Public Health Infrastructure Research Articles

Friendly Residential Environments That Generate Autonomy in Older Persons.

This study aimed to explore the housing and residential environment conditions associated with functional autonomy in older persons. A quantitative cross-sectional study was conducted, including 175 individuals over the age of 60. Participants were non-institutionalized urban residents of Medellín, Colombia, selected by random two-stage sampling (neighborhoods and blocks). Analysis was done according to functional autonomy of action (dependent variable); and demographic conditions, housing, and the physical and social environment suggested by the World Health Organization (WHO) in the strategy of age-friendly cities (independent variables). Univariate, bivariate, and multivariate analyses were performed with these variables, where the odds ratio (OR), association hypothesis test, and confidence intervals were estimated, using logistic regression models. 89.7% of older persons had moderate physical performance. The performance of intergenerational activities (OR = 5.28) and community actions (OR = 11.28) were part of social environments. The adaptations in public transport (OR = 90.33), sanitary services (OR = 4.1), and lighting in parks (OR = 19.9) of the physical environment were the associations found with functional autonomy. Exploring how the physical and social environments surrounding housing are associated with the functional performance of older persons can generate useful information to support public health and city infrastructure strategies that improve their physical performance and maintain autonomy.

BUILDING OUR LARGEST DEMENTIA INFRASTRUCTURE FOR ALZHEIMER'S ACT: POLICIES ADVANCING HEALTHY AGING

Abstract While public health experts cannot yet say how to prevent Alzheimer’s disease and related dementias (ADRD), emerging science indicates that ADRD may be slowed through risk reduction strategies, early diagnosis, and better education and training of front-line health care professionals. Recognizing these scientific advances, the National Plan to Address Alzheimer’s Disease: 2021 Update added a new goal, Goal 6, to the 10-year-old plan emphasizing risk reduction and healthy aging: Accelerate Action to Promote Healthy Aging and Reduce Risk Factors for Alzheimer’s Disease and Related Dementias. CDC is authorized through Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act (P.L. 115-406) to create a uniform national public health infrastructure through BOLD Program and Public Health Centers of Excellence. This presentation will highlight CDC activities that not only build a uniform national public health infrastructure but also promote healthy aging consistent with Goal 6 of the 2021 National Plan.

THE EVOLUTION OF A PUBLIC HEALTH APPROACH TO ADRD AND THE ROLE OF RISK REDUCTION

Abstract CDC, through the Healthy Brain Initiative (HBI) and Building Our Largest Dementia (BOLD) Infrastructure Act, is working to advance cognitive and brain health as integral components of public health practice, to keep older Americans healthy and independent as long as possible. HBI promotes brain health as part of public health practice and BOLD strives to build a uniform public health infrastructure. Both HBI and BOLD focus not only on people with cognitive decline or dementia but also their health care providers and caregivers. Recently, the 2021 Alzheimer’s Disease National Plan added Goal 6, Accelerate Action to Promote Healthy Aging and Reduce Risk Factors for Alzheimer’s Disease and Related Dementias. This presentation will describe the evolution of public health’s role with respect to brain health and caregiving and how the national priority on risk reduction and healthy aging can be beneficial to the health and well-being of older adults.

BUILDING OUR LARGEST DEMENTIA (BOLD) INFRASTRUCTURE FOR ALZHEIMER'S ACT: CENTERS OF EXCELLENCE

Abstract While public health experts cannot yet say how to prevent Alzheimer’s disease and related dementias (ADRD), emerging science indicates that ADRD may be slowed through the implementation of risk reduction strategies, early diagnosis, and better education and training of front-line health care professionals. The Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act was introduced into the Senate (S. 2076) on November 6, 2017 and signed into law on December 31, 2018 (P.L. 115-406) amending the Public Health Service Act (Section 398A; 42 U.S.C. 280c-3-4). CDC's Alzheimer's Disease and Healthy Aging Program (AD+HAP) was authorized to implement the activities outlined in BOLD which were designed to create a uniform national public health infrastructure. This presentation will provide an overview of BOLD and the demonstrate how BOLD Program and Public Health Centers of Excellence recipients are working together to build a uniform national public health infrastructure.

