Frontline Public Health Workers Research Articles

Stewards of Society: Preparedness and Perceptions Among the Unsung Heroes of Public Health Service Delivery

Front-line public health workers are essential to protecting the health of the public, particularly during widespread public health emergencies. Local public health workers were instrumental in mitigating the spread of the coronavirus pandemic through their efforts to contract trace, disseminate tests and vaccines, and educate the public about the dynamic state of the crisis. Yet, reports indicate that the public health workforce has been shrinking for some time. Recent studies indicate more than one-quarter of those serving in public health roles hope to leave the profession within one year because of factors such as stress and burnout. Few studies examine the perceptions of local health workers or the impacts that multi-level governmental responses have on their ability to do their jobs. Having a strong public health workforce is essential for a thriving society, so addressing this gap and identifying solutions are important steps towards identifying solutions for slowing the exodus of public health workers from the field. Through analysis of original survey data of front-line workers mid-pandemic in two western states, this project examines perceptions regarding factors which contribute to added stress and burnout. Findings indicate that workers felt relatively prepared to address a public health crisis, but institutional factors, such as changing job responsibilities, competing governmental directives, and limited resources, may contribute to ongoing feelings of burnout. To address these concerns, decision makers need to provide more resources and have a clear strategy of communication to mitigate conflicting governmental directives.

From the Editors.

From the Editors.

Community Health Representatives as Trusted Sources for Increasing Representation of American Indian Communities in Clinical Research.

Three Tribal CHR programs were engaged to develop and refine culturally centered educational materials and a pre-post survey using a consensus-based decision-making approach. CHRs used these materials in brief education sessions during regular client home visits and community events. At 30 days post CHR intervention, participants (N = 165) demonstrated significantly increased awareness about and ability to enroll in COVID-19 treatment and vaccine trials. Participants also described a significant increase in trust in researchers, decreased perceived barriers related to cost for participation in a clinical trial, and improved belief that participation in a COVID-19 clinical trial for treatment was considered a benefit to American Indian and Alaskan Native people. CHRs as trusted sources of information, coupled with culturally centered education materials designed by CHRs for CHR clients, demonstrated a promising approach to improved awareness of clinical trial research generally and COVID-19 trials specifically among Indigenous and American Indian community members of Arizona.

Epidemiology and psychosocial assessment of COVID-19 among workers of the Nigeria Centre for Disease Control infected with COVID-19.

COVID-19 is a global health crisis. By 2021, Nigeria had 230,000 cases. As the national public health institute, NCDC leads the COVID-19 response. Due to constant contact with infected patients, agency employees are a t high-risk. Here, we describe the transmission and psychosocial effects of COVID- 19 among infected NCDC workers as a learning curve for minimizing occupational transmission among frontline public health workers in future outbreaks. We approved and enrolled all NCDC COVID-19- infected personnel from November to December 2020. We collected data using SurveyMonkey. STATA 14 analyzed the data. 172 of 300 afflicted NCDC staff participated in this study. One-third were between 30 and 39; most were male (104, 60.5%). Most participants worked in the lab (30%) or surveillance (24%). Only 19% (33/172) of participants confirmed pandemic deployment. Most reported interaction with a confirmed case (112/65.1%). Most people (78, 45.3%) felt unhappy when diagnosed. Anger, worry, and low motivation also ranked high (19). The majority reported adequate financial, moral, or psychosocial assistance (26, 70.6%). NCDC staff had a high SARS-CoV-2 infection rate and emotional damage. We urge stricter infection control methods when sending staff for outbreaks response to prevent additional transmission, as well as ongoing psychosocial and economic assistance for afflicted workers.

Community Health Workers as Puentes/Bridges to Increase COVID-19 Health Equity in Latinx Communities of the Southwest U.S.

This study documents the pivotal role that Community Health Workers (CHW) played while supporting underserved Latinx communities affected by COVID-19-related health inequities. With the support of CHWs' agencies historically serving three Latinx-dense counties in Arizona, we recruited CHWs who participated in a state-wide COVID-19 testing project. Using phenomenology and narrative qualitative research methods, five focus groups were facilitated in Spanish between August and November 2021. Bilingual research team members conducted the analysis of the Spanish verbatim transcripts and CHWs reviewed the results for validity. Three interconnected themes reflected the CHWs experiences: (1) CHWs as puentes/bridges with deep community embeddedness through shared experiences and social/cultural context, (2) CHWs as communication brokers and transformational agents, playing a pivotal role in responding to the health and socioeconomic challenges posed by the COVID-19 pandemic, (3) CHWs satisfaction and frustration due to their dual role as committed community members but unrecognized and undervalued frontline public health workers. These findings emphasize the CHWs' commitment towards supporting their communities, even amidst the stressors of the pandemic. It is important to continue to integrate the role of CHWs into the larger healthcare system as opposed to relegating them to short term engagements as was the case during the COVID-19 pandemic. This article provides a set of practice, policy, and future research recommendations, emphasizing the need to allocate greater budgetary and training resources in support of CHWs.

