State Health Departments Research Articles

Rabies surveillance in the United States during 2022.

To provide comprehensive epidemiological information about the distribution and occurrence of rabies during 2022 in the US, Canada, and Mexico. The US National Rabies Surveillance System collected 2022 animal rabies data from US state and territorial public health departments and USDA Wildlife Services. Temporal and geographic analyses were conducted to evaluate trends in animal rabies cases. During 2022, 54 US jurisdictions reported 3,579 animal rabies cases, reflecting a 2.3% decline from 3,663 cases reported in 2021. Six states collectively reported > 50% of animal rabies cases: Texas (395 [11.0%]), Virginia (337 [9.4%]), Pennsylvania (329 [9.2%]), New York (267 [7.5%]), North Carolina (264 [7.4%]), and California (241 [6.7%]). Out of the total reported rabies animal cases, 3,234 (90.4%) were attributed to wildlife, with bats (1,218 [34.0%]), raccoons (1,014 [28.3%]), skunks (660 [18.4%]), and foxes (269 [7.5%]) representing the primary hosts confirmed with rabies. Rabid cats (222 [6.2%]), cattle (42 [1.2%]), and dogs (50 [1.4%]) constituted > 90% of reported domestic animal rabies cases. In 2022, there was an increase in the number of animal samples submitted for rabies testing in the US and Canada. A notable geographic expansion of gray fox rabies virus variant was detected in the US. Three human rabies deaths due to vampire bat rabies infection occurred in Mexico; none were reported from the US and Canada. Laboratory diagnosis of rabies in animals is critical to ensure judicious use of human rabies postexposure prophylaxis.

Infodemics and Vaccine Confidence: Protocol for Social Listening and Insight Generation to Inform Action.

In the fall of 2020, the COVID-19 infodemic began to affect public confidence in and demand for COVID-19 vaccines in the United States. While polls indicated what consumers felt regarding COVID-19 vaccines, they did not provide an understanding of why they felt that way or the social and informational influences that factored into vaccine confidence and uptake. It was essential for us to better understand how information ecosystems were affecting the confidence in and demand for COVID-19 vaccines in the United States. The US Centers for Disease Control and Prevention (CDC) established an Insights Unit within the COVID-19 Response's Vaccine Task Force in January 2021 to assist the agency in acting more swiftly to address the questions, concerns, perceptions, and misinformation that appeared to be affecting uptake of COVID-19 vaccines. We established a novel methodology to rapidly detect and report on trends in vaccine confidence and demand to guide communication efforts and improve programmatic quality in near real time. We identified and assessed data sources for inclusion through an informal landscape analysis using a snowball method. Selected data sources provided an expansive look at the information ecosystem of the United States regarding COVID-19 vaccines. The CDC's Vaccinate with Confidence framework and the World Health Organization's behavioral and social drivers for vaccine decision-making framework were selected as guiding principles for interpreting generated insights and their impact. We used qualitative thematic analysis methods and a consensus-building approach to identify prevailing and emerging themes, assess their potential threat to vaccine confidence, and propose actions to increase confidence and demand. As of August 2022, we have produced and distributed 34 reports to >950 recipients within the CDC and externally. State and local health departments, nonprofit organizations, professional associations, and congressional committees have referenced and used the reports for learning about COVID-19 vaccine confidence and demand, developing communication strategies, and demonstrating how the CDC monitored and responded to misinformation. A survey of the reports' end users found that nearly 75% (40/53) of respondents found them "very" or "extremely" relevant and 52% (32/61) used the reports to inform communication strategies. In addition, our methodology underwent continuous process improvement to increase the rigor of the research process, the validity of the findings, and the usability of the reports. This methodology can serve as a diagnostic technique for rapidly identifying opportunities for public health interventions and prevention. As the methodology itself is adaptable, it could be leveraged and scaled for use in a variety of public health settings. Furthermore, it could be considered beyond acute public health crises to support adherence to guidance and recommendations and could be considered within routine monitoring and surveillance systems.

Don’t Read the Comments: Discourse About COVID-19 Vaccines in a State Health Department's Social Media Comments

Don’t Read the Comments: Discourse About COVID-19 Vaccines in a State Health Department's Social Media Comments

The Use of the CDC Preventive Health and Health Services Block Grant to Address Social Determinants of Health to Advance Health Equity.

