Public Health Trends Research Articles

Challenges and Opportunities

In this article, the authors consider the future possibility of public administration in South Africa being transformed by artificial intelligence (AI). It discusses the difficulties and advantages of AI/ML in this set up. They can use artificial intelligence (AI) to enhance the productivity of the public sector, quality in decision, and contribute to people's participation. The results show that AI can reduce paperwork, anticipate public health trends, make recommendations for people to get the best chance of recovery, and even optimise resource allocation – all with a view towards improving service delivery and governance. Problems with infrastructure, gaps in digital access, as well as scarcity of AI expertise within the public service work against any real integration of artificial intelligence. The study underscores the significance of strategic planning, large-scale infrastructural investments, and robust policy reforms in order to harness the full range of benefits from artificial intelligence (AI) with a fair share accruing to all.

Trends and inequalities in the use of deworming medication during pregnancy in Sierra Leone, 2008–2019

BackgroundIntestinal worm infections are a significant public health concern for pregnant women in low- and middle-income countries. These infections can lead to anaemia, malnutrition, and adverse pregnancy outcomes, including premature birth and low birth weight. Deworming medication during pregnancy is a safe and effective strategy to prevent these complications and improve maternal and child health. This study aims to investigate the trends and inequalities in the use of deworming medication during pregnancy among women in Sierra Leone between 2008 and 2019.MethodsThe study utilised data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. We used the Health Equity Assessment Toolkit developed by the World Health Organisation to calculate various measures of inequality, including difference, ratio, population attributable risk, and population attributable fraction. An inequality assessment was conducted for five stratifiers: age, economic status, level of education, place of residence, and sub-national province.ResultsThe prevalence of deworming medication during pregnancy was 43.8% in 2008, 72.4% in 2013, and 83.5% in 2019 in Sierra Leone. There was a decrease in age-related inequality from a difference of 3.7% in 2008 to −0.8% in 2019. Economic-related inequality increased from a difference of −8.5% in 2008 to −8.2% in 2019. Both population attributable fraction and population attributable risk were zero in all survey years for economic status, indicating no improvement in the setting average without economic-related inequality. Inequality in education increased from a difference of -8.9% in 2008 to −8.4% in 2019 and decreased from a difference of −2.6% in 2008 to –5.5% in 2019 for place of residence. Provincial inequality decreased from a difference of 29.5% in 2008 to 11.8% in 2019. The population attributable risk for province reveals that the setting average could have been 10.5 percentage points lower in 2008, 8.2 percentage points lower in 2013, and 5.9 percentage points lower in 2019 without provincial inequality.ConclusionThe prevalence of deworming medication use during pregnancy substantially increased from 2008 to 2019 (43.8% to 83.5%) in Sierra Leone. This suggests a positive public health trend in maternal healthcare access and education. Inequalities related to economic status and education increased slightly while age-related, place of residence and provincial inequalities decreased. This indicates an inequitable distribution of this essential healthcare intervention across these stratifiers. The government and policymakers should continue efforts to raise awareness and promote the use of deworming medication during pregnancy.

Enhanced Labeling to Promote Consumption of Nutrient Dense Foods and Healthier Diets.

Background/Objectives: Efforts are underway worldwide to design and deploy food labeling systems that provide consumers with the information needed to shift dietary patterns toward nutrient dense, healthier foods. Despite a compelling need for progress, worrisome public health trends persist that are rooted in the popularity of unhealthy, heavily processed foods. Methods: The nutrition and health-related content on the packaging of nine common foods sold in the US and Europe is analyzed and compared. The current scope of nutrient-specific messaging is characterized, including messages highlighting health-related benefits stemming from the mix and levels of mostly macronutrients in food products. Results: An average of 6.9 unique nutrition-related messages appear on the packaging of nine US food products, while EU food products contain an average of 5.0. Messaging around the ingredients in food products accounts for the largest share, e.g., "100% whole grain", "Vegan", and "No artificial preservatives". The macronutrients of fat, fiber, cholesterol, salt, sugar, and protein are the focus of most messaging around health benefits. The degree of food processing and essential vitamin, mineral, and phytochemical micronutrients receive little or no attention, despite their importance in positive health outcomes. Conclusions: Current nutrition-related labeling fails to inform consumers of the enormous differences in the contribution of food products in meeting nutritional needs. Existing metrics and rating systems do not effectively account for the critical relationship between nutrient density and caloric content. Existing metrics and systems do not reflect the impacts of processing on food nutritional quality in ways that provide consumers meaningful information. New concepts, metrics, and label elements are described that could promote healthier dietary patterns. Clear and mandatory nutrition labeling could begin shifting market share toward healthier options, and this could trigger and guide changes in manufactured food recipes that make brand-name products healthier, benefiting all consumers.

