Local Public Health Officials Research Articles

Early warning COVID-19 outbreak in long-term care facilities using wastewater surveillance: correlation, prediction, and interaction with clinical and serological statuses

The unprecedented COVID-19 pandemic has highlighted the strategic value of wastewater-based surveillance (WBS) of SARS-CoV-2. This multisite 28-month-long study focused on WBS for older residents in 12long-term care facilities (LTCFs) in Edmonton (AB, Canada) by assessing relationships between COVID-19, WBS, and serostatus during the pandemic. Wastewater samples collected two to three times per week were tested for SARS-CoV-2 using RT-quantitative PCR. Theserostatus of antibodies was examined using immunoassays. The data of clinical COVID-19 outbreaks based on extensive testing were obtained from local public health officials. Analyses included calculating correlations between 7-day rolling averages for WBS and COVID-19 cases and investigating whether WBS led or lagged confirmed outbreaks using a multinomial test. Wastewater results correlated well with clinical COVID-19 infections and outbreaks at participating LTCFs. 1058 (36·0%) of 2936collected wastewater samples were SARS-CoV-2 positive, compared with 1247people (resident n=671, staff n=572, and unknown n=4) reporting positive test results of 21 673clinical samples assessed (5·8%). WBS led clinical testing in 32 (60·4%) confirmed outbreaks, which was significantly different from WBS lagged (12outbreaks [22·6%, 95% CI 11·3-33·7]). Non-detection of WBS SARS-CoV-2 served as a negative predictor for outbreaks. WBS results attested protective immunity in vaccinated individuals before the omicron wave. Aparallel increase in the proportions of positive WBS SARS-CoV-2 and anti-nucleocapsid antibodies underlined that omicron was an immunity-evading variant despite high seropositivity of neutralising antibodies after multiple doses of vaccine. Implementation of WBS could enable targeted clinical investigations and improve cost-effectiveness of COVID-19 outbreak management in LTCFs. WBS and serostatus provided informed dynamic changes of infections and immunity. Critical evidence was that LTCF WBS is an effective early warning system to support rapid public health outbreak management and protect vulnerable older populations. Canadian Immunity Task Force for COVID-19 and Alberta Health.

Effectively engaging faith-based leaders on syringe services programs: U.S. pastors’ knowledge, perceptions, and questions

ObjectiveTo identify faith-based leaders’ (FBLs’) knowledge, perceptions, and questions about syringe services programs (SSPs).MethodsWe conducted a one-time, national online survey of 461 Christian FBLs August–September 2022.Results56% of FBLs agreed they support having SSPs in their communities; only 7% strongly disagreed. We identified 15 main questions FBLs have about SSPs. We found statistically significant differences based on FBL Protestant affiliations. Mainline FBLs are more knowledgeable about SSPs, likely to believe a larger number of SSP services would benefit their community, supportive of SSPs, interested in data related to SSPs, and likely to look to local public health officials to shape their opinions on SSPs compared with non-mainline FBLs.ConclusionsSSP advocates can address questions that FBLs have about SSPs before beginning outreach. By understanding common Protestant denominational affiliations, advocates can focus initial engagement efforts on FBLs in their communities who are more likely to support SSPs. Our findings suggest that local public health officials can influence FBLs’ opinions about SSPs.

Knowledge, Attitudes, and Practices Regarding Dengue Prevention Among Health Volunteers in an Urban Area - Malang, Indonesia.

The dengue prevention program known as "One House One Mosquito Larva Inspector" involves health volunteers who play a crucial role in the surveillance of mosquito larvae and reporting their findings to local public health officials. This study aimed to identify factors related to the knowledge, attitudes, and practices (KAP) of dengue prevention behavior among these health volunteers. A study was conducted in 5 sub-districts in Malang, an urban area in Indonesia. We employed a cross-sectional design and utilized a semi-structured questionnaire to assess the KAP of 400 health volunteers. Data were collected through face-to-face interviews. Multiple logistic regression analysis revealed that individuals with a more positive attitude (odds ratio [OR], 1.69; p<0.05) and those with family sizes greater than five persons (OR, 1.90; p<0.05) were more likely to engage in effective dengue prevention practices. Additionally, possesing good knowledge was significantly assocated with more positive attitude (OR, 2.24; p<0.001). Furthermore, 40% reduction in positive attitude was observed in those over 45 years (OR, 0.60; p<0.05). The best practices most frequently reported by the majority of respondents included always reporting their surveillance activities (75.8%) and cleaning the water container in the bathroom at least once a week (65.2%). However, only 52.2% of respondents regularly checked for mosquito larvae in their neighborhood. Sustainable promotion and training for the "One House One Mosquito Larva Inspector" initiative are necessary, particularly among young health volunteers, to improve dengue prevention behaviors both within their own homes and in the surrounding environment.