State public health departments use federal funding to examine and address social determinants of health (SDOH) within their communities to improve health and advance health equity. Yet, most federal funding is categorical (ie, funding used for a specific program or narrow purpose), which can create barriers to addressing social and structural drivers of inequity. The Preventive Health and Health Services Block Grant (PHHS Block Grant) is a flexible funding mechanism that provides health departments the latitude to identify and fund initiatives that address local public health needs. It is unclear, however, to what extent health departments use this flexible resource to incorporate SDOH into their programs. Cross-sectional, descriptive analysis of state health department PHHS Block Grant program administrative data. This study examined PHHS Block Grant budgets and workplans for the federal Fiscal Year 2021 to assess whether state health departments aligned their grant-funded program with the national objectives associated with the Healthy People 2030 SDOH Framework. Forty-seven states and the District of Columbia were included in this study. Percent of states that used PHHS Block Grant funds to address SDOH; proportion of funding allocated to address SDOH; percentage of programs that addressed SDOH. Three-fourths (75%) of states allocated funds to 97 programs aligning with at least 1 Healthy People 2030 SDOH-related objective. Fifty of the programs were fully or primarily funded by the PHHS Block Grant. Results also show that as the states' PHHS Block Grant funding level increased so did the percent of states that allocated funding toward SDOH programs. This study shows that state health departments are using the PHHS Block Grant to address SDOH, and that the grant plays an important funding role for these programs. States are incorporating the grant into their funding strategies to address SDOH.

Spatiotemporal Cluster Detection for COVID-19 Outbreak Surveillance: Descriptive Analysis Study.

During the peak of the winter 2020-2021 surge, the number of weekly reported COVID-19 outbreaks in Washington State was 231; the majority occurred in high-priority settings such as workplaces, community settings, and schools. The Washington State Department of Health used automated address matching to identify clusters at health care facilities. No other systematic, statewide outbreak detection methods were in place. This was a gap given the high volume of cases, which delayed investigations and decreased data completeness, potentially leading to undetected outbreaks. We initiated statewide cluster detection using SaTScan, implementing a space-time permutation model to identify COVID-19 clusters for investigation. To improve outbreak detection, the Washington State Department of Health initiated a systematic cluster detection model to identify timely and actionable COVID-19 clusters for local health jurisdiction (LHJ) investigation and resource prioritization. This report details the model's implementation and the assessment of the tool's effectiveness. In total, 6 LHJs participated in a pilot to test model parameters including analysis type, geographic aggregation, cluster radius, and data lag. Parameters were determined through heuristic criteria to detect clusters early when they are smaller, making interventions more feasible. This study reviews all clusters detected after statewide implementation from July 17 to December 17, 2021. The clusters were analyzed by LHJ population and disease incidence. Clusters were compared with reported outbreaks. A weekly, LHJ-specific retrospective space-time permutation model identified 2874 new clusters during this period. While the weekly analysis included case data from the prior 3 weeks, 58.25% (n=1674) of all clusters identified were timely-having occurred within 1 week of the analysis and early enough for intervention to prevent further transmission. There were 2874 reported outbreaks during this same period. Of those, 363 (12.63%) matched to at least one SaTScan cluster. The most frequent settings among reported and matched outbreaks were schools and youth programs (n=825, 28.71% and n=108, 29.8%), workplaces (n=617, 21.46% and n=56, 15%), and long-term care facilities (n=541, 18.82% and n=99, 27.3%). Settings with the highest percentage of clusters that matched outbreaks were community settings (16/72, 22%) and congregate housing (44/212, 20.8%). The model identified approximately one-third (119/363, 32.8%) of matched outbreaks before cases were associated with the outbreak event in our surveillance system. Our goal was to routinely and systematically identify timely and actionable COVID-19 clusters statewide. Regardless of population or incidence, the model identified reasonably sized, timely clusters statewide, meeting the objective. Among some high-priority settings subject to public health interventions throughout the pandemic, such as schools and community settings, the model identified clusters that were matched to reported outbreaks. In workplaces, another high-priority setting, results suggest the model might be able to identify outbreaks sooner than existing outbreak detection methods.

Development, Evaluation, and Initial Findings of New York State Department of Health Community Drug Checking Pilot Programs.