A PUBLIC HEALTH APPROACH TO ALZHEIMER’S DISEASE RISK REDUCTION: WHERE WE ARE AND WHERE WE’RE HEADED

Abstract A growing body of evidence has identified potential modifiable risk factors for Alzheimer’s disease and related dementias (ADRD). In 2021, the National Plan to Address Alzheimer's Disease (National Plan) included a new goal to promote healthy aging and address risk factors to help delay onset or slow progression of ADRD. Applying a robust public health approach to ADRD risk reduction can help achieve meaningful progress at the population level. The activities outlined in the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act (P.L. 115-406) are designed to create a uniform national public health infrastructure with a focus on various issues including risk reduction. The purpose of this session is to illustrate a public health approach to ADRD risk reduction, including its current status along with future directions and priorities. An overview of the National Plan’s new goal regarding ADRD risk reduction (McGuire) and data highlighting the current burden of key modifiable risk factors in the United States along with important disparities (Omura) will be presented. Holt will describe how ADRD risk reduction is integrated into the work of BOLD funding recipients, and Head will present experiences implementing public health activities that support ADRD risk reduction in the field along with successes and lessons learned. Finally, priorities and future directions for a public health approach to ADRD risk reduction will be presented from the perspective of the CDC’s Building Our Largest Dementia Infrastructure Public Health Center of Excellence on Dementia Risk Reduction (Baumgart).

Urban living and chronic diseases in the presence of economic growth: Evidence from a long-term study in southeastern China.

High-speed urban development has brought about an increase in per capita income in low- and middle-income countries (LMICs) as well as the high prevalence rate of chronic diseases. Based on a study of chronic diseases from 2011 to 2021 in southeastern China, we used multivariate adjusted logistic regression method to analyze the effect of urban living on the incidence of typical chronic diseases and the trend of such effect with the improvement of public healthcare system. We adopted potential mediating risk factors of urban lifestyles including body mass index (BMI), frequency of dining out, sedentary time, and psychological distress in the adjusted estimation. Baseline results indicate a positive relationship between living in urban areas and the prevalence of type 2 diabetes, hyperlipidemia, and hypertension. Regarding the mediating factors, psychological distress had the highest positive coefficient (Cr) on type 2 diabetes, hyperlipidemia, and hypertension (Cr: 0.4881-0.7084), followed by BMI (Cr: 0.1042-0.1617) and frequency of dining out (Cr: 0.0311-0.0478), and finally, sedentary time (Cr: 0.0103-0.0147). However, regression results on the follow-up survey reveal that trend in the impact of living in urban areas on chronic disease diminished as the level of the healthcare system improved. Additionally, urban living was more positively correlated with the incidence of metabolic disease than with the incidence of cardiovascular disease and cancer. Our findings provide empirical evidence that future urban health planning in LMICs should pay sustained attention to upgrading the level of public health infrastructure covering urban residents as well as rural-to-urban migrants, constructing a long-term dynamic system of chronic disease prevention and control, and regularly monitoring the mental health problems of residents in order to interrupt the process of urban chronic disease prevalence in an early stage.

107. Identification of state-level variables associated with changes in vaccination coverage rates in adults aged 18 to 64 in the United States

Abstract Background Despite the recognized value of life-course vaccination, adult vaccine uptake remains low. State-level vaccination coverage disparities may be associate with state-level variables (e.g., policies, programs, practices, and population characteristics). The objective of this study was to identify state-level variables associated with increased adult vaccination coverage rates (VCR) in the US for influenza, tetanus, herpes zoster (HZ), and pneumococcal vaccines over time. Methods Retrospective, exploratory database analysis of 2011-2019 Behavioral Risk Factor Surveillance System (BRFSS) data was used to calculate state-level VCRs for adults 18-64 years old. Using publicly available data, state-level variables associated with increases in VCRs were identified via a systematic variable selection. The multivariable regression models included variables meeting the criteria: correlations > 0.4 or < -0.4 (continuous) or Kruskal-Wallis Test p-value < 0.2 (categorical). Results Final multivariable regression models included 5 variables: Medicaid expansion status, accountable care organizations in place, health homes program, percentage of adults who report not seeing a doctor in past 12 months because of cost, and percentage of adults who report participating in any physical activity. In the multivariable models, the following state-level variables were significantly associated with changes in VCR: Influenza: percentage of adults who report participating in any physical activity (p = .01)Pneumococcal: percentage of adults who report not seeing a doctor in the past 12 months because of cost (p = .02)HZ: health homes (p = .04); percentage of adults who report participating in any physical activity or exercise (p = .01); percentage of adults who report not seeing a doctor in past 12 months because of cost (marginally significant, p = .056)Tetanus: none Conclusion Few state-level variables demonstrated an association with changes in VCR but some significant findings were observed in final models. Associated variables may not have a direct relationship but may be associated with public health infrastructure supporting vaccination ecosystems. Further research is underway to better understand the factors affecting adult vaccination. Disclosures Amanda Eiden, PhD, MBA, MPH, Merck & Co., Inc.: Stocks/Bonds Mark A. Price, MA, MEd, Merck: Advisor/Consultant|Merck: I am an employee of RTI Health Solutions. Merck has contracted with my company to conduct the study described in the abstract. Alexandra Bhatti, JD, MPH, Merck & Co. Inc.: Grant/Research Support|Merck & Co. Inc.: Stocks/Bonds.