Human respiratory syncytial virus subgroups A and B outbreak in a kindergarten in Zhejiang Province, China, 2023.

In May-June 2023, an unprecedented outbreak of human respiratory syncytial virus (HRSV) infections occurred in a kindergarten, Zhejiang Province, China. National, provincial, and local public health officials investigated the cause of the outbreak and instituted actions to control its spread. We interviewed patients with the respiratory symptoms by questionnaire. Respiratory samples were screened for six respiratory pathogens by real-time quantitative polymerase chain reaction (RT-PCR). The confirmed cases were further sequenced of G gene to confirm the HRSV genotype. A phylogenetic tree was reconstructed by maximum likelihood method. Of the 103 children in the kindergarten, 45 were classified as suspected cases, and 25 cases were confirmed by RT-PCR. All confirmed cases were identified from half of classes. 36% (9/25) were admitted to hospital, none died. The attack rate was 53.19%. The median ages of suspected and confirmed cases were 32.7 months and 35.8 months, respectively. Nine of 27 confirmed cases lived in one community. Only two-family clusters among 88 household contacts were HRSV positive. A total of 18 of the G gene were obtained from the confirmed cases. Phylogenetic analyses revealed that 16 of the sequences belonged to the HRSV B/BA9 genotype, and the other 2 sequences belonged to the HRSV A/ON1 genotype. The school were closed on June 9 and the outbreak ended on June 15. These findings suggest the need for an increased awareness of HRSV coinfections outbreak in the kindergarten, when HRSV resurges in the community after COVID-19 pandemic.

"We are still tired": staff and administrators’ experiences during the COVID-19 pandemic within California residential care facilities for older adults

BackgroundExtensive research has been conducted on the impacts of the COVID-19 pandemic on long-term care workers in specialized care facilities. However, little is known about the impacts faced by facilities that provide generalized long-term support and care, such as residential care facilities for older adults (RCFs). This study describes the challenges experienced by staff and administrators of RCFs during the COVID-19 pandemic.MethodsAn electronic questionnaire collecting data using both closed- and open-ended questions on staff experiences was sent to 5,721 unique RCF administrator emails within the state of California between June-December 2021. Email addresses were obtained from the public database of RCFs available through the California Health and Human Services Open Data Portal. Descriptive statistics were calculated on quantitative data regarding staff preparedness training, access to resources, and administrators’ confidence in meeting recommended guidelines during the pandemic. Inductive thematic analysis was conducted on qualitative data regarding the confidence levels in meeting pandemic guidelines and challenges faced related to staff stress and morale.ResultsA total of 150 RCF administrators across California (response rate of 2.6%) completed the survey. Over three-fourths of respondents indicated their facilities had a designated staff member to train other staff members on emergency preparedness plans and the most frequently used resources during the COVID-19 pandemic were the Department of Social Services Community Care Licensing Division (88.7%), the county health department (86.7%), and the Centers for Disease Control and Prevention (80.7%). Administrators felt least confident in their facilities’ ability to maintain adequate staffing (52.0%), communication with nearby hospitals (62.1%) and communication with state and local public health officials (69.8%) during the pandemic. Three central themes emerged from the thematic analysis on staff stress and morale: (1) physical safety, mental and emotional impact of the COVID-19 pandemic; (2) staffing issues; and (3) challenges with guidelines in managing the ongoing pandemic.ConclusionsFindings from this research study can be used to actively target training resources for facility administrators and staff that have been identified as most frequently used and relevant for emergency preparedness in these understudied facilities. Additionally, developing a better understanding of the staffing stress and morale difficulties in RCFs can provide insight on how policymakers can assist these critical facilities in better preparing for future crises.