The illicit drug landscape in the United States is dynamic, featuring a risky and erratic drug supply. Drug checking programs (DCP) have been successfully implemented and studied extensively in Canada and Europe but are scarce in the United States. Integrating DCP at harm reduction programs provides an opportunity to engage people at the point-of-care and deliver a combination of harm reduction services, access to healthcare services, and linkages to treatment. The New York State Department of Health (NYSDOH) developed and supports operation of 8 pilot community DCP sites throughout the state. The DCP were trained to utilize Fourier-transform infrared spectroscopy (FTIR) technology to deliver real-time results to participants. The NYSDOH community DCP pilot began development in 2022. Partnerships were formed across multiple domains including other DCP, universities, forensic laboratories, syringe service and harm reduction programs, and legal and regulatory offices within the NYSDOH. The first pilot sites began operating in mid-2023 and program expansion is on-going. Evaluation staff were extensively engaged in development and implementation phases. Qualitative evaluation focused on barriers, facilitators, and lessons learned from program staff and technicians. Quantitative evidence was gathered to assess the reach of the DCP and accuracy of results attained by drug checking technicians during their training periods. Drug checking results helped characterize the illicit drug supply. Development and implementation of DCP in NYS was facilitated by strong partnerships across sectors including public health and harm reduction. DCP may involve diverse partners who do not regularly collaborate, and health departments are positioned to build relationships and convene partners for program implementation. Evaluation findings highlight the importance of facilitating on-going training and technical assistance to DCP for quality assurance. The initial successes and lessons learned from the NYSDOH DCP demonstrate state public health departments' ability to successfully deploy this innovative harm reduction strategy.

Emergency surgery for traumatic brain injury in geriatric patients

Objectives: Verify the sociodemographic profile of an elderly victim of trauma due to a fall who is admitted to the ICU of a public reference hospital to determine whether there are relationships between his age, comorbidities, length of stay, complications and clinical results. A retrospective analytical study with a quantitative approach was carried out between April and October 2014 in the Intensive Care Unit (ICU) of the Hospital de Base do Distrito Federal, administered by the State Department of Health of the Federal District, DF. Using the TrakCare® computerized medical record, sociodemographic data were found on elderly people hospitalized between the fall of July 2012 and July 2014, including mechanisms of trauma, comorbidities, length of stay, use of invasive devices, vasoactive and sedative drugs, complications and clinical internships. Results: The sample was made up of 52 elderly people, the majority of whom were men and the injury was a fall in height. Lung infection, septic shock, use of blood products and acute renal failure were the main complications. Despite the high mortality observed in the study, the majority of elderly people survived the traumatic event. Male sex, traumatic brain injury (TBI), pulmonary septic shock and dialysis were the main causes of mortality. Conclusion: Falling in height, fractures and severe TBI were extremely common, and most patients had more than one complication during hospitalization. No significant difference was found between age and mortality.

Leveraging a geographic information system (GIS) to identify lung cancer care disparities and opportunities in rural Appalachia.

78 Background: The Rural Appalachian Lung Cancer Screening Initiative is led by the Association of Cancer Care Centers (ACCC) and patient advocacy partners. Recognized by the White House Cancer Moonshot, this initiative seeks to improve lung cancer screening rates by partnering with health systems in rural Appalachia to develop and implement interventions. An 11-county region bordering West Virginia, Virginia, and Kentucky has significantly higher mortality and lung cancer incidence rates than the national rates of 35.0 and 54.0 per 100,000 people, respectively (Table 1). This region was identified as the focus area for the initiative with participation from health systems in Pike County, KY, and Buchanan County, VA. Methods: To understand availability of local resources, ACCC developed an interactive GIS tool that identifies screening and referral locations as well as essential services in the region. Lung cancer screening sites, oncology services, mammography locations, critical access hospitals, NCI-designated cancer centers, federally qualified health centers (FQHCs) and look-alikes, rural health clinics, and primary care/general health services were identified from publicly available data and data requested from state departments of health. Facilities were contacted to verify services when unclear. STATA 18 was used to combine and clean data for upload to Google MyMaps, creating an interactive map. Results: Of the 11 counties, all contain at least 1 FQHC or primary care site. However, 5 of the counties do not have lung cancer screening sites and 7 of the counties do not have oncology service sites (Table). The closest NCI-designated cancer centers to the participating sites are over 140 miles away. Conclusions: While there is a notable presence of primary care, access to lung cancer screening and oncology care is limited. Sites can utilize this map to inform development of interventions by considering potential geographical challenges, identifying referral sites, outreach opportunities, and partners to facilitate lung cancer screening and education. Further, these methods are replicable, and can be used to inform current access to care and improve equitable delivery of lung cancer screening in regions across the U.S. Distribution of lung cancer mortality, incidence, and infrastructure within initiative focus region. Region Mortality*(per 100,000) Incidence*(per 100,000) # Lung Cancer Screening Sites # Oncology Services Sites KY (1 county) 70 109.3 2 2 VA (6 counties) 45.0 – 61.4 42.9 – 68.6 4 3 WV (4 counties) 57.6 – 74.8 100.4 – 111.5 1 0 *Lung & Bronchus, 2016-2020 age-adjusted death rates (KY, VA, WV) and incidence rates (KY, WV). Lung & Bronchus, 2015-2019 age-adjusted incidence rate (VA). Source: statecancerprofiles.cancer.gov.

