State Health Officials Research Articles

A Field Placement Approach to Enhance State and Local Capacity for Opioid-Related Issues Affecting Pregnant and Postpartum People and Infants Prenatally Exposed to Opioids and Other Substances.

Opioid use disorder (OUD) poses a significant public health concern impacting maternal and infant outcomes. In 2018, the Centers for Disease Control and Prevention (CDC) partnered with the Association of State and Territorial Health Officials (ASTHO) to develop the Opioid use disorder, Maternal outcomes, and Neonatal abstinence syndrome Initiative Learning Community (OMNI LC) to identify and disseminate best practices and strategies for implementing systems-level changes in state health departments to address OUD affecting pregnant and postpartum persons and infants prenatally exposed to opioids. In 2019, the OMNI LC incorporated a field placement approach that assigned temporary field placement staff in five select OMNI LC states to provide important linkages, facilitate information sharing, and strengthen capacity among state and local health departments and other partners supporting maternal and child health communities affected by the opioid crisis. Using an implementation science framework, the field placement approach was assessed using five implementation outcome measures: appropriateness, acceptability, implementation cost, sustainability, and feasibility. Written responses from the participating OMNI LC states on these implementation outcome measures were analyzed to (1) highlight key strategies used by field placement staff, (2) assess the implementation of the OMNI LC field placement approach within the context of implementation science, and (3) identify implementation barriers. This report describes the implementation of a temporary field placement approach and suggests that this approach could be replicated to enhance state and local capacity to respond to the opioid crisis or other high-consequence events.

COVID-19 Case Investigation and Contact Tracing Programs and Practice: Snapshots From the Field.

Between Fall 2020 and Spring 2021, the Association of State and Territorial Health Officials conducted 2 rapid queries to collect information from the field regarding the status of COVID-19 case investigation and contact tracing (CI/CT) programs and practice. These short surveys were distributed to senior deputies in state and territorial health agencies, yielding a response rate of 45.8% (November 2020) and 40.7% (April 2021). Findings indicated that CI/CT staff roles and assigned functions varied across jurisdictions, as did staffing levels/capacity, approaches for linking individuals to social supports, and program changes that were planned or underway. Agency-reported staffing levels/capacity and programmatic challenges changed over time, highlighting the dynamic nature of CI/CT program practice and implementation. While findings from the surveys cannot be generalized to the national level, they provide critical insights from the field on CI/CT program implementation, challenges, and changes in response to the evolving COVID-19 epidemic in the United States.

In Case You Haven't Heard…

As Regina LaBelle leaves the Office of National Drug Control Policy (ONDCP) and Rahul Gupta, M.D., takes over in the wake of his confirmation last month, there are still questions about how the staff will react. This is a new deal for the office. Gupta, the first medical doctor to ever lead the ONDCP, was West Virginia's state health officer from 2015–18, and then went on to work at the March of Dimes. He was leader of the Kanawha‐Charleston Health Department from 2009 until 2014. “As a practicing physician and former health official who has served in rural communities, I have seen firsthand the heartbreaking toll of addiction and overdose in our communities, but I have also seen how we can save lives if we understand the individuals behind the statistics and meet them where they are,” said Gupta in taking office. “President Biden has made clear that addressing addiction and the overdose epidemic is an urgent priority. As Director, I will diligently work to advance high‐quality, data‐driven strategies to make our communities healthier and safer.” It was widely believed that Biden chose Gupta to nominate to win West Virginia Senator Joe Manchin's vote on the infrastructure bill.

Hawaii State Hospital's new $160M psychiatric facility sits empty

In May, the Hawaii Department of Health (DOH) unveiled a long‐awaited $160 million psychiatric facility at the Hawaii State Hospital to help improve safety and alleviate overcrowding, the Honolulu Star‐Advertiser reported Oct. 24. The new facility took years to develop, but five months after state officials opened the building to media tours, it remains empty as the DOH continues to develop policies to govern its operations and struggles to fill staff positions. A state health official declined to speculate on when it would start accepting patients. The union representing many of the staff says a fundamental dispute over the vision for the facility has caused months of delays. Rather than a new hospital designed to treat mental illness, the Hawaii Government Employees Association (HGEA) says the state has essentially built a prison, and it's taken time for state health officials to fully recognize that. “It is truly going to be a correctional facility for individuals who have mental illness,” said HGEA Executive Director Randy Perreira. State health officials say recruitment didn't start until after a statewide hiring freeze was lifted in April and emphasized in emailed responses that “there have been challenges to hiring hospital personnel throughout the country, and Hawaii is no exception.”

Development of a Biosecurity Index for the Districts of India for the Assessment of Capacity to Cope with Infectious Disease Outbreak

Background: In the context of newly emerging diseases, global health security has gained importance in recent years. The pandemic COVID-19 has reemphasized the significance. Despite increased attention to enhance health security, the existing capacities were not optimally prepared to respond to public health threats posed by emerging infectious diseases. Objective: The objective of the study was to develop a simple tool that can help monitor and build up the critical capacity to prevent, detect, respond and help identify the gaps in the preparedness of the health system. Methods: The cross-sectional study was conducted from January 2018 – December 2018 amongst the district level health functionaries like the disease surveillance, laboratory, and the animal health focal points in the selected districts across the three South Indian states. Results: The responses received from the participants of the study were scored and categorized by domains into a biosecurity index, which was easily adaptable to all districts and easy to implement by a district official or state health officer for the initial assessment. Data acquired from this tool could be analysed to build and inform readiness and response plans for preventing and controlling health emergencies. Conclusion: The biosecurity index developed for the Indian districts was an appropriate instrument for epidemic preparedness assessment.

Enhancing U.S. Local, State, and Federal Preparedness Through Simulated Interactive Tabletop Exercises of a Mock Antibiotic-Resistant Gonorrhea Outbreak, 2018-2019.

Responding effectively to outbreaks of antibiotic-resistant gonorrhea (ARGC) in the future will likely prove challenging. Tabletop exercises (TTXs) may assist local, state, and federal public health officials evaluate existing ARGC outbreak response plans, strengthen preparedness and response effectiveness, and identify critical gaps to address before an outbreak. In 2018 to 2019, Centers for Disease Control and Prevention (CDC) collaborated with state partners to develop and implement TTXs to simulate a public health emergency involving an ARGC outbreak. Before the TTXs, 2 state-local health department pairs developed ARGC outbreak response plans. During each 1-day exercise (in Indiana and Illinois), participants discussed roles, clinical management, public health response, and communication based on predeveloped response plans. Observers identified outbreak response strengths and gaps, and participants completed feedback forms. Forty-one (Illinois) and 48 people (Indiana) participated in each TTX, including sexually transmitted disease clinical staff, laboratorians, public health infectious disease program staff, and CDC observers. Strengths and gaps varied by jurisdiction, but identified gaps included: (1) local access to gonorrhea culture and timely antimicrobial susceptibility testing, (2) protocols for clinical management of suspected treatment failures, (3) communication plans, and (4) clarity regarding state and local responsibilities. The CDC observers identified opportunities to provide national-level technical assistance, foster local antimicrobial susceptibility testing, and develop further response guidance. Tabletop exercises summary reports were used to guide modifications to local response plans to address gaps. The TTXs allowed participants to practice responding to a simulated public health emergency and may have enhanced local response capacity. Centers for Disease Control and Prevention made TTX implementation materials publicly available.

Acceptability of Adolescent COVID-19 Vaccination Among Adolescents and Parents of Adolescents - United States, April 15-23, 2021.

On May 10, 2021, the Food and Drug Administration (FDA) expanded its Emergency Use Authorization for the Pfizer-BioNTech COVID-19 vaccine to include adolescents aged 12-15 years; this authorization was followed by interim recommendations from the Advisory Committee on Immunization Practices (ACIP) for the vaccine among this age group (1). Using data from nonprobability-based Internet panel surveys administered by the Healthcare and Public Perceptions of Immunizations (HaPPI) Survey Collaborative, the acceptability of adolescent COVID-19 vaccination and self-reported factors increasing vaccination intent were assessed among independently recruited samples of 985 adolescents aged 13-17 years and 1,022 parents and guardians (parents) of adolescents aged 12-17 years during April 15-April 23, 2021, prior to vaccine authorization for this age group. Approximately one quarter (27.6%) of parents whose adolescents were already vaccine-eligible (i.e., aged 16-17 years) reported their adolescent had received ≥1 COVID-19 vaccine dose, similar to the proportion reported by vaccine-eligible adolescents aged 16-17 years (26.1%). However, vaccine receipt reported by parents of adolescents differed across demographic groups; parents identifying as female or Hispanic, or who had an education lower than a bachelor's degree reported the lowest adolescent COVID-19 vaccination receipt. Among parents of unvaccinated adolescents aged 12-17 years, 55.5% reported they would "definitely" or "probably" have their adolescent receive a COVID-19 vaccination. Among unvaccinated adolescents aged 13-17 years, 51.7% reported they would "definitely" or "probably" receive a COVID-19 vaccination. Obtaining more information about adolescent COVID-19 vaccine safety and efficacy, as well as school COVID-19 vaccination requirements, were the most commonly reported factors that would increase vaccination intentions among both parents and adolescents. Federal, state, and local health officials and primary care professionals were the most trusted sources of COVID-19 vaccine information among both groups. Efforts focusing on clearly communicating to the public the benefits and safety of COVID-19 vaccination for adolescents, particularly by health care professionals, could help increase confidence in adolescent COVID-19 vaccine and vaccination coverage.

Changes in dental care use patterns due to COVID-19 among insured patients in the United States

BackgroundDemand for dental services has been known to be linked closely to dental insurance and disposable income. Widespread economic uncertainty and health systems changes due to COVID-19 thus may have a significant impact on dental care use. MethodsUsing deidentified dental practice management data from 2019 and 2020, the authors observed variations in dental care use among insured patients since the COVID-19 outbreak (during the period of practice closure and after the reopening) by patient age, procedure type, insurance type, practice size, geographic area, and reopening status. The authors examined whether the rebound in procedure volumes at dental practices can be explained by county-level characteristics using hierarchical regression models. ResultsAlthough dental care use among privately insured patients fully rebounded by August 2020, use still remained lower than the prepandemic level by 7.54% among the publicly insured population. Demand for teledentistry increased 60-fold during practice closure. Geographic characteristics—such as median household income, percentages of rural or Black populations, and dental care professional shortage designations—were associated significantly with the number of procedures performed at dental practices. ConclusionsAs a result of COVID-19, dental practices experienced substantial decreases in procedure volume, particularly among patients covered by public insurance or residing in underserved areas. Practical ImplicationsDuring economic downturns, state health officials should be encouraged to adopt policies to expand access to oral health care for vulnerable populations via oral health promotion strategies and increasing the supply of dentists or midlevel dental care providers in underserved areas.

Keeping your friends close: coordination between state attorneys and health authorities in São Paulo State

What are the effects of collaboration strategies over health litigation? Literature has shown that health litigation decisions are mostly in favor of claimants regardless of what is requested. Based on the notion that presenting a single unite front where state attorneys and health officials join forces increases the chances of having a case decided against claimants, this paper investigates effects of interorganizational collaboration, using geographical proximity between state attorneys’ offices and health authorities as a measure of their collaboration. Results from a logit model using healthcare cases from the State of Sao Paulo indicate that the closer these organizations are, the higher are their chances of success before courts, even when we control for other aspects that might be influencing the judicial decisions or cases themselves.

Malaria Surveillance - United States, 2017.

Malaria Surveillance - United States, 2017.

Observing COVID-19 related behaviors in a high visitor use area of Arches National Park.