Sero-epidemiology of bovine tuberculosis in dairy cattle in Chattogram, Bangladesh

Mycobacterium bovis-caused bovine tuberculosis (bTB) is a global public health concern and commercially significant zoonotic disease. Many wild and domesticated animals, including cattle, are susceptible to this fatal disease and play an important role in cross-species transmission. To gain a better understanding of bTB in dairy cattle, a bTB serological study is also necessary in order to identify efficient bTB control strategies in Bangladesh. In Bangladesh, however, seroepidemiological research is either non-existent or limited (particularly Chattogram). To determine the seroprevalence of bTB and related possible risk factors in dairy cattle, a serological cross-sectional study was conducted (both animal and farm level). We estimated the seroprevalence of bTB was 7.5%(N=442) in this investigation, which also identified one animal-level and two farm-level possible risk factors. Individual animal risk factors included cattle source (own stock: OR=3.4, 95% CI: 1.4-8.1, p=0.006), and farm risk factors included population size (Larger: OR= 26.2, 95% CI: 2.2-319.1, p=0.010) and stocking density (Low and moderate: OR=19.6, 95%CI: 1.5-261.5, p=0.024). In the face-in housing system, there was also a higher risk of bTB seropositivity (OR=4.5). The research's key findings are thoroughly explored, and the findings will aid in the prevention and control of bTB in Bangladesh. In addition, early detection of positive cases, as well as their prompt removal and good farm management practices, can assist in preventing the spread of bTB to new human or bovine hosts. In underdeveloped nations like Bangladesh, a coordinated effort with local public health officials is critical for implementing an efficient TB control program.

Building a Simple Model to Assess the Impact of Case Investigation and Contact Tracing for Sexually Transmitted Diseases: Lessons From COVID-19

During the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention developed a simple spreadsheet-based tool to help state and local public health officials assess the performance and impact of COVID-19 case investigation and contact tracing in their jurisdiction. The applicability and feasibility of building such a tool for sexually transmitted diseases were assessed. The key epidemiologic differences between sexually transmitted diseases and respiratory diseases (e.g., mixing patterns, incubation period, duration of infection, and the availability of treatment) were identified, and their implications for modeling case investigation and contact tracing impact with a simple spreadsheet tool were remarked on. Existing features of the COVID-19 tool that are applicable for evaluating the impact of case investigation and contact tracing for sexually transmitted diseases were also identified. Our findings offer recommendations for the future development of a spreadsheet-based modeling tool for evaluating the impact of sexually transmitted disease case investigation and contact tracing efforts. Generally, we advocate for simplifying sexually transmitted disease-specific complexities and performing sensitivity analyses to assess uncertainty. The authors also acknowledge that more complex modeling approaches might be required but note that it is possible that a sexually transmitted disease case investigation and contact tracing tool could incorporate features from more complex models while maintaining a user-friendly interface. A sexually transmitted disease case investigation and contact tracing tool could benefit from the incorporation of key features of the COVID-19 model, namely its user-friendly interface. The inherent differences between sexually transmitted diseases and respiratory viruses should not be seen as a limitation to the development of such tool.

Racial and Ethnic Differences in Openness to Communication From Local Faith-Based Congregations During Public Health Emergencies.