Substance use policy and practice in the COVID-19 pandemic: Learning from early pandemic responses through internationally comparative field data

ABSTRACT The COVID-19 pandemic has created an unprecedented natural experiment in drug policy, treatment delivery, and harm reduction strategies by exposing wide variation in public health infrastructures and social safety nets around the world. Using qualitative data including ethnographic methods, questionnaires, and semi-structured interviews with people who use drugs (PWUD) and Delphi-method with experts from field sites spanning 13 different countries, this paper compares national responses to substance use during the first wave of the COVID-19 pandemic. Field data was collected by the Substance Use x COVID-19 (SU x COVID) Data Collaborative, an international network of social scientists, public health scientists, and community health practitioners convened to identify and contextualise health service delivery models and social protections that influence the health and wellbeing of PWUD during COVID-19. Findings suggest that countries with stronger social welfare systems pre-COVID introduced durable interventions targeting structural drivers of health. Countries with fragmented social service infrastructures implemented temporary initiatives for PWUD led by non-governmental organisations. The paper summarises the most successful early pandemic responses seen across countries and ends by calling for greater systemic investments in social protections for PWUD, diversion away from criminal-legal systems toward health interventions, and integrated harm reduction, treatment and recovery supports for PWUD.

COVID-19 Deaths and the Impact of Health Disparities, Hospital Characteristics, Community, Social Distancing, and Health System Competition

The United States has one of the highest cumulative mortalities of coronavirus disease 2019 (COVID-19) and has reached 1 million deaths as of May 19th, 2022. Understanding which community and hospital factors contributed to disparities in COVID-19 mortality is important to inform public health strategies. This study aimed to explore the potential relationship between hospital service area (1) community (ie, health professional shortage areas, market competition, and uninsured percentage) and (2) hospital (ie, teaching, system, and ownership status) characteristics (2013-2018) on publicly available COVD-19 (February to October 2020) mortality data. The study included 2514 health service areas and used multilevel mixed-effects linear model to account for the multilevel data structure. The outcome measure was the number of COVID-19 deaths. This study found that public health, as opposed to acute care provision, was associated with community health and, ultimately, COVID-19 mortality. The study found that population characteristics including more uninsured greater proportion of those over 65 years, more diverse populations, and larger populations were all associated with a higher rate of death. In addition, communities with fewer hospitals were associated with a lower rate of death. When considering region in the United States, the west region showed a higher rate of death than all other regions. The association between some community characteristics and higher COVID-19 deaths demonstrated that access to health care, either for COVID-19 infection or worse health from higher disease burden, is strongly associated with COVID-19 deaths. Thus, to be better prepared for potential future pandemics, a greater emphasis on public health infrastructure is needed.

Fireside Chat on the Asian American, Native Hawaiian, and Pacific Islander Special Edition of the Health Equity Journal Featuring Authors.

Fireside Chat on the Asian American, Native Hawaiian, and Pacific Islander Special Edition of the Health Equity Journal Featuring Authors.

Racism in public health services: A research agenda.