Evaluating the efficacy of demand-side communication interventions on claiming rights: evidence from an action research field experiment in India

AbstractCommunication-based interventions increasingly characterize attempts to strengthen policy implementation, especially policies targeting disadvantaged populations who despite their eligibility often fail to access potential benefits. However, factors that determine their effectiveness remains an open empirical question. To examine elements of effective communication in the exercising of rights, we designed and implemented a randomized field experiment around a public informational assistance campaign, spanning an entire urban district in India as part of a larger action research initiative. Situated within the context of India’s ambitious “Right to Education” Act, our intensive campaign employed distinct instruments varying in terms of trustworthiness, expertise, and media richness—frontline public health workers, trained student volunteers, and an interactive voice response system—to assist individuals in the claiming process. While our results reiterate the value of information, we find these effects to be less pronounced for the most disadvantaged. Our results also emphasize the role of expertise in navigating complex administrative processes. However, our analysis points to the necessity of complementing communication-based interventions with other supply-side enabling measures that ensure they aid the most disadvantaged.

Public Health Training Centers' Support for Community Health Workers: Case Studies of Needs Assessment, Training, and Student Field Placement Initiatives.

Community health workers (CHWs) are vital frontline public health workers. Given their trusted roles and connection to and understanding of the communities they serve, CHWs are able to link underserved communities to resources and public health agencies. With CHWs' increased prominence in the public health workforce, calls have been made for expanding and supporting CHW training and career development opportunities. Public health training centers (PHTCs) are mandated to assess public health workforce needs, provide evidence-based professional development trainings, and increase students' aptitude for working with underserved and underresourced communities through applied practice experiences. Public health training centers can support CHWs in each of these areas. Case studies from 3 PHTCs are provided to exemplify how PHTCs are well positioned to support the critical CHW workforce via assessment, training, and student field placements. A regional needs assessment survey with a designated section for CHWs, the provision of accessible and relevant CHW training, and CHW-focused student field placements were implemented in PHTC Regions 6/South Central, 1/New England, and 5/Great Lakes, respectively. The Region 6 needs assessment found that CHWs in Oklahoma had multiple core roles and training interests. A crosswalk of needs and available training in the region guided the creation of tailored CHW trainings. Across 35 CHW-targeted trainings in Region 1, 88.5% of trainees were satisfied with the trainings and identified actions they could take to apply information they learned to their work. Significant improvements ( P < .001) in knowledge occurred across the 13 trainings that had pre-/posttests. In Region 5, students engaged with CHW-based organizations in Wisconsin to inform statewide CHW priority action items and deliverables and found the field placements meaningful for their academic experience. Public health training centers' strengths in workforce development can complement and extend existing efforts to support the CHW workforce.

The Rising Toll of Public Mental Health Work.

