County Public Health Department Research Articles

Infant Mortality Lessons Learned from a Fetal and Infant Mortality Review Program.

Marion County Public Health Department (MCPHD) FIMR staff identified and reviewed 22 fetal and infant deaths to Indianapolis Healthy Start program participants between 2005 and 2012. Trained FIMR nurses completed 13 of 20 maternal interviews and compiled case summaries of all deaths from the MCPHD FIMR database.. Results Case review teams identified a total of 349 family strengths, 219 contributing factors, and made 220 recommendations for future pregnancies. FIMR deliberation values for Healthy Start program participant deaths were similar to other infant deaths in Marion County during the same time period. Common themes that emerged from the reviews included lack of social support, absence of paternal involvement, substance abuse, non-compliance, and poor health behaviors leading to chronic health conditions that complicated many pregnancies. Conclusions A number of the infant deaths in this review could have been prevented with preconception and inter-conception education and by improving the quality and content of prenatal care.

The Social Determinants of Health

The Social Determinants of Health

Web-Based Surveillance of Illness in Childcare Centers.

School absenteeism is an inefficient and unspecific metric for measuring community illness and does not provide surveillance during summertime. Web-based biosurveillance of childcare centers may represent a novel way to efficiently monitor illness outbreaks year-round. A web-based biosurveillance program ( sickchildcare.org ) was created and implemented in 4 childcare centers in a single Michigan county. Childcare providers were trained to report sick children who required exclusion or had parent-reported absences due to illness. Deidentified data on age range, number of illnesses, and illness categories were collected. Weekly electronic reports were sent to the county public health department. Data for reports were gathered beginning in December 2013 and were summarized using descriptive statistics. A total of 385 individual episodes of illness occurred during the study period. Children with reported illness were infants (16%, n = 61), toddlers (38%, n = 148), and preschoolers (46%, n = 176). Illness categories included: fever (30%, n = 116), gastroenteritis (30%, n = 115), influenzalike illness (8%, n = 32), cold without fever (13%, n = 51), rash (7%, n = 26), conjunctivitis (1%, n = 3), ear infection (1%, n = 5), and other (10%, n = 37). The majority of reports were center exclusions (55%, n = 214); others were absences (45%, n = 171). The detection of a gastroenteritis outbreak by web-based surveillance during winter 2013-14 preceded county health reports by 3 weeks; an additional outbreak of hand-foot-mouth disease was detected during June 2014 when standard school-based surveillance was not available. Web-based biosurveillance of illness in childcare centers represents a novel and feasible method to detect disease trends earlier and year-round compared to standard school-based disease surveillance.

Simulating Complex Community Disaster Preparedness: Collaboration for Point of Distribution

Disasters are increasing at local, national, and global levels, as is the need for all nurses and communities to be prepared. Since 2003, decreased funds for disaster preparedness has meant less opportunity for public health departments and emergency management agencies to test disaster response plans. Today’s graduating nurses need strong skills in disaster nursing to manage a variety of disasters in a local to global context. One aim of this article is to briefly describe preparedness planning using a Point of Distribution/Dispensation (POD) and teaching competencies for disaster nursing. We discuss in detail an exemplar about a simulation developed with collaboration among university faculty, the county public health department, and the local emergency management agency (EMA). The article considers insufficient funds for drills and exercises; strategies to increase disaster knowledge and competency of undergraduate nursing students; and realistic, hands-on active learning approaches to disaster response at all levels, including implications for practice.

Assessing the Chemical Status of Water from Wells Which Supply Farms Located on Romania's territory. Part I