Analysis of Profiles of Supporters of Conspiracy Narratives about Vaccination Against COVID-19 on a Social Network

The article analyzes the socio-demographic characteristics and value-worldview self-positioning of the distributors of conspiracy narratives (“conspiracy theories”) about vaccination against COVID-19 on the Russian social network “VK”. The research material consists of 33,674 profiles of VK users who published at least two messages during the pandemic that explicate the stated narrative. The collection and analysis of the material was carried out using big data analysis technologies. The purpose of the study is to determine whether it is possible to identify typical socio-demographic and ideological traits of anti-vaccer conspiracy theorists, which to a certain extent explain their penchant for conspiracy thinking. The results obtained refute the marginal dominance of conspiracy theorists in a pandemic situation. Versions popular in the scientific literature about the predominance of insufficiently educated people among “conspiracy theorists”, or the elderly as more gullible, or women as more suggestible, or residents of villages and small provincial towns as more conservative, etc. are not confirmed by the large-scale empirical studies of large user data. The results of the study may be useful for developing countermeasures and strategies to address public mistrust of institutions and official trends in public health, in particular vaccination policies. The traditional focus on information and educational measures (explanations about the dangers of the disease and the benefits of the vaccine) seems to be ineffective in the context of the emergence of value systems, cognitive distortions, general socio-political tension and other reasons that are still awaiting serious study.

Malaria reporting timeliness analysis and factors associated with delayed notification, 2018-2022, Nepal.

In order to monitor public health trends and identify disease outbreaks early, efficient and reliable notification and surveillance systems are essential. Nepal uses a 1-3-7 malaria surveillance approach. The Short Message System (SMS) -based system for timely notification has been established. However, knowledge gaps exist regarding the timeliness of notification, treatment initiation, and case-based investigations. Hence, this study identifies the timeliness of notification and factors associated with delayed notification. This study used a cross-sectional approach and used secondary malaria surveillance data from Nepal's national malaria elimination program for the period of 2018 to 2022. The study revealed that the majority (79.9%) of malaria cases were male, with a male-to-female ratio of 3.96:1. Occupation was found to be significantly associated with delayed notification. Repatriate workers had 0.60 times lower odds of experiencing delayed notification compared to the reference occupation. Similarly, individuals diagnosed in the Sudurpaschim and Lumbini provinces had significantly lower odds (0.48 and 0.38, respectively) of encountering delayed notification compared to the reference province. Furthermore, relying on a single laboratory tool for malaria diagnosis (either RDT or microscopy only) was significantly associated with delayed notification. Individuals diagnosed solely with RDT or microscopy had 2.04 and 1.79 times higher odds of experiencing delayed notification, respectively, compared to those diagnosed using both laboratory tools. This study provides insight into the timeliness of surveillance system approach by assessing delayed notification and the factors associated with it. No delays are identified in median notification, treatment time and in case investigation. Improvement in the timeliness of malaria reporting over the years was observed. Provinces with high burden of malaria and repatriate workers showed lower delayed notification and conversely, cases diagnosed with single laboratory tool showed delayed notification time.