Back to table of contents Next article Taking IssueFull AccessThe Rising Toll of Public Mental Health WorkMark Baptiste, M.D., and Rachel Talley, M.D.Mark BaptisteSearch for more papers by this author, M.D., and Rachel TalleySearch for more papers by this author, M.D.Published Online:1 Jul 2022https://doi.org/10.1176/appi.ps.22073007AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Severe mental health workforce shortages and high rates of health care worker burnout have been highlighted as key priority areas to address the U.S. national mental health crisis. Briana S. Last and colleagues (1) present timely findings that underscore the urgency of these priorities. The authors elucidate several facets of the emotional and financial strain experienced by public mental health workers in Philadelphia and demonstrate an inverse association between level of education debt and frequency of evidence-based intervention (EBI) delivery. These findings are alarming but not surprising based on our frontline experience providing clinical care and training in multidisciplinary public mental health settings. Consistent with this study’s findings, we have found that low compensation, high workload driven by volume-based payer incentives, and constant exposure to psychosocially complex and chronically traumatized populations are the ingredients for burnout and high turnover. Despite the best efforts of frontline clinicians and local behavioral health and payer authorities such as those in Philadelphia, these forces can become unsurmountable barriers to sustained uptake of EBIs in settings where they are most needed.Most clinicians in this study needed to work an additional job to supplement their income and carried significant education debt. The authors rightly highlight the crippling effect of low Medicaid reimbursement rates and fee-for-service (FFS) payment models on financial stability and ability to provide appropriate compensation in public mental health settings. Further, FFS financially incentivizes and rewards volume, potentially sacrificing quality. Continuously embedding an EBI can require both initial short-term training/supervision and longer-term, “refresher” venues for training, particularly with staff turnover. In overburdened and understaffed public FFS settings, consistently protecting clinician time for training in EBI is hardly feasible; these tasks compete with the pressure to generate billable encounters. Time and volume demands are uniquely burdensome in public settings because clinicians are charged with applying EBIs from research study conditions to complex populations with multiple comorbid clinical and psychosocial issues. When system financial constraints limit case management access, patients often look to clinicians to assist, further absorbing clinical time. These conditions make the consistent delivery of EBI impossible.Higher rates of reimbursement, increased use of episode-of-care payments with appropriate rates, and increased use of value- and performance-based payment rewarding evidence-based care are critically needed to increase the financial ability of public mental health systems to properly compensate their staff and align payment incentives with delivery of EBI. In addition to these system-level solutions, we applaud Ms. Last and colleagues for suggesting how increased financial resources could be prioritized to directly benefit individual clinicians. We underscore Last and colleagues’ suggestions of compensated ongoing consultation in EBI on the job and wage incentives for use of EBI. Well-intentioned efforts to implement new clinical interventions often do not account for the extra time and energy clinicians require to learn and effectively use these strategies.When a precarious personal financial situation combines with the volume-focused pressure of FFS and the complex conditions of patients in public mental health settings, seeing clinicians experience burnout and secondary stress response is not surprising. High rates of secondary traumatic stress, burnout, and posttraumatic stress disorder in the study’s sample are particularly alarming when coupled with clinician-reported difficulties in affording mental health care. Staff burnout and resultant turnover complicate the ability of public mental health systems to provide consistent long-term provider-patient relationships and care, whether evidence based or not. Beyond the authors’ suggestions of increased peer and supervisory support, benefits covering mental health care and robust employee assistance programs with trauma-informed resources should be considered a mandatory part of trauma-focused EBI intervention, just as is training in the intervention itself. The increased move toward hiring independent contractors removes critical mental health supports for employees.Despite the passion and dedication of frontline public mental health workers, the current financial and emotional toll of their work settings not only stymies sustained uptake of EBI but also threatens the sustainability of this work as a long-term career path. Without significant investment in the financial and emotional well-being of this workforce, we fear a continued migration of talented public mental health clinicians to the private sector.Department of Psychiatry, University of Pennsylvania, Philadelphia.Send correspondence to Dr. Baptiste ([email protected]).Reference1 Last BS, Schriger SH, Becker-Haimes EM, et al.: Economic precarity, financial strain, and job-related stress among philadelphia’s public mental health clinicians. Psychiatr Serv 2022; 73:774–786Abstract, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 73Issue 7 July 2022Pages 721-721 Metrics PDF download History Published online 1 July 2022 Published in print 1 July 2022

Community Health Worker Activities in Public Health Programs to Prevent Violence: Coding Roles and Scope.

In multiple and related forms, violence is a serious public health issue with lasting impacts on health and wellness in the United States. Community health workers (CHWs) are frontline public health workers and trusted members of communities. We aimed to analyze recent examples of CHW activities in violence prevention public health programs with a goal of informing future programs and research. We collected more than 300 documents published between 2010 and 2020 to identify public health programs to prevent violence including CHW activities. We used an iterative process to develop and apply a coding scheme to the CHW activities. We identified 20 public health programs to prevent violence which included CHW activities. CHWs most often addressed community violence, youth violence, and family violence and played an average of 8 of 10 core roles per program. Fewer than a third (i.e., 6 programs) reported community-focused CHW activities to address upstream and structural determinants of health inequities. This first examination, to our knowledge, of the intersection of the CHW and violence prevention literature shows that CHWs have played many of their core roles in public health programs to address multiple forms of violence. (Am J Public Health. 2022;112(8):1191-1201. https://doi.org/10.2105/AJPH.2022.306865).