Aim of this study was to assess the chemical status of water by point of view of the indicators parameters coming from the decentralized system of water supply (wells) and which supply the water of dairy farms performed in 63 wells from the same number of farms from 5 located in: S-E, N-W and central of Romania at the request of farmers. It has been studied the parameters that indicate the status of water acidification: pH (SRISO 10523/97); indicator parameters having as landmark the minimum list of parameters monitored by the laboratories of profile from county public health department: hardness (STAS 3326/76), iron (STAS 3086/68), CCOMn (STAS:3002/85), ammonia (spectrometry), parameters indicative of saline inclusions: chlorides (STAS 3049/88), sulfates (SRISO 10523/97). Characterization of the chemical state of water: good or poor was done after the values that define the worst condition. The limit values for each parameter are compared to those required by the L.107/1996, L.458/2002, 311/2004, O.621/2012. Were recorded values which attesting good quality status for 21 wells:[ 1 Buzău (BZ),12 Cluj (CJ),2 Mureş (MS),6 Sălaj (SJ)] and 42 wells whose water quality status it is poor (6 AB, 5 BZ,17 CJ, 7 MS). Exceeding the limits values were found at the parameters: CCOMn (CJ: 05.29±3.87mgO2/dm3, 10.59±2.04 mgO2/dm3 AB); ammonia: (AB: 0.56±0.08 mg/dm3, MS: 0.51±0.1 mg/dm3), iron (BZ: 0.85±1.05 mg/dm3, CJ: 0.37±0.47 mg/dm3, MS: 0.62±0.57mg/dm3), chlorides (AB: 330.42±208.8 mg/dm3, MS: 243.18±164.8 mg/dm3). Contamination risk score of wells in the studied areas is medium (3 point).

Notes from the Field: Outbreak of Serogroup B Meningococcal Disease at a University - California, 2016.

On January 31, 2016, the Santa Clara County Public Health Department (SCCPHD) was notified of a suspected case of meningococcal disease in a university undergraduate student. By February 2, two additional suspected cases had been reported in undergraduate students living on the same campus. The index patient (patient A) required intensive care, whereas patients B and C had milder illness; there were no deaths. All three patients were part of overlapping social networks and had attended the same events during the week before the onset of patient A's symptoms, but whether they had direct contact with one another could not be verified. Serogroup B Neisseria meningitidis was identified in cerebrospinal fluid and blood from patient A and in blood from patient B. Serogroup B has been responsible for all U.S. college outbreaks of meningococcal disease since 2011 (1). Laboratory results for patient C were inconclusive.

Alert-Enabled Application Integrating Data Quality Monitoring for Multiple Sources

An interactive, point-and-click (R-Shiny) application was developed to facilitate the routine assessment of known data quality factors that compromise the integrity and timeliness of data sets used at the Marion County Public Health Department (MCPHD). The code (and associated documentation) for this application is being made available online so that other surveillance practitioners interested in adopting this approach can mix and match the features they are most interested in to create customized data quality assessment applications that meet their needs.

Human-Centered Design as an Approach for Place-Based Innovation in Public Health: A Case Study from Oakland, California.

This case study provides a high-level overview of the human-centered design (HCD) or "design thinking" process and its relevance to public health. The Best Babies Zone (BBZ) initiative is a multi-year project aimed at reducing inequities in infant mortality rates. In 2012, BBZ launched pilot programs in three US cities: Cincinnati, Ohio; New Orleans, Louisiana; and Oakland, California. The Alameda County Public Health Department (ACPHD), the lead for the Oakland BBZ site, identified HCD as a promising approach for addressing the social and economic conditions that are important drivers of health inequities. HCD is a process for creating innovative products, services, and strategies that prioritizes the needs of the intended population. ACPHD partnered with the Gobee Group (a social innovation design consultancy) to develop the Design Sprint. The Design Sprint was a 12-week pilot in which 14 professionals from nine organizations used the HCD process to develop concepts for stimulating a vibrant local economy in the Oakland Best Babies Zone. Thirty- to sixty-minute semi-structured interviews were conducted with all 14 individuals involved in the Design Sprint. With the exception of one interview, the interviews were audio-recorded, transcribed, and inductively coded to identify themes. Our experience suggests that HCD can: enhance community engagement; expedite the timeframe for challenge identification, program design, and implementation; and create innovative programs that address complex challenges.

APhA names 2015 Immunization Champions

The APhA Immunization Champion Awards recognize individuals and organizations in the pharmacy profession, and friends and allies of pharmacy, who have made outstanding efforts to improve vaccination rates within their communities.

Our Choice/Nuestra Opción: the Imperial County, California, Childhood Obesity Research Demonstration study (CA-CORD).