Analysis Research Public Health Trends with the RE-AIM Model and VOSviewer : A Literature Review

Abstract This study uses the VOSviewer tool to conduct research mapping analysis in order to examine public health research using the RE-AIM Framework. Descriptive analysis is used with a quantitative bibliometric approach in this research strategy. Based on Web of Science search results, the research data was acquired with the keywords "sanitation, public health, RE-AIM". From the data produced in the last five years (2017–2022), A total of 279 scholarly articles were acquired. The findings demonstrated that each year, more study has been conducted on public health and RE-AIM, and the topic of sanitation and RE-AIM has never been conducted. In conclusion, Currently, research on the subject of public health and RE-AIM is worthwhile, and it involves research that is still infrequently done. It is therefore anticipated that this research will serve as a guide for selecting the research topic Keywords : Bibliometrics, VOSviewer, Public Health, RE-AIM

Metagenomic profiling of raw wastewater in Portugal highlights microbiota and resistome signatures of public health interest beyond the usual suspects

In response to the rapid emergence and dissemination of antimicrobial resistant bacteria (ARB) and genes (ARGs), integrated surveillance systems are needed to address antimicrobial resistance (AMR) within the One Health Era. Wastewater analyses enable biomarker monitoring at the sewershed level, offering timely insights into pathogen circulation and ARB/ARGs trends originating from different compartments. During two consecutive epidemic waves of the COVID-19 pandemic in Portugal, taxonomic and functional composition of raw urban wastewater from two wastewater treatment plants (WWTPs) representing one million in equivalent population, located in the main urban areas of the country, were profiled by shotgun metagenomics. Hospital wastewater from two central hospitals located in the WWTPs catchment areas were also sequenced. The resistome and virulome were profiled using metagenomic assemblies without taxonomic constraint, and then specifically characterized for ESKAPE pathogens.Urban and hospital wastewater exhibited specific microbiota signatures, Pseudomonadota dominated in the first and Bacteroidota in the latter. Correlation network analyses highlighted 85 (out of top 100) genera co-occurring across samples. The most frequent ARGs were classified in the multidrug, tetracyclines, and Macrolides, Lincosamides, Streptogramins (MLS) classes. Links established between AMR determinants and bacterial hosts evidenced that the diversity and abundance of ARGs is not restricted to ESKAPE, being also highly predominant among emergent enteropathogens, like Aeromonas and Aliarcobacter, or in the iron (II) oxidizer Acidovorax. The Aliarcobacter genus accumulated high abundance of sulphonamides and polymyxins ARGs, while Acinetobacter and Aeromonas hosted the highest abundance of ARGs against beta-lactams. Other bacteria (e.g. Clostridioides, Francisella, Vibrio cholerae) and genes (e.g. vanA-type vancomycin resistance) of public health interest were detected, with targeted monitoring efforts being needed to establish informative baseline data. Altogether, results highlight that wastewater monitoring is a valuable component of pathogen and AMR surveillance in healthy populations, providing a community-representative snapshot of public health trends beyond priority pathogens.

Sentiment Analysis Based on Machine Learning Techniques: A Comprehensive Review

In the landscape of digital communication, sentiment analysis stands out as a pivotal technology for deciphering the vast troves of unstructured text generated online. When integrated with machine learning, sentiment analysis transforms into a powerful tool capable of distilling insights from complex human emotions and opinions expressed across social media, reviews, and forums. This review paper embarks on a thorough exploration of the integration of machine learning techniques with sentiment analysis, shedding light on the latest advancements, challenges, and applications spanning various sectors including public health, finance, and consumer behavior. It meticulously examines the role of machine learning in elevating sentiment analysis through improved accuracy, adaptability, and depth of analysis. Furthermore, the paper discusses the implications of these technologies in understanding consumer sentiment, tracking public health trends, and forecasting market movements. By synthesizing findings from seminal studies and cutting-edge research, this review not only charts the current landscape but also forecasts the trajectory of sentiment analysis. It underscores the necessity for ongoing innovation in machine learning models to keep pace with the evolving digital discourse. The insights presented herein aim to guide future research endeavors, highlight the transformative impact of machine learning on sentiment analysis, and outline the potential for new applications that could benefit society at large.

Factors influencing smartwatch use and comfort with health data sharing: a sequential mixed-method study protocol

IntroductionSmartwatches have become ubiquitous for tracking health metrics. These data sets hold substantial potential for enhancing healthcare and public health initiatives; it may be used to track chronic health conditions,...

“Learn to Function in the System”: The Organizational Socialization of Urban Physical Educators

Purpose: The purpose of this study was to explore how urban physical educators’ experiences influence their motivations toward vocational persistence emphasizing health and fitness. Methods: Participants included 16 urban physical educators who participated in semistructured interviews about their experiences teaching in urban settings. For minority youths, who predominantly attend urban public schools, fitness rates are lower than the national average. Physical education has been discussed as a potential solution to combating this public health trend; however, considering Common Core reforms in public education by which health and physical education has been de-emphasized as a curricular requirement, scholars are pursuing knowledge of how the experiences of urban physical educators are evolving. Using occupational socialization as the operating theoretical framework, this study seeks to explore how 16 urban physical educators’ experiences are evolving with the changes in public education, including administrative support and other indicators of marginalization and attrition. Results: Qualitative data analysis resulted in the construction of six themes which suggest that teaching students to develop and maintain a healthy lifestyle remains a powerful motivator for urban physical educators’ persistence despite feelings of marginalization and burnout. Conclusions: The authors provide practical suggestions for practitioners and scholars to overcome feelings of marginalization and lack of resources.

Abstract WP277: Stroke Etiology in Young Adults With Substance Abuse

Introduction: Recent public health trends suggest increasing rates of substance abuse among young people. Substance use has been associated with an increased risk of stroke, and specifically, cocaine use is known to more likely cause lacunar and cardioembolic strokes. However, less is known about the stroke etiology with other substances. Methods: We conducted a retrospective review of stroke patients between the ages of 18 to 50 years presenting to our Young Stroke Center between April 2022 through August 2023. For each case, data including basic demographics and medical history were collected, and stroke etiology was determined by a vascular neurologist. Patients with substance use at the time of stroke were compared to all non-substance use related stroke and analyzed with respect to TOAST stroke etiology. Substance use was defined as use of opioids, cocaine, marijuana, or alcohol abuse. Analysis was performed with logistic regression adjusting for age, sex, and race. Results: Of 187 patients in the registry, 25 patients had substance use at time of stroke compared with 162 patients with non-substance use related stroke. There were 10 marijuana, 4 opioid, 0 cocaine, 3 alcohol abuse and 8 polysubstance use (including 3 cocaine) cases. There were no significant differences in age at time of stroke (36.9 ± 7.1 vs. 38.8 ± 8.2 years) and race (50.0% vs. 53.4% Black) between substance use and non-substance use related stroke groups, respectively. There was a significantly higher proportion of males with substance use (62.5% vs. 31.9% male; OR [95% CI]: 4.0 [1.6-10.0]). In the substance use group, a higher proportion had cardioembolic stroke etiology (20.8% vs. 9.2%; OR [95% CI]: 4.1 [1.2-14.0]); however, there was no significant difference with respect to the other TOAST stroke etiologies. In patients with active substance use and cardioembolic stroke etiology, heart failure with reduced ejection fraction and atrial fibrillation were the etiologies found. Conclusion: Our findings indicate that among young individuals with active substance use at the time of their stroke, cardioembolic etiology appears to be more likely than in young stroke patients without substance use. This underscores the need for comprehensive cardiac evaluation in this population.

Ultra-processed food and non-communicable diseases in the United Kingdom: A narrative review and thematic synthesis of literature.

The social and economic constructs of the United Kingdom (UK) provide a fertile food environment for the dramatic expansion in the ultra-processed food (UPF) market, driving increased UPF consumption. This has coincided with the significant increase in the incidence and prevalence of non-communicable diseases (NCDs) such as obesity, type 2 diabetes, cardiovascular disease, and cancer, with an inherent impact on morbidity and mortality. Our review aims to assess the current epidemiological and public health trends in the United Kingdom, specifically examining consumption of UPFs and subsequent development of NCDs, summarizing existing meta-analytical and experimental approaches. First, we address important socioeconomic and psychosocial domains that may contribute to increased availability and consumption of UPF. Additionally, we explore the putative mechanistic basis for the association between UPFs and NCDs: partly attributable to their energy density, the macro- and micronutrient composition (including high refined carbohydrate, saturated, and trans fats composition, in addition to low fiber and protein content), and artificially engineered additives and other compounds that adversely affect health in inadequately researched pathophysiological pathways. This review highlights the importance of promoting minimally processed diets to both clinical and political decision makers.

Public health trends in neurologically relevant infections: a global perspective

Neuroinfectious diseases represent a growing threat to public health globally. Infections of the central nervous system remain challenging to diagnose and treat, partially driven by the fact that a high proportion of emerging pathogens are capable of causing neurological disease. Many of the trends driving the emergence of novel pathogens, including climate change, ecological degradation, urbanization, and global travel, have accelerated in recent years. These circumstances raise concern for the potential emergence of additional pathogens of pandemic potential in the coming years, necessitating a stronger understanding of the forces that give rise to the emergence and spread of neuroinvasive pathogens and a commitment to public health infrastructure to identify and treat these diseases. In this review, we discuss the clinical and epidemiological features of three types of emerging neuroinvasive pathogens of significant public health consequences that are emblematic of key ongoing trends in global health. We first discuss dengue viruses in the context of climate change, considering the environmental factors that allow for the expansion of the geographic range and seasonal population of the viruses’ vector. We then review the rising prevalence of fungal meningitis secondary to medical tourism, a trend representative of the highly globalized nature of modern healthcare. Lastly, we discuss the increasing prevalence of antibiotic-resistant neurological infections driven by the intersection of antibiotic overuse in medical and agricultural settings. Taken together, the rising prevalence of these conditions necessitates a recommitment to investment in public health infrastructure focused on local and global infectious disease surveillance coupled with ongoing development of novel therapeutics and vaccines for emerging pathogens. Such emerging threats also obviate the need to address the root causes driving the emergence of novel infectious diseases, including a sustained effort to address anthropogenic climate change and environmental degradation.

Connecting Humans and Non-Humans

A recent trend in public health campaigns has been to include non-human health data to capture all relevant variables related to human well-being. This specific approach is the foundation of the World Health Organization restructuring in the early 2000s as they adopted the “one health” framework. Politically, this movement is influential and draws significant health funding globally. "One health" is characterized by a multi-disciplinary collaboration between medical, veterinary, and health sciences. Similarly, the post-human turn in medical anthropology recognizes that viewing the non-human contributions to the cultural construction of health as symbolic does not adequately address how non-humans and nature independently contribute to human health realities. Ethnographic studies of the non-human perspective shed light on how humans are not the only beings that influence culturally constructed reality, nor are they exclusively in control of cultural phenomena. Theoretical trends in anthropology and public health seemingly converge; however, an artificial academic barrier between the sciences and social sciences remains. As these two disciplines are coming closer together through their data, breaking down structural barriers that prevent the successful integration of knowledge has potential to improve human health outcomes. Methodological concessions will have to occur on all sides to make the inclusion of the social sciences in public health possible. Doing so can bring academia closer to a comprehensive scientific understanding of human health.

US Infant Pertussis Incidence Trends Before and After Implementation of the Maternal Tetanus, Diphtheria, and Pertussis Vaccine