Relationships among thriving at work, organisational commitment and job satisfaction among Chinese front-line primary public health workers during COVID-19 pandemic: a structural equation model analysis

ObjectivesThis study aims to explore the mediating effect and influence mechanism of organisational commitment on the association among thriving at work and job satisfaction among frontline primary public health workers...

Psychological stress self-help interventions for healthcare workers in the context of COVID-19 in China: A randomized controlled trial protocol

BackgroundPublic health emergencies may lead to severe psychological stress, especially for healthcare workers, including frontline healthcare workers and public health workers. However, few stress management interventions have been implemented for healthcare workers even though they require more comprehensive interventions than the general public. Self-Help Plus (SH+) is a novel psychological self-help intervention developed by the World Health Organization. It is accessible, scalable, and cost-effective and has the potential to be quickly applied to help people cope with stress and adversity. The major objective of this study is to evaluate the effectiveness of SH+ interventions on the alleviation of stress levels and mental health problems among healthcare workers. MethodsA randomized controlled trial of SH+ will be conducted to investigate the stress level and mental health status of Chinese healthcare workers and control subjects in Guangzhou. Assessments will be performed before (baseline), at the end of (1 month), and 2 months after (3 months) the intervention. After completing the baseline screening questionnaire, eligible participants will be randomly assigned to one of the two groups in a 1:1 ratio by block randomization. During the 1-month intervention period, the intervention group will receive the SH+ intervention and the control group will receive information about mental health promotion. The intervention will be delivered by the research assistant via social media platforms. The primary outcome is the level of stress, which will be measured by a 10-item Perceived Stress Scale. Secondary outcomes including mental health symptoms will also be collected. DiscussionGiven the potential for multiple COVID-19 waves and other infectious disease pandemics in the future, we expect that SH+ will be an effective stress management intervention for healthcare workers. The findings from this study will facilitate the application of SH+, and the trial is expected to be extended to a larger population in the future.

The COVID-19 policy and strategic documents storm: a heartfelt request from the battlefield

IssueThe COVID-19 pandemic declared by WHO on 11 March 2020 brought not only a big threat to the global population but also a huge number of technical, policy and strategic documents with a very varied level of quality and accessibility. It has been a great challenge for frontline public health workers to surf the information wave, in order to effectively apply it in the context of crisis management.DescriptionCOVID-19 related policy, strategic and operational documents analysed and implemented by our team -at a public health centre at health department level, in the Valencian Region (Spain)- during the pandemic were reviewed. Key elements considered were: length, quality of structure and content, validity period, as well as dissemination channel.ResultsFrom February 2020 to date, the European Centre for Disease Prevention and Control (ECDC) alone has published 90 guidance and technical reports, representing 1,503 pages (mean length 16,7 pages, SD 14,0, range 3-92). As regards the Spain national COVID-19 strategy, i.e., a total of 26 versions have been issued so far, between 24 January 2020 and 26 February 2021. Mean length was 19,8 pages (SD 6,8, range 8-31) and average validity period of versions was 15,7 days (SD 16,4, range 1-70). They did not include a summary of recent changes. They were made publicly available through the official Ministry of Health website. As for regional-level documents, 5,3% (21) did not have a date, and their main channel of dissemination was via email.LessonsWe strongly recommend that policy and strategic documents at all levels comply with a minimum set of quality standards -including essential elements such as organization, title, publication date, page numbers, table of contents, key messages, and summary of changes in comparison with previous versions- and are disseminated through internet or intranet knowledge management systems. This would efficiently save a large number of hours and headaches to frontline professionals.Key messages In the context of public health crisis management, timely and appropriate access of frontline public health professionals to updated and concise information is crucial.COVID19 policy and strategic documents at all levels were reviewed. They should comply with a minimum set of quality standards, including a summary of recent changes, and be adequately disseminated.

Sidebar: Community Health Worker Prevention Services: COVID-19 and Beyond.