During public health emergencies, people at risk of exposure or illness will likely be presented with extensive information about an unfamiliar topic and be asked to make decisions quickly. In difficult situations, people often turn to trusted leaders, including from their local faith-based congregation (FBC). We examined how people receive, interpret, and respond to health communication information from clergy and lay leaders from their local FBC during public health emergencies. We analyzed responses to 10 questions from a 2021 nationally representative US survey. Porter Novelli designed the survey and administered it to 4510 US adults aged ≥18 years, of whom 3553 people completed the survey. We examined sociodemographic characteristics, trust of health information from clergy and lay leaders, and willingness to engage in health behaviors recommended by their FBC and receive health services through their local FBC. All estimates were weighted. We conducted bivariate analysis with contrast t tests for proportions at α = .05. More than half of adults (55.4%), including 65.8% of non-Hispanic Black and 58.8% of Hispanic or Latino adults, were members of an FBC. Among FBC members, a higher percentage of Hispanic or Latino (29.1%) and non-Hispanic Black (36.3%) adults than non-Hispanic White adults (20.4%) reported trust in their FBC for health information (P < .05). This trust translated into greater intent to engage in health behaviors promoted by the local FBC among non-Hispanic Black respondents (31.4%) compared with non-Hispanic White respondents (22.5%) (P < .05). Public health officials can consider ways to better understand how the cultures and practices of populations being served influence people's health perceptions and behaviors. Collaboration between federal, state, and local public health officials and FBCs can promote health equity during public health emergencies.

Geographic information system protocol for mapping areas targeted for mosquito control in North Carolina.

Geographic information systems (GIS) can be used to map mosquito larval and adult habitats and human populations at risk for mosquito exposure and possible arbovirus transmission. Along with traditional methods of surveillance-based targeted mosquito control, GIS can help simplify and target efforts during routine surveillance and post-disaster (e.g., hurricane-related flooding) to protect emergency workers and public health. A practical method for prioritizing areas for emergency mosquito control has been developed and is described here. North Carolina (NC) One Map was used to identify state-level data layers of interest based on human population distribution and mosquito habitat in Brunswick, Columbus, Onslow, and Robeson Counties in eastern NC. Relevant data layers were included to create mosquito control treatment areas for targeted control and an 18-step protocol for map development is discussed. This protocol is expected to help state, territorial, tribal, and/or local public health officials and associated mosquito control programs efficiently create treatment area maps to improve strategic planning in advance of a disaster. This protocol may be applied to any NC county and beyond, thereby increasing local disaster preparedness.

Preparedness Plan Ensures Dental Service Sustainability During a Public Health State of Emergency

Background In early 2020, the COVID-19 pandemic emerged bringing risk of disease, disability and death to all Americans. As public health officials scrambled to respond, dental offices were shuttered leaving little access to dental care.Methods Collaborating with medical colleagues and partnering with the local public health department, the Asian Health Services (AHS) dental team developed a preparedness plan to ensure the safe and effective ongoing delivery of oral health care services, respond to the national public health state of emergency and support local public health efforts to contain the pandemic.Results AHS dental services remained operational throughout the COVID-19 pandemic due to the swift and strategic response of the dental team. COVID-19 contact tracing, testing and vaccination became new services rendered by dental personnel, which are now integrated into policies, programs and services. Professional education and training were also updated to ensure sustained preparedness.Conclusions By having a comprehensive and coordinated preparedness plan in place, AHS was able to effectively support public health efforts and serve the oral health care needs of the community.Practical Implications Preparedness efforts implemented by a coordinated effort between AHS’s medical and dental leadership in cooperation with local public health officials during the recent COVID-19 pandemic may serve as a future model for all health care professionals.

Small Area Forecasting of Opioid-Related Mortality: Bayesian Spatiotemporal Dynamic Modeling Approach

Opioid-related overdose mortality has remained at crisis levels across the United States, increasing 5-fold and worsened during the COVID-19 pandemic. The ability to provide forecasts of opioid-related mortality at granular geographical and temporal scales may help guide preemptive public health responses. Current forecasting models focus on prediction on a large geographical scale, such as states or counties, lacking the spatial granularity that local public health officials desire to guide policy decisions and resource allocation. The overarching objective of our study was to develop Bayesian spatiotemporal dynamic models to predict opioid-related mortality counts and rates at temporally and geographically granular scales (ie, ZIP Code Tabulation Areas [ZCTAs]) for Massachusetts. We obtained decedent data from the Massachusetts Registry of Vital Records and Statistics for 2005 through 2019. We developed Bayesian spatiotemporal dynamic models to predict opioid-related mortality across Massachusetts' 537 ZCTAs. We evaluated the prediction performance of our models using the one-year ahead approach. We investigated the potential improvement of prediction accuracy by incorporating ZCTA-level demographic and socioeconomic determinants. We identified ZCTAs with the highest predicted opioid-related mortality in terms of rates and counts and stratified them by rural and urban areas. Bayesian dynamic models with the full spatial and temporal dependency performed best. Inclusion of the ZCTA-level demographic and socioeconomic variables as predictors improved the prediction accuracy, but only in the model that did not account for the neighborhood-level spatial dependency of the ZCTAs. Predictions were better for urban areas than for rural areas, which were more sparsely populated. Using the best performing model and the Massachusetts opioid-related mortality data from 2005 through 2019, our models suggested a stabilizing pattern in opioid-related overdose mortality in 2020 and 2021 if there were no disruptive changes to the trends observed for 2005-2019. Our Bayesian spatiotemporal models focused on opioid-related overdose mortality data facilitated prediction approaches that can inform preemptive public health decision-making and resource allocation. While sparse data from rural and less populated locales typically pose special challenges in small area predictions, our dynamic Bayesian models, which maximized information borrowing across geographic areas and time points, were used to provide more accurate predictions for small areas. Such approaches can be replicated in other jurisdictions and at varying temporal and geographical levels. We encourage the formation of a modeling consortium for fatal opioid-related overdose predictions, where different modeling techniques could be ensembled to inform public health policy.

Hereditary etiology of non-syndromic sensorineural hearing loss in the Republic of North Ossetia-Alania.

More than 50% of congenital hearing loss is hereditary, in which the majority form is non-syndromic. In this study we estimate the most prevalent pathogenic genetic changes in an Ossetian cohort of patients. This is useful for local public health officials to promote genetic counseling of affected families with regard to high allele frequencies of prevalent pathogenic variants and assortative mating in the community of people with hearing loss. In this study, genetic heterogeneity of hereditary non-syndromic sensorineural hearing loss (NSNHL) in a cohort of 109 patients and an assessment of the frequency of two GJB2 gene pathogenic variants in a cohort of 349 healthy individuals from the populations of the Republic of North Ossetia-Alania (RNO-Alania) were assessed. The molecular genetic cause of NSNHL in the GJB2 gene in RNO-Alania was confirmed in ~30% of the cases, including ~27% in Ossetians. In Russian patients, the most frequent variant is GJB2:c.35delG (~83%). The GJB2:c.358_360delGAG variant was found to be the most frequent among Ossetians (~54%). Two genetic variants in GJB2, c.35delG and c.358_360delGAG, accounted for 91% of GJB2 pathogenic alleles in the Ossetian patients. A search for large genome rearrangements revealed etiological cause in two Ossetian patients, a deletion at the POU3F4 gene locus associated with X-linked hearing loss (type DFNX2). In another Ossetian patient, a biallelic pathogenic variant in the MYO15A gene caused hearing loss type DFNB3 was identified, and in one Russian family a heterozygous MYH14 gene variant associated with dominant NSNHL was found. Thus, the informative value of the diagnosis was ~37% among all patients with NSNHL from RNO-Alania and ~32% among the Ossetians. These estimates correspond to the literature data on the fraction of recessive genetic forms of hearing loss within the affected population. The importance of this study consists not only in the estimation of the most prevalent pathogenic genetic changes in the Ossetian cohort of patients which could be useful for the public health but also in the genetic counselling of the affected families with regard to the high allele frequencies of revealed pathogenic variants as well as to the assortative mating in community of people with hearing loss.