Despite recent declines among young children, obesity remains a public health burden in the United States, including among Latino/Hispanic children. The determining factors are many and are too complex to fully address with interventions that focus on single factors, such as parenting behaviors or school policies. In this article, we describe a multisector, multilevel intervention to prevent and control childhood obesity in predominantly Mexican-origin communities in Southern California, one of three sites of the CDC-funded Childhood Obesity Research Demonstration (CA-CORD) study. CA-CORD is a partnership between a university-affiliated research institute, a federally qualified health center, and a county public health department. We used formative research, advisory committee members' recommendations, and previous research to inform the development of the CA-CORD project. Our theory-informed multisector, multilevel intervention targets improvements in four health behaviors: fruit, vegetable, and water consumption; physical activity; and quality sleep. Intervention partners include 1200 families, a federally qualified health center (including three clinics), 26 early care and education centers, two elementary school districts (and 20 elementary schools), three community recreation centers, and three restaurants. Intervention components in these sectors target changes in behaviors, policies, systems, and the social and physical environment. Evaluation activities include assessment of the primary outcome, BMI z-score, at baseline, 12-, and 18-months post-baseline, and sector evaluations at baseline, 12, and 24 months. Identifying feasible and effective strategies to prevent and control childhood obesity has the potential to effect real changes in children's current and future health status.

“Bfed” Texting Program and “Breastfeeding: A Smart Choice” Class: Using Cell Phones to Reach Gen Y Mothers

Santa Barbara County Public Health Department Nutrition Services and Women, Infants, and Children program in California are meeting the needs of Generation Y mothers through the first of its kind two-way texting program for breastfeeding peer counselor participants called “Bfed.” In addition, there is a prenatal breastfeeding class that has topics that use the phone with apps, video clips that include actual successful breastfeeding peers, and a YouTube site to view at a later time. Class participants actually use their cell phones during class instead of having to turn them off.

The Southeastern Minnesota Beacon Project for Community-driven Health Information Technology: Origins, Achievements, and Legacy

Introduction:The Southeastern (SE) Minnesota Beacon organized all the health care providers, county public health organizations, and school districts in the deployment and integration of health information exchange (HIE) and targeted health communication around childhood asthma and diabetes. The community cooperated to establish a clinical data repository for all residents in the 11-county region. Through this community of practice approach that involved traditional and nontraditional providers, the SE Minnesota Beacon was able to realize unique applications of this technology. This manuscript overviews the associated organization and infrastructure of this community collaboration.Background:The Office of the National Coordinator for Health Information Technology (ONC), as part of the American Recovery and Reinvestment Act of 2009 (ARRA) stimulus, established 17 projects throughout the United States targeting the introduction and meaningful use of health information technology (HIT). These 17 communities were intended to serve as an example of what could be accomplished. The SE Minnesota Beacon is one of these communities.Methods:The community ultimately opted for peer-to-peer HIE, using Nationwide Health Information Network (NwHIN) Connect software. The clinical data repository was established using the infrastructure developed by the Regenstrief Institute, which operated as a trusted third party. As an extension to HIE, the consortium of county public health departments created a patient data portal for use by school nurses and parents. Childhood asthma was addressed by creating, exchanging, and maintaining an “asthma action plan” for each affected child, shared throughout the community, including through the patient portal. Diabetes management introduced patient treatment decision tools and patient quality of life measures, facilitating care. Influenza vaccination was enhanced by large-scale community reporting in partnership with the state vaccination registry. The methodology and principles for arriving at these solutions included community engagement, sustainability, scalability, standards, and best practices that fit a variety of organizations—from large, robust providers to small organizations.Findings:The SE Minnesota Beacon demonstrated that all providers for a geographically defined population can cooperate in the development and shared governance of a low-cost, sustainable HIE, and the operation of a community-managed clinical data repository. Furthermore, these infrastructures can be leveraged to collaboratively improve the care of patients, as demonstrated for childhood asthma and adult diabetes mellitus.Conclusion:The shared governance of HIT by a community can palpably change the scope and success of collaborations targeted to improve patient and community health care.