Community health workers (CHWs) are frontline public health workers with “an unusually close understanding of the community served” [[1][1]]. This allows CHWs to connect community members with needed services and improve cultural competence of those services. According to the American Public

Moderating effect of people-oriented public health services on depression among people under mandatory social isolation during the COVID-19 pandemic: a cross-sectional study in China

BackgroundPublic health measures, such as social isolation, are vital to control the spread of the coronavirus disease 2019 (COVID-19), but such measures may increase the risk of depression. Thus, this study examines the influencing and moderating factors of depressive symptoms among individuals subjected to mandatory social isolation.MethodsAn online cross-sectional survey was conducted to collect data from people under mandatory home or centralized social isolation in Shenzhen, China, from February 28 to March 6, 2020. The perceived risk of infection with COVID-19, perceived tone of media coverage, perceived quality of people-oriented public health services, and their depressive symptoms were assessed. Three rounds of stepwise multiple regression were performed to examine the moderating effects after controlling various variables, such as demographics, duration and venue of mandatory social isolation, infection and isolation status of family, time spent on COVID-related news, and online social support.ResultsAmong the 340 participants, 57.6% were men, the average age was 35.5 years old (SD = 8.37), and 55.6% held a bachelor’s degree or above. Individuals subjected to mandatory social isolation generally reported low levels of depressive symptoms. Perceived susceptibility to infection was relatively low, whereas perceived tone of media coverage was mainly positive. In terms of perceived quality of public health services, 12 (3.5%), 103 (30.3%), and 225 (66.2%) participants reported low, medium, and high quality of people-oriented services, respectively. Perceived susceptibility was positively associated with depression, whereas perceived tone of media coverage was negatively associated. The quality of people-centered public health services moderated the association between perceived risk and depressive symptoms and between perceived tone of media coverage and depressive symptoms.ConclusionsThis study revealed the depressive symptoms among individuals subjected to mandatory social isolation during the COVID-19 pandemic and highlighted that frontline public health workers play a critical role in protecting public mental health.

Community Health Worker Knowledge, Attitudes, Practices and Readiness to Manage Intimate Partner Violence.

Intimate partner violence (IPV) is an important public health concern with higher prevalence among women. Community health workers (CHWs) are trusted frontline public health workers that bridge gaps between communities and healthcare services. Despite their effectiveness in delivering services and improving outcomes for different chronic conditions, there is a dearth of understanding regarding CHW management of IPV. The purpose of this study is to examine knowledge, attitudes, practices, and readiness to manage IPV among a sample of CHWs (n = 152). Participants completed an online version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS), which was modified for CHW practice. Psychometrics of the newly adapted tool, along with empirical relationships between knowledge, attitudes, and readiness to manage IPV were examined. Most sub-scales yielded moderate to high reliability (0.70 < α’s < 0.97), some sub-scales had low reliability (0.57 < α’s < 0.64), and construct validity was established for several of the subscales. On average, many CHWs had low scores on objective knowledge of IPV (mean = 15.4 out of 26), perceived preparation to manage IPV (mean = 3.8 out of 7), and perceived knowledge of IPV (mean = 3.7 out of 7). About 56% of CHWs indicated having no previous IPV training, 34% did not screen for IPV, and 65% were in the contemplation stage of behavior change. Multiple regression models indicated that knowledge, staff capabilities and staff preparation were significant predictors of perceived preparedness to manage IPV (all p’s < 0.05). Results can inform future credentialing requirements and training programs for CHWs to better assist their clients who are victims of IPV.

Addressing social determinants of health in community pharmacy: Innovative opportunities and practice models

Social determinants of health (SDoH) account for up to 90% of health outcomes, whereas medical care accounts for only 10%-15%; despite this disparity, only 24% of hospitals and 16% of physician practices screen for the 5 social needs. Community-embedded and highly accessible, pharmacies are uniquely positioned to connect individuals to local community and social resources and thereby address SDoH. In this article, we explore novel community pharmacy practice models that address SDoH, provide real-world examples of these models, and discuss pathways for reimbursement and sustainability. A number of innovative community pharmacy practice models that focus on social issues are currently being explored. These include integrating community health workers (CHWs) or SDoH specialists, wherein CHWs are frontline public health workers who can effectively bridge the health care system and their community, whereas SDoH specialists are pharmacy team members trained with substantial SDoH knowledge and how to use it to connect pharmacy patients to community resources. Three community pharmacy networks have implemented pilot programs using either a CHW or SDoH specialist model. An essential component for program success in all cases has been partnership development and increased interdependence between the pharmacies, local community organizations, and the public health sector. New payment models and financial incentives will be necessary to expand and sustain these programs. A potential Approach may be the use of Z codes, a subset of ICD-10-CM codes specific to assessing SDoH. Although opportunities are developing for community pharmacies to play a major role in sustainably addressing SDoH, additional work is needed before there is a widespread acceptance of pharmacies becoming service referral destinations for patients with social needs. Evaluation of these models on a wider scale will be necessary to fully evaluate their effectiveness, costs, and implementation within different community pharmacy settings.