State-Level Childhood Lead Poisoning Prevention Policies and Practices in the United States: 2022-2023.

The purpose of this analysis is to better understand laws and practices guiding prevention activities in childhood lead poisoning prevention programs funded by the Centers for Disease Control and Prevention (CDC). In 2022, CDC surveyed 62 funded programs using the Awardee Lead Profile Assessment. Information was collected about childhood lead poisoning-related laws and guidance, surveillance and prevention strategies, and program services including at what blood lead levels (BLLs) various activities are performed. Separately, CDC reviewed state health department websites to obtain information on which states implemented CDC's updated blood lead reference value. Awardee Lead Profile Assessment results are only reported for 47 states, the District of Columbia, and Puerto Rico. Almost all programs (96%) have laws requiring reporting of BLLs, and 51% require BLLs be reported electronically to jurisdictional health departments. Most programs (80%) prioritize areas and populations that are high risk for lead poisoning prevention activities. Approximately half of the programs (51%) have a lead elimination plan or goal. Thirty-nine percent of the programs have already implemented policies, laws, or regulations to achieve lead elimination, and 74% are in the Northeast and Midwest regions of the country. As of March 2023, 71% of the programs have implemented CDC's updated blood lead reference value, and most (65%) did so via guidance for health care providers and laboratories for what BLL should initiate case management and other services for lead-exposed children. Almost all programs have mandatory BLL reporting laws, and about two-thirds of the programs updated their BLLs that trigger public health action.

Private well water stewardship in rural Georgia

This study sought to identify the psychosocial influences on the practice of well stewardship behaviors (water testing, water treatment, and well maintenance) in rural Georgia, USA. Three interventions (education, the provision of household water treatment systems [HWTS], and both education and HWTS) were evaluated using a four-group, randomized controlled trial. A total of 64 private well owners completed a pretest measuring psychosocial factors and stewardship behaviors before receiving an intervention. Following a 104-day waiting period, participants completed a posttest and interviews were conducted to identify the barriers and facilitators to use (S1 File). Pretest results showed that 34% of well owners have ever tested their water and that only 25% treat their water before consumption. The education-only intervention showed no influence on stewardship behaviors, resulted in no new water tests and had no impact on psychosocial factors. The HWTS-only intervention had no significant effect on testing and treatment behaviors, though it had a significant effect on abilities (R2 = .87, p< 0.05) and self-regulation (R2 = 1.0, p<0.01). The intervention of both education and HWTS had no effect on testing and no significant effect on treatment behaviors, though had a significant effect on abilities (R2 = .84, p<0.05) and self-regulation (R2 = .93, p<0.05). This study identified three barriers to the use of HWTS: beliefs, knowledge, and functionality. Two factors (piece of mind and ease of use) were identified as facilitators to the use of HWTS. The results of this study indicate that providing water treatment systems does not guarantee use and that current educational efforts provided by state and local health departments may be ineffective.