An Approach to Assessing Multicity Implementation of Healthful Food Access Policy, Systems, and Environmental Changes

Local governments play an increasingly important role in improving residents’ access to healthful food and beverages to reduce obesity and chronic disease. Cities can use multiple strategies to improve community health through, for example, land use and zoning policies, city contracting and procurement practices, sponsorship of farmers markets and community gardens, and vending and concession practices in parks and recreation facilities. With 41 cities in the Hennepin County Human Services and Public Health Department jurisdiction, the county undertook to measure the extent to which cities were engaged in making policy, systems, and environmental (PSE) changes to increase residents’ access to healthful food. The results revealed that some cities, particularly those with higher resident demand for healthful food, are making nationally recommended PSE changes, such as sponsoring farmers markets and community gardens. Cities have moved more slowly to make changes in areas with perceived negative cost consequences or lesser public demand, such as parks and recreation vending and concessions. This article describes the assessment process, survey tools, findings, and implications for other health departments seeking to undertake a similar assessment.

The impact of changes in county public health expenditures on general health in the population

We estimate the effect of changes in the per capita expenditures of county departments of public health on county-level general health status. Using panel data on 40 counties in California (2001-2009), dynamic panel estimation techniques are combined with the Lewbel instrumental variable technique to estimate an aggregate demand for health function that measures the causal cumulative impact that per capita public health expenditures have on county-level general health status. We find that a $10 long-term increase in per capita public health expenditures would increase the percentage of the population reporting good, very good or excellent health by 0.065 percentage points. Each year expenditures were increased would result in ∼24,000 individuals moving from the 'poor or fair health' category to the 'good, very good or excellent health' category across these 40 counties. In terms of the overall impact of county public health departments on general health status, at current funding levels, each annual expenditure cycle results in over 207,000 individuals being in the 'good, very good or excellent' categories of health status rather than the 'poor or fair' categories.

Cervical Cancer Screening: Exploring Appalachian Patients’ Barriers to Follow-Up Care

This article describes a community-based Patient Navigation (PN) project conducted to identify potential barriers to seeking follow-up cervical cancer care in southeastern Kentucky. Patient navigators (PNs) were placed in cervical cancer programs within county public health departments where they interviewed patients about their perceived barriers to seeking follow-up care after receiving a positive Pap test result. Participants identified various potential barriers at three levels: the individual/personal level, the health care system level and the community/environmental level. One identified barrier that was unique to this study was a lack of consistency between follow-up recommendations and follow-up guidelines for patients under age 21. Implications are discussed.

The Tennessee Department of Health WORKshops on Use of Secondary Data for Community Health Assessment, 2012

Community health assessment is a core function of public health departments, a standard for accreditation of public health departments, and a core competency for public health professionals. The Tennessee Department of Health developed a statewide initiative to improve the processes for engaging county health departments in assessing their community’s health status through the collection and analysis of secondary data. One aim of the Tennessee Department of Health was to position county public health departments as trusted leaders in providing population data and engaging community stakeholders in assessments. The Tennessee Department of Health’s Division of Policy, Planning, and Assessment conducted regional 2-day training workshops to explain and guide completion of computer spreadsheets on 12 health topics. Participants from 93 counties extracted data from multiple and diverse sources to quantify county demographics, health status, and resources and wrote problem statements based on the data examined. The workshops included additional staff development through integration of short lessons on data analysis, epidemiology, and social-behavior theory. Participants reported in post-workshop surveys higher degrees of comfort in interpreting data and writing about their findings on county health issues, and they shared their findings with health, hospital, school, and government leaders (including county health council members) in their counties. Completion of the assessments enabled counties and the Tennessee Department of Health to address performance-improvement goals and assist counties in preparing to meet public health accreditation prerequisites. The methods developed for using secondary data for community health assessment are Tennessee’s first-phase response to counties’ request for a statewide structure for conducting such assessments.

Addressing the Social Determinants of Health through the Alameda County, California, Place Matters Policy Initiative

In Alameda County, California, significant health inequities by race/ethnicity, income, and place persist. Many of the county's low-income residents and residents of color live in communities that have faced historical and current disinvestment through public policies. This disinvestment affects community conditions such as access to economic opportunities, well-maintained and affordable housing, high-quality schools, healthy food, safe parks, and clean water and air. These community conditions greatly affect health. At the invitation of the Joint Center for Political and Economic Studies' national Place Matters initiative, Alameda County Supervisor Keith Carson's Office and the Alameda County Public Health Department launched Alameda County Place Matters, an initiative that addresses community conditions through local policy change. We describe the initiative's creation, activities, policy successes, and best practices.