Building a Coaching Culture-The Roles of Coaches, Mentors, and Sponsors.

Building a Coaching Culture-The Roles of Coaches, Mentors, and Sponsors.

Prevalence of mental health problems and associated factors among front-line public health workers during the COVID-19 pandemic in China: an effort\u2013reward imbalance model-informed study

BackgroundPoor mental health status and associated risk factors of public health workers have been overlooked during the COVID-19 pandemic. This study used the effort–reward imbalance model to investigate the association between work-stress characteristics (effort, over-commitment, reward) and mental health problems (anxiety and depression) among front-line public health workers during the COVID-19 pandemic in China.MethodsA total of 4850 valid online questionnaires were collected through a self- constructed sociodemographic questionnaire, the adapted ERI questionnaire, the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item General Anxiety Disorder Scale (GAD-7). Hierarchical logistic regression analysis was conducted to investigate the association between ERI factors and mental health problems (i.e., depression and anxiety), with reward treated as a potential moderator in such associations.ResultsThe data showed that effort and over-commitment were positively associated with depression and anxiety, while reward was negatively associated with depression and anxiety. Development and job acceptance were the two dimensions of reward buffered the harmful effect of effort/over-commitment on depression and anxiety, whereas esteem was non-significant.ConclusionsThis study confirmed the harmful effects of effort and over-commitment on mental health among public health workers during the COVID-19 pandemic in China. Such effects could be alleviated through an appropriate reward system, especially the development and job acceptance dimensions of such a system. These findings highlight the importance of establishing an emergency reward system, comprising reasonable work-allocation mechanism, bonuses and honorary titles, a continuous education system and better career-development opportunities.

Integration of genomic sequencing into the response to the Ebola virus outbreak in Nord Kivu, Democratic Republic of the Congo.

On 1 August 2018, the Democratic Republic of the Congo (DRC) declared its tenth Ebola virus disease (EVD) outbreak. To aid the epidemiologic response, the Institut National de Recherche Biomédicale (INRB) implemented an end-to-end genomic surveillance system, including sequencing, bioinformatic analysis and dissemination of genomic epidemiologic results to frontline public health workers. We report 744 new genomes sampled between 27 July 2018 and 27 April 2020 generated by this surveillance effort. Together with previously available sequence data (n = 48 genomes), these data represent almost 24% of all laboratory-confirmed Ebola virus (EBOV) infections in DRC in the period analyzed. We inferred spatiotemporal transmission dynamics from the genomic data as new sequences were generated, and disseminated the results to support epidemiologic response efforts. Here we provide an overview of how this genomic surveillance system functioned, present a full phylodynamic analysis of 792 Ebola genomes from the Nord Kivu outbreak and discuss how the genomic surveillance data informed response efforts and public health decision making.

Working conditions and health status of 6,317 front line public health workers across five provinces in China during the COVID-19 epidemic: a cross-sectional study

ABSTRACTBackgroundPublic health workers at the Chinese Centre for Disease Control and Prevention (China CDC) and primary health care institutes (PHIs) were among the main workers who implemented prevention, control, and containment measures. However, their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of front line public health workers in China during the COVID-19 epidemic.MethodsBetween 18 February and 1 March 2020, we conducted an online cross-sectional survey of 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We surveyed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health using a self-constructed questionnaire and standardised measurements (i.e., Patient Health Questionnaire and General Anxiety Disorder scale). To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders.ResultsThe prevalence of depression, anxiety, and poor self-rated health was 21.3, 19.0, and 9.8%, respectively, among public health workers (27.1, 20.6, and 15.0% among CDC workers and 17.5, 17.9, and 6.8% among PHI workers). The majority (71.6%) made immense efforts in both field and non-field work. Nearly 20.0% have worked all night for more than 3 days, and 45.3% had worked throughout the Chinese New Year holiday. Three risk factors and two protective factors were found to be independently associated with all three health outcomes in our final multivariate models: working all night for >3 days (multivariate odds ratio [ORm]=1.67~1.75, p<0.001), concerns about infection at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), initiating COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and ability to persist for > 1 month at the current work intensity (ORm=0.44~0.55, p<0.001).ConclusionsChinese public health workers made immense efforts and personal sacrifices to control the COVID-19 epidemic and faced the risk of mental health problems. Efforts are needed to improve the working conditions and health status of public health workers and thus maintain their morale and effectiveness during the fight against COVID-19.