Despite racism and its impact on health inequities being increasingly studied in health care settings, racism in public health services has so far been neglected in public health research. Studying racism in public health services provides many opportunities to explore the relationship between racism and health protection. We identify several research themes to be explored on (1) non-stigmatizing and community-driven risk communication, (2) surveillance by public health authorities of racialized minority groups, (3) racism experiences in everyday interactions with public health authorities, (4) legal consequences of encounters with public health authorities and (5) public health infrastructure, structural racism and the intersectionality of marginalization. Tackling these research themes will help to start building an evidence base on how racism interferes with equitable health protection and how to dismantle it.

Governmental public health in Taiwan.

A healthy and safe public health environment is a fundamental responsibility of government; achieving it requires collaboration across multiple sectors. Public health services include, for example, vaccination and quarantine for infectious diseases; health promotion, such as anti-smoking campaigns for noncommunicable diseases; and health insurance for universal health coverage. All these services require intersectoral actions in which the government must play a fundamental role, either partially or totally. The Taiwanese outlook on governmental public health infrastructure and professionalization of public health is given in this paper. It also describes the national governmental public health measures that were employed during the Covid-19 pandemic and discusses the challenges ahead for the country's governmental public health. Governmental public health is essential and should not be affected by changes in political forms or socioeconomic development. Instead, effective governmental public health will promote these developments while protecting citizens' right to health.

‘Forced to Become a Community’: Encampment Residents’ Perspectives on Systemic Failures, Precarity, and Constrained Choice

Homelessness is a serious public health concern with devastating consequences for health and wellbeing of homeless people. Visible signs of homelessness often appear in the form of encampments or tent cities. Such sites often raise controversies about public health and safety without attention to the structural, systemic and individual factors that contribute to their existence, including deficits in basic determinants of health and a failure to protect human rights to housing. The purpose of this paper is to explore the conditions that contribute to homeless encampments and ongoing issues of precarity, and right to housing from the perspective of residents of one encampment. The data set was comprised of 47 affidavits taken from 33 people from one tent city in Victoria, British Columbia (BC) in anticipation of legal action to remove residents and their belongings in 2016. We used Braun and Clarke’s (2006) approach to thematic analysis to identify, analyze and report patterns within the data. Residents spoke to systemic failures within the homeless sector itself as a factor in decisions to live in an encampment. Participants highlighted the challenges of ‘being chained to a backpack’ with nowhere to go and the impact of bylaws and policing on their health and well being. They acknowledged that while living in an encampment is a last resort it is often a better option than the streets or shelters with the benefits of a community, albeit a forced one with ongoing precarity. Public health responses to encampments should focus on centring human rights to adequate housing including self-determination and access to determinants of health. Such responses are aligned with public health commitments to health equity and social justice and require public health infrastructure.

Value of project management during a crisis: Successes and lessons from three large projects in Qatar

Background: The coronavirus disease 2019 (COVID-19) pandemic has tested the limits of national public health infrastructures to an unprecedented extent. A huge challenge has been regarding how to safely manage large public gatherings and how to efficiently administer vaccines to a large population. Method: We evaluated three case studies in project management implemented by the Primary Healthcare Corporation (PHCC) over the course of 2020 and 2021, including: COVID-19 screening for the HH Amir Cup and Asian Football Confederation (AFC) Finals 2020, the FIFA Club World Cup 2020, and finally Qatar's National COVID-19 Mass Vaccination Project in the Qatar National Convention Centre (QNCC) in 2021. Results: The key themes arising from all the three projects include the importance of developing a strategic plan, project management planning, clarifying and communicating roles and responsibilities, situational decision making, strong leadership, flexibility, result orientation in implementing the project, strong logistical support for providing necessary resources on the ground, and ensuring that staff at all levels are fully supported in performing their duties. In addition, the project management team was successful in building knowledge and experience across events with each successive project benefitting from lessons learned from previous projects. As a result of the strong record of project management established over the course of these experiences, PHCC was able to successfully manage the mass vaccination project with a high level of efficiency in comparison to similar national programs implemented elsewhere, both regionally and globally. Conclusion: The successful implementation of these projects, maintaining a high level of client and staff safety and satisfaction, demonstrates the value of project planning and continuous monitoring in successful implementation even in the context of uncertain conditions such as a global pandemic. Public and community health authorities may benefit by applying similar principles as the COVID-19 pandemic continues to unfold.