Determinants of Rabies Post-Exposure Prophylaxis Completion in Sarawak

Objective: Rabies remains persistent in Sarawak despite efforts to control its spread. This study investigates the determinants of rabies post-exposure prophylaxis (PEP) completion among individuals in Sarawak that have been exposed to potential rabies transmission through animal bites.Material and Methods: A retrospective cohort study, using a universal sampling approach was employed, utilizing data from the Sarawak i-Bite System. Binary logistic regression was used to identify significant variables: a p-value<0.05 was considered as statistically significant.Results: The mean age of people having experienced animal bites was 38.1 (S.D.=22.4) years. Most were male (51.6%) and of Chinese ethnicity (37.2%). The predominant sites of animal bites were the upper (53%) and lower limbs (39.5%). Category 3 bite injuries and bites from fully confined pets were the most frequently reported (68.9% and 43.9%, respectively). In total 56.5% of the study population had a complete rabies vaccine regimen as post-exposure prophylaxis, while 5.4% had incomplete vaccinations, and 38% received no vaccination. The majority received treatment at government hospitals (59.1%). The significant determinants of rabies post-exposure prophylaxis completion in Sarawak were the Iban ethnicity (odd ratio (OR)=2.9, 95% confidence interval (CI):1.08-2.44, p-value=0.02), grade 3 bite (OR=3.9, 95% CI=,1.86-4.68, p-value<0.001), pet mixed with stray (OR=2.41, 95% CI=1.32-2.33, p-value<0.001), stray animals (OR=2.41, 95% CI=1.78-3.25, p-value,0.001) and treated in a government hospital (OR=0.63, 95% CI=0.47-0.83, p-value<0.001).Conclusion: This study reported that only 56.5% of patients completed the rabies PEP series. The important determinants of PEP completion status were found to be the Iban ethnicity, bite severity, category of animal, and place of treatment. These findings offer valuable insights to assist the Sarawak State Health Department in prioritizing strategies to enhance the compliance rate, with the ultimate goal of eliminating dog-mediated Rabies deaths by 2030.

Public Maternal Health Dashboards in the United States: Descriptive Assessment.

Data dashboards have become more widely used for the public communication of health-related data, including in maternal health. We aimed to evaluate the content and features of existing publicly available maternal health dashboards in the United States. Through systematic searches, we identified 80 publicly available, interactive dashboards presenting US maternal health data. We abstracted and descriptively analyzed the technical features and content of identified dashboards across four areas: (1) scope and origins, (2) technical capabilities, (3) data sources and indicators, and (4) disaggregation capabilities. Where present, we abstracted and qualitatively analyzed dashboard text describing the purpose and intended audience. Most reviewed dashboards reported state-level data (58/80, 72%) and were hosted on a state health department website (48/80, 60%). Most dashboards reported data from only 1 (33/80, 41%) or 2 (23/80, 29%) data sources. Key indicators, such as the maternal mortality rate (10/80, 12%) and severe maternal morbidity rate (12/80, 15%), were absent from most dashboards. Included dashboards used a range of data visualizations, and most allowed some disaggregation by time (65/80, 81%), geography (65/80, 81%), and race or ethnicity (55/80, 69%). Among dashboards that identified their audience (30/80, 38%), legislators or policy makers and public health agencies or organizations were the most common audiences. While maternal health dashboards have proliferated, their designs and features are not standard. This assessment of maternal health dashboards in the United States found substantial variation among dashboards, including inconsistent data sources, health indicators, and disaggregation capabilities. Opportunities to strengthen dashboards include integrating a greater number of data sources, increasing disaggregation capabilities, and considering end-user needs in dashboard design.

The Maternal and Child Health Workforce: A Snapshot of Current and Future Needs From Public Health WINS 2021.

To summarize and examine data collected from the first-ever Public Health Workforce Interests and Needs Survey Maternal and Child Health (MCH) module. Responses from MCH governmental public health employees in 47 state health departments and 288 local health departments (LHDs) in the United States. Demographic characteristics; 4 measures from the MCH module: the importance of and skill level in 5 MCH competencies in daily work, growth and leadership development opportunities, and additional workforce development needs. The MCH workforce predominantly self-identified as women (91.2%) and as White, non-Hispanic (55.2%). At least 70% of respondents reported MCH competencies as important in their daily work, but only 44% to 57% reported being proficient in those competencies. The MCH workforce in LHDs were less likely than those in state health departments to report being proficient in MCH competencies (adjusted prevalence rate ratio range: 0.83-0.92) or have growth and leadership development opportunities (adjusted prevalence rate ratio range 0.76-0.90). The MCH module highlights a need to further prioritize workforce development efforts for governmental public health staff, especially in LHDs. There is an ongoing need to meet public health professionals where they are and to tailor training models and workforce development plans to account for new and ongoing stressors faced by the workforce.