ABSTRACT Many illnesses can become especially serious when contracted within the first year of life; pertussis remains quite deadly despite recent medical advances in disease prevention. Current guidance on vaccination in the United States includes 3 doses of the DTaP (diphtheria, tetanus toxoid, and acellular pertussis) vaccine beginning at 2 months of age, but this regimen leaves infants younger than that very vulnerable to illness. Research has shown both that vaccinating mothers with tetanus toxoid reduces tetanus, diphtheria, and pertussis (Tdap) between 27 and 36 weeks of gestation significantly reduces instances of pertussis in infants younger than 2 months, and that maternal vaccination rates have risen in the last few years. However, research is lacking in analyzing the relationship between vaccination rates in pregnant mothers and the burden of pertussis in infants in the United States. This study was designed to assess data from 2000 to 2019 and examine the association of Tdap vaccination during pregnancy with trends in infant pertussis. This analysis included data obtained from the National Notifiable Diseases Surveillance System between 2000 and 2019. This included a total of 57,460 cases of pertussis in infants younger than 1 year and a total of 19,322 cases in infants younger than 2 months. The rate of pertussis incidence for infants younger than 2 months in the time period before the implementation of prenatal Tdap was calculated to be 165.3 per 100,000 individuals, with no significant trend observed annually (P = 0.28). After the implementation of routine maternal Tdap, incidence decreased to 80.9 per 100,000 infants between 2017 and 2019. Accounting for both time periods, the mean annual incidence was calculated as 121.8 per 100,000 infants younger than 2 months. Annual incidence also showed a significant decreasing trend in the period after implementation of maternal Tdap vaccination (slope: −14.53 per 100,000 infants per year; P = 0.001). The change in trends before and after this implementation was also significant (P = 0.01). In a slightly older age group of 6 to 12 months of age, mean annual incidence of pertussis was 19.7 per 100,000 infants. In the time period before implementation of maternal Tdap, incidence among infants aged 6 to 12 months was consistently 4 to 12 times less than infants younger than 2 months and did not significantly change after the implementation of the maternal vaccine. Comparing the 2 age groups, there was no significant change in the difference in incidence between infants younger than 2 months and those between 6 and 12 months in the period before the maternal vaccine, and after its implementation, there was a significant decrease in the incidence difference between the 2 groups (P < 0.001). These results suggest an association between the maternal Tdap vaccination and trends of pertussis incidence in infants younger than 2 months. This also indicates a possible reduction in disease burden attributable to maternal Tdap vaccination before delivery. Limitations of this study include limited availability of individual maternal vaccination status, as well as an inability to identify if any infants were vaccinated before the age of 2 months. Further research should focus on clinical impact of the Tdap vaccination in context with the later DTaP vaccination and on analyzing the trends in disease associated with both vaccinations. Clinical guidelines should also be examined to ensure that public health trends and individual health trends are in alignment.

Broad Trends in Public Health and Epidemiology Informatics.

The objective of this study is to highlight innovative research and contemporary trends in the area of Public Health and Epidemiology Informatics (PHEI). Following a similar approach to last year's edition, a meticulous search was conducted on PubMed (with keywords including topics related to Public Health, Epidemiological Surveillance and Medical Informatics), examining a total of 2,022 scientific publications on Public Health and Epidemiology Informatics (PHEI). The resulting references were thoroughly examined by the three section editors. Subsequently, 10 papers were chosen as potential candidates for the best paper award. These selected papers were then subjected to peer-review by six external reviewers, in addition to the section editors and two chief editors of the IMIA yearbook of medical informatics. Each paper underwent a total of five reviews. Out of the 539 references retrieved from PubMed, only two were deemed worthy of the best paper award, although four papers had the potential to qualify in total. The first best paper by pertains to a study about the need for a new annotation framework due to inadequacies in existing methods and resources. The second paper elucidates the use of Weibo data to monitor the health of Chinese urbanites. The correlation between air pollution and health sensing was measured via generalized additive models. One of the primary findings of this edition is the dearth of studies identified for the PHEI section, which represents a significant decline compared to the previous edition. This is particularly surprising given that the post-COVID period should have led to an increased use of information and communication technology for public health issues.

Child Pedestrian Safety.

The field of pedestrian safety has advanced with new evidence related to pediatric pedestrian education, the risks of distracted walking, the benefits of design and programming in safe routes to school, and the emergence of the "Vision Zero" strategy to eliminate all traffic fatalities and severe injuries while increasing safe, healthy, equitable mobility for all. This statement is a revision of the 2009 American Academy of Pediatrics policy statement "Pedestrian Safety" and is accompanied by a technical report (www.pediatrics.org/cgi/doi/10.1542/peds.2023-062508) providing additional detail to support recommendations. This statement is intended to assist practicing pediatricians to offer evidence-based advice to families about the benefits of active transportation and the specific risks and safety precautions to consider for child pedestrians at different ages. For community pediatricians and the American Academy of Pediatrics, the statement provides an overview of specific programs and policies that, if implemented, could foster independent mobility for children while increasing pediatric pedestrian safety. This statement identifies trends in public health and urban design relevant to pedestrian safety.