Commentary] #CapTheCrossBronx: Grassroots Advocacy & Public Health Research to Secure Federal Funding for Reimagining the Cross Bronx Expressway (Policy & Practice Commentary)

The Cross Bronx Expressway is perhaps one of the greatest threats to the health of Bronx residents today. It is a major source of air pollution, noise pollution, and economic malaise. These threats can be mitigated with deck parks over the expressway. While deck parks are not a new idea, it was not until there was hard data on the damage that the expressway was doing to the health and economic well-being of local residents that policymakers had a reason to listen. The Cross Bronx Expressway presents a rare example of clear-cut translation of quantitative research into social policy. In this commentary, we discuss how a study on the cost-effectiveness of placing deck parks on a freeway translated into a grass-roots campaign to secure federal funding for a major public health infrastructure project.

Service delivery at Title X sites in Texas during the COVID-19 pandemic.

The important role of Title X sites in supporting publicly funded reproductive healthcare was elevated during the COVID-19 pandemic, as many people experienced economic uncertainty and changed their fertility preferences. In this study, we assessed changes in service delivery during the first year of the COVID-19 pandemic at Title X-supported sites in Texas, a large state with a high uninsured rate and a diverse Title X network. Using surveys of Title X-funded organizations in Texas from April and November 2020, we examined the percentage of organizations reporting service modifications. With administrative data on 507,947 client encounters between March 2019 and March 2021, we assessed change in client volume at the onset of the pandemic and evaluated the association between regional COVID-19 case rates and the provision of key Title X services. In April 2020, most organizations (78%) limited in-person operations while implementing telehealth (74%) and contactless contraception (67%). Network-wide encounter volume declined by 26% at pandemic onset (incidence rate ratio [IRR]=0.74, 95% confidence interval [CI]=0.65, 0.84). Health departments experienced the steepest declines in encounter volume (IRR=0.43, 95% CI=0.36-0.50). Weekly encounters, particularly for long-acting reversible method placement/removal and sexually transmitted infection testing, decreased as COVID-19 rates increased. Investment in public health infrastructure, including providing robust support to health departments as well as rebuilding and expanding the Title X network, is essential to safeguarding access to publicly funded reproductive healthcare during and after the pandemic.

Multiplexed rapid antigen tests developed using multicolored nanoparticles and cross-reactive antibody pairs: Implications for pandemic preparedness

Global public health infrastructure is unprepared for emerging pathogen epidemics, in part because diagnostic tests are not developed in advance. The recent Zika, Ebola, and SARS-CoV-2 virus epidemics are cases in point. We demonstrate here that multicolored gold nanoparticles, when coupled to cross-reactive monoclonal antibody pairs generated from a single immunization regimen, can be used to create multiple diagnostics that specifically detect and distinguish related viruses. The multiplex approach for specific detection centers on immunochromatography with pairs of antibody-conjugated red and blue gold nanoparticles, coupled with clustering algorithms to detect and distinguish related pathogens. Cross-reactive antibodies were used to develop rapid tests for i) Dengue virus serotypes 1–4, ii) Zika virus, iii) Ebola and Marburg viruses, and iv) SARS-CoV and SARS-CoV-2 viruses. Multiplexed rapid antigen tests based on multicolored nanoparticles and cross-reactive antibodies and can be developed prospectively at low cost to improve preparedness for epidemic outbreaks.

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.

Enhancing the Applied Epidemiology Workforce: The Impact of the 2021 Epidemiology Capacity Assessment on CSTE's Workforce Priorities.

The Council of State and Territorial Epidemiologists (CSTE) conducted the seventh Epidemiology Capacity Assessment (ECA) from January to April 2021 in state and territorial health departments. The ECA serves to enumerate the applied epidemiology workforce and evaluate workforce capacity across the nation. The results of the ECA demonstrated a need for additional epidemiologists across jurisdictions and challenges of maintaining a trained workforce and improving public health infrastructure. The results of the ECA serve as the foundation for CSTE's workforce priorities, which focus on transforming applied epidemiology by promoting the field as a career opportunity, recruitment, and retention strategies, upskilling the workforce, and enhancing infrastructure. CSTE has outlined current and future workforce priorities, and these priorities contribute to a larger strategy to transform the field and enhance applied epidemiology capacity nationwide. This report describes the programmatic actions taken by CSTE in response to the results of the 2021 ECA.

Overcoming barriers and improving public health nursing practice.

Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N=491). Our study identified an older, very experienced, and well-educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision-making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded.