the retail food industry. The purpose of this study was to identify and validate conceptual domains around food safety culture and develop an assessment tool that can be used to assess food workers’ perceptions of their restaurant’s food safety culture. The study, conducted from March 2018 through March 2019, surveyed restaurant food workers for their level of agreement with 28 statements. We received 579 responses from 331 restaurants spread across eight different health department jurisdictions. Factor analysis and structural equation modeling supported a model composed of four primary constructs. The highest rated construct was Resource Availability (x¯=4.69, sd=0.57), which assessed the availability of resources to maintain good hand hygiene. The second highest rated construct was Employee Commitment (x¯=4.49, sd=0.62), which assessed workers’ perceptions of their coworkers’ commitment to food safety. The last two constructs were related to management. Leadership (x¯=4.28, sd=0.69) assessed the existence of food safety policies, training, and information sharing. Management Commitment (x¯=3.94, sd=1.05) assessed whether food safety was a priority in practice. Finally, the model revealed one higher-order construct, Worker Beliefs about Food Safety Culture (x¯=4.35, sd=0.53). The findings from this study can support efforts by the restaurant industry, food safety researchers, and health departments to examine the influence and effects of food safety culture within restaurants.

Abstract Background: To characterize neurodevelopmental abnormalities in children up to 36 months of age with congenital Zika virus exposure. Methods: From the U.S. Zika Pregnancy and Infant Registry, a national surveillance system to monitor pregnancies with laboratory evidence of Zika virus infection, pregnancy outcomes and presence of Zika associated birth defects (ZBD) were reported among infants with available information. Neurologic sequelae and developmental delay were reported among children with ≥ 1 follow-up exam after 14 days of age or with ≥ 1 visit with development reported, respectively. Results: Among 2,248 infants, 9.9% were born preterm, and 10.0% were small-for-gestational age. Overall, 122 (5.4%) had any ZBD; 91.8% of infants had brain abnormalities or microcephaly, 23.0% had eye abnormalities, and 14.8% had both. Of 1,881 children ≥ 1 follow-up exam reported, neurologic sequelae were more common among children with ZBD (44.6%) vs. without ZBD (1.5%). Of children with ≥ 1 visit with development reported, 46.8% (51/109) of children with ZBD and 7.4% (129/1739) of children without ZBD had confirmed or possible developmental delay. Conclusion: Understanding the prevalence of developmental delays and healthcare needs these children with congenital Zika virus exposure can inform health systems and planning to ensure services are available for affected families.

Abstract Background Community-based harm reduction vending machines (HRVM) are not new to the field of public health; numerous countries have implemented them in response to the needs of people who use drugs over the last three decades. However, until recently, few existed in the United States. Given the rapidity with which communities are standing up harm reduction vending machines, there is a pressing need for a consolidated examination of implementation evidence. This scoping review summarizes existing literature using multiple implementation science frameworks. Methods The scoping review was conducted in five stages including 1) Identify the research question; 2) Identify relevant studies; 3) Select the publications based on inclusion/exclusion criteria; 4) Review and extract data; and, 5) Summarize results. PubMed, Embase, and Web of Science were searched and authors screened publications in English from any year. Data were extracted by applying implementation constructs from RE-AIM and the Consolidated Framework for Implementation Research (CFIR). Both frameworks provided a useful lens through which to develop knowledge about the facilitators and barriers to HRVM implementation. The review is reported according to PRISMA guidelines. Results After applying the full inclusion and exclusion criteria, including the intervention of interest (“vending machines”) and population of interest (“people who use drugs”), a total of 23 studies were included in the scoping review. None of the studies reported on race, making it difficult to retroactively apply a racial equity lens. Among those articles that examined effectiveness, the outcomes were mixed between clear effectiveness and inconclusive results. Evidence emerged, however, to address all CFIR constructs, and positive outcomes were observed from HRVM’s after-hour availability and increased program reach. Recommendations: HRVM implementation best practices include maximizing accessibility up to 24 hours, 7 days a week, offering syringe disposal options, ensuring capability of data collection, and allowing for anonymity of use. Organizations that implement HRVM should establish strong feedback loops between them, their program participants, and the broader community upfront. Considerations for future research include rigorous study designs to evaluate effectiveness outcomes (e.g. reduced drug overdose deaths) and examination of HRVM reach among ethnic and racial communities.