State Health Officials Research Articles

Views From State-Level Policy Actors About the US Federal Government COVID-19 Response.

The United States takes a federalist approach to pandemic responses while the bulk of pandemic powers sits at the state level. Thus, comprehensive accounts of how state health officials managed the crisis and how the federal government affected those efforts are needed to better understand the governmental response to the COVID-19 pandemic. This article reports the results of semistructured interviews with 29 state-level policy actors from 16 US states. Interviewees discussed multiple aspects of the US federal COVID-19 response that affected the response in their states, including communications with the public, intergovernmental communications, and federal actions regarding various aspects of health service preparedness including emergency funding, procurement, testing capacity, vaccine development and distribution, and data systems. This research enriches the discussion about US pandemic preparedness and response, and indicates that alignment of public communications across government levels, enhanced intergovernmental communication, inclusion of rural perspectives, and federal investment in and sustainment of health service preparedness are key factors that can improve future US pandemic responses.

P-2174. Politics and Money? Mpox Vaccine Coverage in the US: A Study in Healthcare Variation

Abstract Background During the United States (US) mpox outbreak of 2022-2023, the federal government distributed mpox vaccines (JYNNEOS) to individual states for distribution to at-risk persons. For local distribution, there was no immediate federal funding available. The vaccines were not commercially available. Vaccination data was reported to states’ public health and the Centers of Disease Control and Prevention. There was considerable variation in vaccine coverage across different states. Mpox vaccine coverage and associated factors for US states. Methods Using public data, we sought to identify state-level factors associated with full mpox vaccine coverage (two doses), including: political identity, public health spending, public health staffing, diversity index, poverty rate, percentage of population at-risk, and mpox cases. Data sources were: 2020 presidential election result, Association of State and Territorial Health Officials, 2020 US Census, and the CDC. Univariate and multivariable linear regression was performed using all studied variables. P-value of < 0.05 was used to note statistical significance. Factors associated with mpox vaccine coverage: univariate linear regression. Results Nationally, average full mpox vaccine coverage for at-risk persons was 21%. Univariate analysis showed that Republican political status was associated with lower JYNNEOS vaccine coverage. Higher coverage was associated with higher public health spending per capita, increased diversity index, higher proportion of at-risk population, and greater number of absolute mpox cases. Multivariable analysis showed the following: Republican states achieved -5.65% lower vaccine coverage (p=0.036), each $1 increase in public health spending increased vaccine coverage by 0.05% (p=0.000), each additional MSM++ (men who have sex with men [MSM] on HIV pre-exposure prophylaxis plus MSM with HIV) per 1,000 people increased vaccine coverage by 1.5% (p=0.000), and each additional mpox case increased vaccine coverage by 0.003% (p=0.032). Multicollinearity check showed low correlation among tested variables. Factors associated with mpox vaccine coverage: multivariable linear regression. Conclusion Higher mpox vaccine coverage was achieved in US states with Democratic political orientation, higher public health funding, higher proportion of at-risk population, and higher mpox cases. Additional analyses toward equitable vaccine access are needed. Disclosures All Authors: No reported disclosures

Examining the Priorities of Local Health Departments in California: A Mixed Methods Study.

Prioritization is an essential task of local health departments (LHDs). We examined the alignment of priorities reported in Community Health Needs Assessments (CHNA) priorities align with priorities in the Community Health Improvement Plans (CHIP). We report factors that influence the choice of priorities and the alignment of the priorities. A mixed method study design. California. CHNA and CHIP documents were sought for all 58 counties. Interviews were conducted with 19 state and local public health officials. The priorities in the CHNA and the CHIP were coded as i) only in the CHNA, ii) only in the CHIP, or iii) in both the CHNA and the CHIP. The interviewees were asked to share their experiences related to issue prioritization and decision-making in public health agencies. The interviews were coded and thematically analyzed to identify barriers and facilitators of the prioritization process. The alignment between the needs prioritized in CHNA and the priorities targeted in CHIP was 35%. The interviews identify reasons for the misalignment, including a need to include priorities in the CHNA even though LHDs are not able to address them, political factors that influence the selection of priorities, and a lack of discretionary funding or capacity/expertise within the agency or its community partners to respond to the needs identified. The lack of discretionary funding was particularly acute for smaller (rural) LHDs (CMSP) and resulted in their often having to focus on priorities where there was state or federal funding. LHDs face numerous challenges in aligning the priorities reported in the CHNA and the priorities they focus upon in the CHIP. LHDs should consider using a formal, transparent, and evidence-based approach to setting aligning. Future research should focus on developing a formal decision-making process that is appropriate for local public health decision-making.

COVID-19 pandemic in the Niger Delta: the Akwa Ibom State experience

ABSTRACT Although the COVID-19 pandemic was not Nigeria’s first encounter with a global health crisis, it profoundly disrupted nearly every sector of society. This study focuses on Akwa Ibom State in Nigeria’s Niger Delta, offering insights into how the pandemic unfolded within the state. Utilising a qualitative methodology that combines content analysis of newspapers with anonymised interviews, framed by New Institutionalism Theory (NIT), this research reveals how the pandemic’s peak intensified tensions between state administration and health officials, alongside public controversies regarding the distribution and use of palliative measures. Our findings highlight the importance of prioritising public needs and ensuring that government actions align with this priority for effective crisis management during large-scale public health emergencies.

Perspectives on Public Health Department Accreditation: Lessons Learned From Ohio's Accreditation Mandate.

Ohio is the only state that requires local health departments (LHDs) to be accredited by the Public Health Accreditation Board (PHAB). As of May 2024, 80% of Ohio's 111 LHDs achieved accreditation, making Ohio the state with the highest proportion of accredited LHDs in the country. This study examined the experience of public health accreditation in Ohio including the perceived value of PHAB accreditation for LHDs. It also explored the extent to which perspectives on the value of mandatory accreditation differed between state and local health officials. Data for this study was obtained from 5 focus group interviews with 41 participants, representing state and local perspectives on PHAB accreditation in Ohio. Interviews were recorded, transcribed, and coded using inductive and deductive coding for a thematic analysis. Focus group participants outlined numerous advantages that accreditation has brought to their organizations. Commonly cited benefits include enhancements in quality improvement and performance management, strengthened collaborations and partnerships, improved communications, and optimized resource use. Challenges in achieving accreditation involved the financial expenses associated with the process and constraints on staffing resources. State officials generally expressed positive views on the accreditation mandate, perceiving it as a pathway to modernize the public health system and ensure consistency in service delivery across communities. In contrast, local stakeholders offered more nuanced perspectives and voiced concerns about the intentions behind the mandate. The experience of health officials in Ohio offers lessons for both PHAB and officials in other states working to increase public health department accreditation levels. Successful implementation of accreditation mandates requires trust between state and local partners, open communication, and clarity of purpose. Moreover, attaining accreditation necessitates substantial resources, including technical assistance, financial support, and a robust workforce.

Best Practices and Lessons Learned From the Public Health Disability Specialists Program: Addressing the Needs of People With Disabilities During COVID-19.

The Association of State and Territorial Health Officials (ASTHO) and the National Association of County and City Health Officials (NACCHO) applied funding issued by the US Centers for Disease Control and Prevention (CDC) to implement the Public Health Disability Specialists Program, part of a project to address the needs of people with disabilities during the COVID-19 pandemic. Disability specialists (subject matter experts) were embedded within state, territorial, and city/county health departments to help ensure disability inclusion in emergency planning, mitigation, and recovery efforts. To evaluate the success of the Disability Specialists Program in improving emergency response planning, mitigation, and recovery efforts for people with disabilities within participating jurisdictions. Disability specialists worked with their assigned jurisdictions to conduct standardized baseline health department needs assessments to identify existing gaps and inform development and implementation of improvement plans. CDC, ASTHO, and NACCHO implemented a mixed methods framework to evaluate specialists' success. State, territorial, and local health departments across 28 jurisdictions between January 2021 and July 2022. Average number of categories of gaps addressed and qualitative documentation of strategies, barriers, and promising practices. Specialists identified 1010 gaps (approximately 36 per jurisdiction) across eight needs assessment categories, most related to mitigation, recovery, resilience, and sustainability efforts (n=213) and communication (n=193). Specialists addressed an average of three categories of gaps identified; common focus areas included equitable COVID-19 vaccine distribution and accessible communications. Specialists commonly mentioned barriers related to limited health agency capacity (eg, resources) and community mistrust. Promising practices to address barriers included sharing best practices through peer-to-peer networks and building and strengthening partnerships between health departments and the disability community. Embedding disability specialists within state, territorial, and local health departments improved jurisdictional ability to meet evolving public health needs for the entire community, including people with disabilities.