Detection of acute HIV-1 infections utilizing NAAT technology in Dallas, Texas

BackgroundThe detection of an acute human immunodeficiency virus infection (AHI) is vital in the fight against the spread of HIV to uninfected partners. Detection early after transmission is critical because the virus is replicating at a high level and is undetectable by serological markers. Nucleic acid amplification testing can detect HIV-1 RNA 10–12 days after exposure. ObjectiveProvide Dallas County Public Health Department the ability to detect an AHI and maintain a three day turn-around-time for a reactive specimen. Study designThe population includes patients requesting HIV testing at various clinics throughout the state of Texas. Analyze various pool sizes for the pooling of specimens with the Aptima HIV-1 RNA qualitative assay to detect an acute HIV infection. Modify the HIV testing algorithm to include the detection of an acute HIV infection without delaying reporting results to original submitters. Perform a study to compare the detection of HIV in various HIV assays (3rd generation EIA assay, 4th generation EIA assay, HIV-1 RNA NAAT). Perform public health follow-up on patients who are confirmed to have an acute HIV infection with a goal of preventing the spread to uninfected partners. ResultsA pooling protocol was validated and performed concurrently with the EIA to maintain a reactive result released after three days of collection. Of the 148,888 (2009–2012) specimens screened for HIV, 161 AHIs were detected and the public health follow-up identified an additional 13 new HIV infections that had been a contact to one of the AHIs. ConclusionWithout the advancement in technology, patients could have received a negative or indeterminate test prior to implementing the NAAT, resulting in a delay in diagnosis and potential spread to uninfected partners. Improving the detection of an AHI is crucial in preventing the spread of the virus.

The Building Blocks Collaborative: Advancing a Life Course Approach to Health Equity Through Multi-Sector Collaboration

Too many children are born into poverty, often living in disinvested communities without adequate opportunities to be healthy and thrive. Two complementary frameworks-health equity and life course-propose new approaches to these challenges. Health equity strategies seek to improve community conditions that influence health. The life course perspective focuses on key developmental periods that can shift a person's trajectory over the life course, and highlights the importance of ensuring that children have supports in place that set them up for long-term success and health. Applying these frameworks, the Alameda County Public Health Department launched the Building Blocks Collaborative (BBC), a countywide multi-sector initiative to engage community partners in improving neighborhood conditions in low-income communities, with a focus on young children. A broad cross-section of stakeholders, called to action by the state of racial and economic inequities in children's health, came together to launch the BBC and develop a Bill of Rights that highlights the diverse factors that contribute to children's health. BBC partners then began working together to improve community conditions by learning and sharing ideas and strategies, and incubating new collaborative projects. Supportive health department leadership; dedicated staff; shared vision and ownership; a flexible partnership structure; and broad collective goals that build on partners' strengths and priorities have been critical to the growth of the BBC. Next steps include institutionalizing BBC projects into existing infrastructure, ongoing partner engagement, and continued project innovation-to achieve a common vision that all babies have the best start in life.

Adoption and implementation of a computer-delivered HIV/STD risk-reduction intervention for African American adolescent females seeking services at county health departments: implementation optimization is urgently needed.

Although group-delivered HIV/sexually transmitted disease (STD) risk-reduction interventions for African American adolescent females have proven efficacious, they require significant financial and staffing resources to implement and may not be feasible in personnel- and resource-constrained public health clinics. We conducted a study assessing adoption and implementation of an evidence-based HIV/STD risk-reduction intervention that was translated from a group-delivered modality to a computer-delivered modality to facilitate use in county public health departments. Usage of the computer-delivered intervention was low across 8 participating public health clinics. Further investigation is needed to optimize implementation by identifying, understanding, and surmounting barriers that hamper timely and efficient implementation of technology-delivered HIV/STD risk-reduction interventions in county public health clinics.