SynD: Australian synthetic health data community of practice

ObjectivesThe current workflow for health data research in Australia is inefficient. After funding is secured, researchers often face delays of months or years to access the necessary data. Synthetic data could significantly improve the pace and impact of health data research but lacks foundational infrastructure. We aim to develop this infrastructure and support the use of synthetic data to improve data access and research quality across Australia. ApproachWe held two workshops with Australian groups working on synthetic data. The format included participant updates and invited talks on international approaches to synthetic data and health data research. Workshops collected use cases and stimulated discussion on national collaboration. A facilitator then led thematic analysis to draft a consensus roadmap and terms of reference towards national synthetic data infrastructure. ResultsWe recruited 18 participants. Participants were cross sectoral: universities (9), research funding bodies (5), state health departments (4). Represented six states and territories: Queensland (6), New South Wales (3), Victoria (3), Western Australia (3), Australian Capital Territory (2), South Australia (1). Gender: women (11), men (7). The roadmap includes stakeholder engagement, a governance framework, and training events. ConclusionSynD is an Australian community of practice for synthetic health data. Our mission is to unlock the value of health information through synthetic data to advance research, education, innovation and service delivery within the health and care sector. This collaborative effort should ensure a harmonised approach to the safe and effective utilisation of synthetic data to enhance health outcomes across Australia.

Assessment of Public Health Agency and Utility Training Needs for CDC National Wastewater Surveillance System Jurisdictions in the United States.

Since the start of the COVID-19 pandemic, wastewater surveillance hasemerged as a critical tool for tracking the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus and other pathogens in communities throughout the United States. In 2020, the Centers for Disease Control and Prevention (CDC) launched the National Wastewater Surveillance System (NWSS), which partners with state, local, tribal, and territorial health departments to develop and implement wastewater collection and analysis systems and to share data. In 2022, the CDC established the first two NWSS Centers of Excellence to lead its implementation and coordination efforts-one in Colorado (Colorado CoE) and one in Houston (Houston CoE). As the NWSS expands, it is becoming more important to support the training needs of jurisdictions at different stages of developing their wastewater surveillance infrastructure. To evaluate these needs, the Colorado CoE and Houston CoE conducted a needs assessment study of NWSS-funded public health agencies and public utilities departments located in the United States using surveys developed by the Colorado CoE. The results of the surveys showed that although some training needs were universal, it will be most beneficial to develop training modules tailored to the needs of entities that operate wastewater surveillance programs of various sizes, workforce experience levels, and at different stages in the infrastructure development process.

State Department of Health's Equitable Funding Allocation Methodology to Address COVID-19 Health Disparities Among High-Risk and Underserved Populations.

The Washington State Department of Health developed an equitable funding allocation methodology incorporating quantitative and qualitative decision-making components. We describe the methodology and an implementation evaluation performed by an external evaluation team using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) evaluation framework. The evaluation team concluded that the methodology was developed in a way that used a racial equity lens and prioritized intersectionalities in the communities that the funding was intended to serve. (Am J Public Health. 2024;114(S7):S575-S579. https://doi.org/10.2105/AJPH.2024.307833).

Community-Engaged Survey Approach to Pandemic Impacts on Marginalized Communities, Massachusetts, 2020-2021.

Objectives. To describe how an innovative, community-engaged survey illuminated previously unmeasured pandemic inequities and informed health equity investments. Methods. The methodological approach of Massachusetts' COVID-19 Community Impact Survey, a cross-sectional online survey, was driven by key health equity principles: prioritizing community engagement, gathering granular and intersectional data, capturing root causes, elevating community voices, expediting analysis for timeliness, and creating data-to-action pathways. Data collection was deployed statewide in 11 languages from 2020 to 2021. Results. The embedded equity principles resulted in a rich data set and enabled analyses of populations previously undescribed. The final sample included 33 800 respondents including unprecedented numbers of populations underrepresented in traditional data sources. Analyses indicated that pandemic impacts related to basic needs, discrimination, health care access, workplace protections, employment, and mental health disproportionately affected these priority populations, which included Asian American/Pacific Islanders and parents. Conclusions. Equity-centered data approaches allow for analyses of populations previously invisible in surveillance data, enable more equitable public health action, and are both possible and necessary to deploy in state health departments. (Am J Public Health. 2024;114(S7):S599-S609. https://doi.org/10.2105/AJPH.2024.307800).