Epidemiology and Prevention of Child Pedestrian Injury.

This report supports policy recommendations in the accompanying policy statement "Child Pedestrian Safety" (www.pediatrics.org/cgi/doi/10.1542/peds.2023-62506). It reviews trends in public health and urban design relevant to pedestrian safety and provides information to assist practicing pediatricians discussing the benefits of active transportation and the specific risks and safety precautions to consider for child pedestrians at different ages. The report offers the evidence base for which programs and policies that, if implemented, could foster independent mobility for children while increasing pediatric pedestrian safety. Since the previous policy statement was published in 2009, the field of pedestrian safety has advanced with new evidence related to pediatric pedestrian education, the risks of distracted walking, the benefits of design and programming in safe routes to school, and the emergence of the "Vision Zero" public health and safety initiatives to prevent all serious and fatal transportation injuries.

University Student Food Insecurity as a Form of Structural Violence

Studies of college student food insecurity emphasize the personal characteristics of students and their individual health outcomes, reflecting trends in public health to encourage individual lifestyle changes. More recent work in public health diverges from this focus to encourage conceptualizing health issues not as individual failings but rather as failures of larger systems that are necessary to support health and well-being, implicating the availability of grocery stores, adequate wages, and other contextual barriers to healthy eating. We argue that college student food insecurity should not be conceptualized in terms of the factors affecting individual students but in terms of how the institutional context of the university both creates the conditions under which some students are more likely to be food insecure and also neglects to address these structural failures. Using the framework of structural violence to examine specific ways that these failures occur and are made invisible in the case of college student hunger, we examine recent changes in universities. Unfortunately, these efforts support the focus on individual efforts and success, which contribute to higher rates of food insecurity for students than the general population.

Views on increased federal access to state and local National Syndromic Surveillance Program data: a nominal group technique study with state and local epidemiologists

BackgroundUS public health authorities use syndromic surveillance to monitor and detect public health threats, conditions, and trends in near real-time. Nearly all US jurisdictions that conduct syndromic surveillance send their data to the National Syndromic Surveillance Program (NSSP), operated by the US. Centers for Disease Control and Prevention. However, current data sharing agreements limit federal access to state and local NSSP data to only multi-state regional aggregations. This limitation was a significant challenge for the national response to COVID-19. This study seeks to understand state and local epidemiologists’ views on increased federal access to state NSSP data and identify policy opportunities for public health data modernization.MethodsIn September 2021, we used a virtual, modified nominal group technique with twenty regionally diverse epidemiologists in leadership positions and three individuals representing national public health organizations. Participants individually generated ideas on benefits, concerns, and policy opportunities relating to increased federal access to state and local NSSP data. In small groups, participants clarified and grouped the ideas into broader themes with the assistance of the research team. An web-based survey was used to evaluate and rank the themes using five-point Likert importance questions, top-3 ranking questions, and open-ended response questions.ResultsParticipants identified five benefit themes for increased federal access to jurisdictional NSSP data, with the most important being improved cross-jurisdiction collaboration (mean Likert = 4.53) and surveillance practice (4.07). Participants identified nine concern themes, with the most important concerns being federal actors using jurisdictional data without notice (4.60) and misinterpretation of data (4.53). Participants identified eleven policy opportunities, with the most important being involving state and local partners in analysis (4.93) and developing communication protocols (4.53).ConclusionThese findings identify barriers and opportunities to federal-state-local collaboration critical to current data modernization efforts. Syndromic surveillance considerations warrant data-sharing caution. However, identified policy opportunities share congruence with existing legal agreements, suggesting that syndromic partners are closer to agreement than they might realize. Moreover, several policy opportunities (i.e., including state and local partners in data analysis and developing communication protocols) received consensus support and provide a promising path forward.