TOOLS TO SUPPORT NEEDS ASSESSMENTS ON DEMENTIA, COGNITIVE HEALTH, AND CAREGIVING

Abstract Dementia, cognitive health, and caregiving are not always included in community health needs assessments, leading to their absence in public health improvement and strategic plans, and subsequent lack of action and funding to address these needs. In response, the Alzheimer’s Association and the Association of State and Territorial Health Officials published the Needs Assessment Toolkit for Dementia, Cognitive Health, and Caregiving. Designed for state, local, and territorial public health and aging officials, this toolkit helps communities identify unmet needs of older adults, scale up existing community strengths, and promote healthy aging. The toolkit embeds health equity as a cornerstone to assessing community health. It offers approaches to operationalize equity in the assessment process by including wide representation of people from different racial and ethnic backgrounds, geographic locations, and levels of socioeconomic status and educational attainment. The toolkit’s five steps are modular in design and allow jurisdictions to enter the process at any stage. It considers alignment with jurisdiction-wide plans including Alzheimer’s plans, health improvement plans, aging plans, and the Healthy Brain Initiative Road Map, helping public health agencies advance attention to Alzheimer’s through their networks. Developed through an iterative process, expert input from public health and aging practitioners guided the development and organization. Over 1,600 comments were reconciled to ensure usability among stakeholders, elevate equity to an essential component throughout the assessment process, and add value to allied strategic plans. This presentation complements Learn, Plan, Do: Public Health Planning to Address Dementia and Caregiving, abstract ID 1229181.

Changes in the Public Charge Rule and Health of Mothers and Infants Enrolled in New York State's Medicaid Program, 2014‒2019.

Objectives. To examine the effect of the January 2017 leak of the federal government's intent to broaden the public charge rule (making participation in some public programs a barrier to citizenship) on immigrant mothers and newborns in New York State. Methods. We used New York State Medicaid data (2014-2019) to measure the effects of the rule leak (January 2017) on Medicaid enrollment, health care utilization, and severe maternal morbidity among women who joined Medicaid during their pregnancies and on the birth weight of their newborns. We repeated our analyses using simulated measures of citizenship status. Results. We observed an immediate statewide delay in prenatal Medicaid enrollment by immigrant mothers (odds ratio = 1.49). Using predicted citizenship, we observed significantly larger declines in birth weight (-56 grams) among infants of immigrant mothers. Conclusions. Leak of the public charge rule was associated with a significant delay in prenatal Medicaid enrollment among immigrant women and a significant decrease in birth weight among their newborns. Local public health officials should consider expanding health access and outreach programs to immigrant communities during times of pervasive antiimmigrant sentiment. (Am J Public Health. 2022; 112(12):1747-1756. https://doi.org/10.2105/AJPH.2022.307066).

Masking Behaviors in the Absence of Local Mandate-An Observational Study from Hillsborough County, Florida.

The purpose of this study was to understand the predictors of masking-especially age, race/ethnicity and gender-in Hillsborough County Florida, a region without mask mandates. Masking and social distancing behaviors of individuals were observed in Hillsborough County during one-week intervals in July 2021, August 2021 and Late September-early October 2021. Demographic and behavioral observations were recorded and logistic regression was utilized to determine the odds ratio of wearing a mask amongst various groups. Overall, masking ranged from 36.80% to 48.64%, peaking during the second observation period. Masking rates were highest amongst people of color, women and seniors. Establishments posting mask-negative language, such as "masks NOT required," saw a 46% decrease in the odds of masking compared to establishments without mask-related signage (thereby defaulting to no mandate). Understanding who engaged in masking and social distancing behaviors will provide local public health officials with a deeper understanding of the effectiveness of previously used strategies, which can be leveraged in future surges of COVID-19 and other emergencies to create maximum impact. Lessons learned regarding policy implementation and understanding patterns of uptake of health guidelines are important for the continuous improvement of public health practice.

Reasons for Turnover of Kansas Public Health Officials during the COVID-19 Pandemic.

Public health officials played a critical role in COVID-19 mitigation and response efforts. In Kansas, 51 local health department (LHD) administrators and/or local health officers left their positions due to the pandemic between 15 March 2020 and 31 August 2021. The purpose of this study was to identify factors that led to turnover of Kansas local public health officials during the COVID-19 pandemic. Those eligible to participate in this study included former LHD administrators and/or health officers who were employed at or contracted by a Kansas LHD on 15 March 2020 and resigned, retired, or were asked to resign prior to 31 August 2021. Researchers used a demographic survey, a focus group, and key informant interviews to collect data. Twelve former LHD leaders participated in this study. Four themes emerged from phenomenological analysis: politicization of public health; a perceived lack of support; stress and burnout; and the public health infrastructure not working. The findings of this study can guide the Kansas public health system to address the issues leading to turnover of leadership and prevent future turnover. Future research must explore strategies for mitigating leadership turnover and identify alternative public health structures that could be more effective.

Association between COVID-19 vaccine hesitancy and trust in the medical profession and public health officials

One's personal physician, national and state or local public health officials, and the broader medical profession play important roles in encouraging vaccine uptake for COVID-19. However, the relationship between trust in these experts and vaccine hesitancy has been underexplored, particularly among racial/minority groups where historic medical mistrust may reduce uptake.Using an April 2021 online sample of US adults (n = 3041) that explored vaccine hesitancy, regression models estimate levels of trust in each of these types of experts and between trust in each of these experts and the odds of being COVID-19 vaccine takers vs refusers or hesitaters. Interaction terms assess how levels of trust in the medical profession by race/ethnicity are associated with vaccine hesitancy. Trust in each expert is positively associated with trust in other experts, except for trust in the medical profession. Only trust in one's own doctor was associated with trust in the medical profession, as measured by factor scores derived from a validated scale. Lower levels of trust in experts were significantly associated with being either a hesitater or a refuser compared to being a taker. Black respondents had higher odds of being either a hesitater or a refuser compared to white respondents but the interaction with trust was insignificant. For Hispanic respondents only, the odds of being a hesitater declined significantly when trust in the medical profession rose. Mistrust in the medical profession, one's doctor and national experts contributes to vaccine hesitancy. Mobilizing personal physicians to speak to their own patients may help.

Malaria Surveillance - United States, 2018.

Malaria Surveillance - United States, 2018.

All Public Health is Local: Lessons From Eagle County During the First 2 Years of the Coronavirus Disease-2019 Pandemic.

Background:During the coronavirus disease-2019 (COVID-19) pandemic cumulative United States COVID-19 deaths per capita were higher than all other large, high-income nations, but with substantial variation across the country.Objective:The aim was to detail the public health response during the pandemic in Eagle County, Colorado.Research Design and Measures:Observational study using pre-COVID-19 county public health metrics. Pandemic actions were recorded from a narrative summary of daily phone consultations by a county-wide taskforce and interviews. Outcomes obtained from local, state, and nationally reported databases.Methods:Eagle County began with a life expectancy of 85.9, low all-cause age-adjusted death rates equal for both White and Latinx populations, a high household median income, and other prepandemic advantages. It also launched an innovative, independent county-wide taskforce lead by experienced mid-level managers. The taskforce implemented rapid communication of decision consequences, made immediate course corrections without traditional organizational approvals or contradictory political pressures.Results:Eagle County was first in Colorado to obtain Personal Protective Equipment and to establish a drive-through testing facility. The COVID-19 case fatality rate was 0.34%. The sole intensive care unit never reached maximum capacity. By March 2022, Eagle County had administered at least 1 vaccine dose to 100% of the population and 83% were fully vaccinated.Conclusions:It is not possible to directly attribute superior outcomes to either the baseline characteristics of Eagle County or its innovative taskforce design and deployment. Rather this report highlights the potential impact that improving the baseline health status of US citizens and permitting novel problem-solving approaches by local public health officials might have for the next pandemic.

Spatial and temporal pattern of cannabis use disorder in California 2010-2019

As cannabis use is being legalized in an increasing number of states, it is important to understand the changing dynamic of the risk in cannabis use disorder (CUD). Shape-based time-series clustering was used to identify ZIP Code Tabulation Areas (ZCTAs) with similar changing pattern in CUD over time. We conducted a cross-sectional logistic regression analysis to investigate the most recent ZCTA socio-demographic characteristics in relation to the changing CUD rates. The emergency discharge rates generally increased during 2010-2016. Increase during 2017-2019 was found in Sacramento and Santa Barbara County. Approximately 13% of ZCTAs showed an increasing trend of hospitalization discharge during 2017-2019. Males and non-Hispanic Black had larger increase than other groups during 2017-2019. The recent growing trend was found associated with greater racial diversity and rural ZCTAs. The findings from this study hold promise for local public health officials to adjust the cannabis intervention strategies in target districts and improve overall health outcomes.