Feasibility Study of a Mobile Health Parenting Intervention Among Somali/Somali Americans From Refugee Families in the United States

Mobile health parenting interventions often do not account for inequities in parenting education and health resources for racial minority, refugee, and low-income families. We examined the feasibility of a mobile health intervention to address maternal and child wellness needs in Somali/Somali Americans from refugee families. Using a community-engaged research approach, our interdisciplinary academic team, in collaboration with Somali/Somali American community members, healthcare providers, and state, county, and local health officials, developed a culturally sensitive audio-based messaging intervention. The messages contained four topics (parent–child relationships, child nutrition, child health, and maternal self-care) and were delivered in an audio-based format upon the community’s needs. Forty-six Somali/Somali American parents ( Mage = 31) participated in the feasibility study, and 12 parents provided feedback. Based on thematic analysis, Somali/Somali American parents found the content and delivery style helpful in caring for their children and themselves and expressed interest in continuing this intervention. We discuss the implications for using mobile health interventions to address health inequities in marginalized communities.

Implementing a Needs Assessment to Advance Health Equity in Overdose Prevention and Surveillance Initiatives.

State, local, and federal agencies have expanded efforts to address the root causes of overdoses, including health inequity and related social determinants of health. As an Overdose Data to Action (OD2A) technical assistance provider, the Association of State and Territorial Health Officials (ASTHO) conducted the first national needs assessment to understand capacity and technical assistance needs of OD2A jurisdictions in advancing health equity. ASTHO designed and disseminated the OD2A Recipient Health Equity Needs Assessment (RHENA) to 66 OD2A-funded jurisdictions from February to March 2022. OD2A principal investigators and staff were contacted via email and asked to complete the needs assessment within 6 weeks. One coder manually coded open-ended responses, conducted a thematic analysis on the qualitative data, and performed a simple frequency analysis on the quantitative data. Fifty-two jurisdictions (78.8%) responded, including 36 states, 12 cities/counties, and 2 territories. Most jurisdictions (n = 46; 88.5%) reported having a formal or informal health equity lead in place. Common barriers included a lack of access to data sources (n = 37; 71.2%), lack of partnerships (n = 20; 38.5%), and lack of funding (n = 14; 26.9%). Respondents reported needing more information sharing among jurisdictions and partner organizations, coaching on best practices, and routine discussions such as peer-to-peer learning sessions. Findings suggest that gaps remain in programmatic policies and principles to address inequities in overdose prevention. Results are being used to identify additional technical assistance opportunities, jurisdictional capacity, and approaches to advance health equity.

Smallpox Geographies: vaccination, borders and Indigenous peoples in Australia's coastal north.

Australia's approach to its biosecurity and borders has always been two-pronged - quarantine first, vaccination second. This article asks what this combination looked like in practice by exploring two neglected smallpox vaccination campaigns directed towards Indigenous peoples in the early twentieth century. We argue these were important campaigns because they were the first two pre-emptive, rather than reactionary, vaccination programs directed towards First Nations people. Second, both episodes occurred in Australia's northern coastline, where the porous maritime geography and proximity to Southeast Asia posed a point of vulnerability for Australian health officials. While smallpox was never endemic, (though epidemic), in Australia, it was endemic at various times and places across Southeast Asia. This shifting spectre of smallpox along the northern coastline was made even more acute for state and federal health officials because of the existing polyethnic relationships, communities, and economies. By vaccinating Indigenous peoples in this smallpox geography, they were envisioned and embedded into a 'hygienic' border for the protection of white Australia, entwining the two-prongs as one approach. In this article, we place public health into a recent scholarship that has 'turned the map upside down' to re-spatialise Australia's history and geography to the north and its global connections, while demonstrating how particular coastlines and their connections were drawn into a national imaginary through a health lens.

'Staying in the lane' of public health? Boundary-work in the roles of state health officials and experts in COVID-19 policymaking.

The state-level COVID-19 response in the United States necessitated collaboration between governor' offices, health departments and numerous other departments and outside experts. To gain insight into how health officials and experts contributed to advising on COVID-19 policies, we conducted semi-structured interviews with 25 individuals with a health specialisation who were involved in COVID-19 policymaking, taking place between February and December 2022. We found two diverging understandings of the role of health officials and experts in COVID-19 policymaking: the role of 'staying in the lane' of public health in terms of the information that they collected, their advocacy for policies and their area of expertise and the role of engaging in the balancing of multiple considerations, such as public health, feasibility and competing objectives (such as the economy) in the crafting of pandemic policy. We draw on the concept of boundary-work to examine how these roles were constructed. We conclude by considering the appropriateness as well as the ethical implications of these two approaches to public health policymaking.

Public health workforce survey data (2016-2021) related to employee turnover: proposed methods for harmonization and triangulation.

Public health workforce numbers are unsustainable at best and dire at worst: based on 2017 and 2019 data, 80,000 FTEs needed to be hired by health departments to provide basic public health foundational services before COVID-19 hit, suggesting that the situation is worse after the mass exodus of public health officials due to the pandemic. As such, a better understanding of public health workforce turnover is critical to improving recruitment and retention in the discipline. This methods report details how the authors harmonized four public health workforce surveys-the Public Health Workforce Interests and Needs Survey (PH WINS), the National Association of County and City Health Officials (NACCHO) Profile, the NACCHO Forces of Change survey, and the Association of State and Territorial Health Officials (ASTHO) Profile-in order to examine employee turnover. We found that 31% of the public health workforce reported considering leaving their positions at some time in the future. Furthermore, the majority of agencies reported that zero vacancies had been filled in both 2018 and 2019. These findings suggest that retention, recruitment, and onboarding may be areas upon which to focus evaluation and quality improvement endeavors, allowing public health organizations to better attract and retain the most qualified candidates.

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

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

A comprehensive roadmap for MedTech innovations uptake into the public healthcare system in India.

The burden of communicable, non-communicable diseases and reproductive maternal, newborn, child & adolescent health in India, reflects the necessity to develop tailored solutions. The plethora of MedTech innovations has provided healthcare facilities with more effective, affordable and accessible healthcare for people across the country. However, in spite of the Make-in-India scheme in the country, the indigenously developed healthcare technology is far from making an impact on the healthcare system. To present a roadmap for MedTech innovations for their successful deployment into the public healthcare system. In addition to the literature review, recommendations were included from several stakeholders such as innovators, manufacturers, policymakers, subject matter experts, funding organizations, State health officials etc. The journey of healthcare innovation from need identification to ideation, to prototyping and validation has paved the way towards the de novo design that caters to unmet needs. Innovations at the advanced technology readiness level (TRL 7/8 and above) demand a holistic and multidisciplinary approach which includes clinical validation, regulatory approval and Health technology assessment. The deployment of healthcare technology into the public healthcare system must consider resources (e.g., time, staff, budget, investment policies), ethical concerns (privacy, security, regulations, ownership), governance (policy, accountability, responsibility etc.), and Skills (capabilities, culture, etc.). The technologies are considered for field trials before the uptake in the public health system. Technology can be a key tool in achieving Universal Health Coverage but its use has to be strategic, judicious, and cognizant of issues around privacy and patient rights.

Laws Governing State Health Official Appointments: A Legal and Historical Review.

The current study presents the legal epidemiological review of State Health Official (SHO) appointment laws, including the evolution of educational and experience requirements of SHOs over time. Findings can inform the discussion about state laws and the substantive, multidisciplinary qualifications essential to successfully leading state public health agencies in the 21st century. Standard policy surveillance methods were used to collect and assess the statutes governing SHO appointment and eligibility from all 50 states and the District of Columbia between 1995 and 2020. SHOs are most frequently appointed by their jurisdiction's Health Secretary (n = 17), followed by Governor nominations with legislative approval (n = 15), and 13 states where the Governor is the sole SHO appointing authority. While a large majority of jurisdictions require certain professional and/or educational minimum qualifications to serve as an SHO, 11 states have no professional or experiential minimum qualifications. The most common minimum requirement found was possessing a medical degree, which is required in 22 jurisdictions (including Washington, District of Columbia). Twelve of these states require the physician to have additional education or experience, such as the possession of experience in public health (n = 5), experience in both public health and management (n = 3), or holding an additional health-related degree (n = 2). Four states added a medical degree as a requirement for SHOs over the last 25 years, while 5 states removed their medical degree requirement. States should reassess their eligibility requirements for SHO service in light of the advancement and demands of public health leadership in the 21st century, as many states continue to look to those with medical training as the primary source for such leadership.

Influenza Antiviral Shortages Reported by State and Territorial Public Health Officials, 2022-2023

This study provides survey results from state and territorial public health preparedness directors regarding antiviral shortages during the 2022-2023 respiratory viral season.

Oh What Tangled Webs We Weave—Unpacking (and Unpicking) the Majority Opinion in Dobbs, State Health Officer of the Mississippi Department of Health et al. v. Jackson Women's Health Organization et al.

Abstract This paper evaluates the majority judgment in the United States Supreme Court in Dobbs v. Jackson Women's Health Organization. It is suggested that much of what is said in the majority opinion ostensibly appears eminently defensible if viewed solely from a narrowly legalistic perspective. But closer analysis suggests that the majority's reasoning has some weaknesses when viewed within that limited paradigm. A further line of inquiry assesses whether adopting such a ‘legalistic’ approach to the question of abortion rights is in any event an appropriate position for the Court to adopt. The final section of the paper explores two additional contextual issues: the first relates to the personal ethical integrity of some of the majority judges; the second to the adequacy of State political processes as a means to address the abortion rights controversy.

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

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

Reducing Overdose Through Policy Interventions: ASTHO's Recommendations for State and Territorial Health Officials and Agencies.

Reducing Overdose Through Policy Interventions: ASTHO's Recommendations for State and Territorial Health Officials and Agencies.

Case Investigation and Contact Tracing in US State and Local Public Health Agencies: Sustaining Capacities and Applying Lessons Learned From the COVID-19 Pandemic and 2022 Mpox Outbreak.

The COVID-19 pandemic illuminated the lack of resources available to US state and local public health agencies to respond to large-scale health events. Two response activities that were notably underresourced are case investigation and contact tracing (CI/CT), which health agencies routinely employ to control and prevent the transmission of infectious diseases. However, the scale of contact tracing required during the COVID-19 pandemic exceeded available resources, even in high-capacity public health agencies. For both routine outbreak response and epidemic preparedness, health agencies must have CI/CT program capacities in place prior to the detection of an outbreak to be ready to respond. Our research builds on previous work to identify the baseline CI/CT capacities needed in US state and local public health agencies to respond to any type of outbreak. Fifteen public health officials representing 10 public health agencies and 4 experts in CI/CT were interviewed about various aspects of their CI/CT program during the COVID-19 pandemic. The interviews coincided with the beginning of the 2022 mpox epidemic. Discussions on CI/CT during that response were collected to augment the interviews, where possible. Findings revealed that CI/CT capacities were underresourced prior to and during the pandemic, as well as during the mpox outbreak, even after substantial additional resourcing and efforts to scale up. Moreover, state and local health agencies encountered challenges in pivoting their COVID-19 CI/CT capacities for the mpox response, suggesting that CI/CT programs should either be designed with flexibility in mind, or should allow for specialization based on the pathogen's mode of transmission and the population at risk. Federal, state, and local health agency staff and officials should consider lessons learned from this research to plan for readily scalable and sustainable CI/CT programs to ensure readiness for future outbreaks.

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

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