Flow cytometry assay modifications: Recommendations for method validation based on CLSI H62 guidelines.

The Clinical and Laboratory Standards Institute (CLSI) H62-Validation of Assays Performed by Flow Cytometry guideline, released in 2021, provides recommendations for platform workflow and quality system essentials, instrument setup and standardization, assay development and optimization and fit-for-purpose analytical method validation. In addition, CLSI H62 includes some recommendations for the validation strategies after a validated flow cytometric method has been modified. This manuscript builds on those recommendations and discusses the impact of different types of assay modifications on assay performance. Recommendations regarding which validation parameters to evaluate depending on the type of modification are provided. The impact of assay modification on the assay's intended use is discussed. When recommending minor deviations from the CLSI H62 process for a laboratory-initiated assay revision (e.g., specimen numbers for sensitivity, specificity, or precision studies), a rationale based on expert opinion is provided with the understanding that not every laboratory, assay type, and circumstance can be comprehensively addressed in this paper. These recommendations are meant as a practical recommendation and are not intended to be restrictive, prescriptive, or understood as necessarily sufficient to meet every specific requirement from regulatory bodies (e.g., FDA or New York State Department of Health).

Developing Infectious Disease Outbreak Emergency Communications for Populations With Limited English Proficiency: Insights to Sustain Collaborations Between Local Health Departments and Community-Based Organizations.

State and local public health departments (LHDs) are encouraged to collaborate with community-based organizations (CBOs) to enhance communication and promote protective practices with communities made vulnerable during emergencies, but there is little evidence-based understanding of practical approaches to fostering collaboration in this context. This research focuses on how collaboration enhances LHD capacity for effective communication for people with limited English proficiency (LEP) during infectious disease outbreaks specifically and strategies to facilitate productive LHD-CBO collaboration. Qualitative, telephone interviews, conducted March-October 2021. Rural and urban jurisdictions with Chinese-speaking or Spanish-speaking populations across the United States. 36 LHD and 31 CBO staff working on outreach to Chinese and Spanish speakers during COVID-19. Interviews were audio-recorded, transcribed verbatim, and analyzed using a team-based, codebook approach to thematic analysis. During COVID-19, CBOs extended LHD capacity to develop and disseminate effective communication, meaning communication that is rapidly in-language, culturally resonant, locally relevant, and trusted. Practical strategies to enable and sustain effective collaboration were needed to address operational dimensions (eg, material and administrative) and relational dimensions (eg, promoting trust and respect). Policies and financing to support LHD-CBO collaborations are critical to improving communication with people with LEP and addressing long-standing inequities in outcomes during outbreaks.

Equipping the Public Health Workforce of the Future: Evaluation of an Evidence-Based Public Health Training Delivered Through Academic-Health Department Partnerships.

Maintaining a skilled public health workforce is essential but challenging given high turnover and that few staff hold a public health degree. Situating workforce development within existing structures leverages the strengths of different organizations and can build relationships to address public health challenges and health equity. We implemented and evaluated an innovative, sustainable model to deliver an established evidence-based public health (EBPH) training collaboratively among Prevention Research Centers (PRC), local and state health departments, and Public Health Training Centers (PHTC). Quantitative data: quasi-experimental, 1-group pre-post. Qualitative data: cross-sectional. Data were collected between December 2021 and August 2022. Four US sites, each a partnership between a PRC, local or state health department, and a PHTC. Governmental public health staff and representatives from other organizations that implement public health programs in practice settings. Course participants completed a pre- and postcourse survey self-rating 14 skills on a 5-point Likert scale. Differences were analyzed using mixed effects linear models. In-depth interviews (n=15) were conducted with course faculty and partners to understand: (1) resources contributed, (2) barriers and facilitators, (3) benefits and challenges, and (4) resources needed to sustain this model. Interviews were transcribed verbatim, and a thematic analysis identified themes. Statistically significant increases in all skills were observed from pre- to postcourse (n=241 at post, 90% response). The skills with the largest increases were understanding economic evaluation enough to inform decision-making (mean change=1.22, standard error [SE]=0.05) and developing an action plan (mean change=1.07, SE=0.07). Facilitators to delivering the course included having a shared goal of workforce development, existing course curricula, and dedicated funding for delivering the course. Collaborative delivery of the EBPH training can ameliorate the effects of high staff turnover, strengthen academic-practice relationships, and promote population-wide health and health equity.