Visitation to parks and protected areas is a common COVID-19 coping strategy promoted by state and national public health officials and political leadership. Crowding and congestions in parks has been a perennial problem and the ability to socially distance within them is an unproven assumption. Is it possible to socially distance in a busy national park that has been designed to concentrate use? An observational study was conducted in July 2020 at the outside foyer of the Visitor Center of Arches National Park. Motion sensor cameras were placed to record one-minute videos when a person entered the field of view. Number of groups, group size, facial coverings and encounters within 6 feet (1.83 meters) of other groups were recorded. Groups were smaller on average than recorded in previous studies. Approximately 61% of the visitors wore masks. Most groups (69%) were able to experience the visitor center with no intergroup encounters. We model the probability of intergroup encounters and find as group size and number of groups increases, the probability of encounters rises. With four groups present, the probability of one or more encounters ranges from 19% to 40% for common group sizes, while if eight groups are present, the probability of one or more encounters increases from 34% to 64% for common group sizes. Under conditions in which park visitors have the physical space to avoid close encounters with other groups they are taking advantage of the opportunity. Visitors are minimizing group size, wearing masks, and remaining socially distant. However, encounters increase as the number or the size of the groups increases. In other areas of the parks this ability to avoid encounters may not be as possible. We recommend that park managers continue to appeal for compliance with CDC guidelines, especially the wearing of masks and encouraging visitors to split up into small groups when visiting.

Provision of the Continuum of Care to Noncommunicable Diseases Post-Floods in Kerala, India 2018.

Integrating noncommunicable disease (NCD) in health care delivery during emergency response posed a major challenge post-floods in Kerala. Kerala experienced an abnormally high rainfall during mid-2018 where more than 400 people lost their lives. State health officials and the Disaster Response Team were sensitized about the importance of including NCDs in the response action. More than 80% of patients with hypertension and diabetes were not under control in Kerala. Under the state NCD cell, an NCD expert group was consulted for drafting the treatment and referral strategies. Steps to tackle NCDs during the disaster response were formulated. The state NCD cell decided to integrate NCDs in the response measures. The technical guidance document by the World Health Organization South-East Asia Region was consulted to formulate actions. The activities were implemented in 6 steps: prioritizing of major NCDS, patient estimation and drug stock preparation, standard treatment protocol, mapping of referral facilities, public engagement, and daily reporting of NCD consultations. Prioritizing the continuum of care of NCDs during floods among the program managers and care providers was crucial. The health education and communication campaign was done to sensitize the known NCD patients to seek early care. Daily reporting of consultations was established.

Academic libraries and research in flux: Global conversations in times of COVID-19

In March 2020, Alameda County, where the University of California (UC)-Berkeley is located, issued a shelter in place order as a response to the COVID-19 pandemic. The UC-Berkeley Library was one of the first libraries in the United States to deal effectively with the new normal that was mandated by local, state, and federal public health officials, shifting to the virtual provision of its services such as instruction, research consultation, and accelerated e-resource acquisition. Library administration encouraged staff to think creatively, to not only provide our services to faculty, users, and students, but also to bridge the physical gap through virtual media to foster collaboration among the community of international librarians.

Lessons Relearned? H1N1, COVID-19, and Vaccination Planning.

Lessons Relearned? H1N1, COVID-19, and Vaccination Planning.

Public Health Officials and COVID-19: Leadership, Politics, and the Pandemic.

Public Health Officials and COVID-19: Leadership, Politics, and the Pandemic.

"Nothing About Us Without Us": Insights from State-level Efforts to Implement Community Health Worker Certification.

As community health workers (CHWs) have increasingly become recognized as members of health care teams, several states have considered or implemented processes to certify them. Between April and September 2017, we interviewed 41 stakeholders (e.g., CHWs, employers, and state health officials) in seven states that had considered or developed CHW certification to gather information about their processes and lessons learned. Interviewees reported several areas to consider in developing certification such as requiring training and education, deciding whether to certify based on experience, ensuring that CHWs are members of communities served, and avoiding marginalization of some groups of CHWs. Participants highlighted strategies for ensuring active CHW leadership in decision-making about certification. Interviewees identified best practices for supporting CHW workforce development such as using national models and standardized training, supporting CHW leadership, involving CHW professional groups, convening workgroups, and educating stakeholders. Findings are relevant to states seeking to grow their CHW workforce.

731. The Emergence of Mobile Colistin Resistance (mcr) Genes among Enteric Pathogens in the United States — 2008–2019

BackgroundColistin, once seldom used clinically, has resurged as a “last resort antibiotic” for multidrug-resistant infections and is still used in animal agriculture in countries outside the United States. During 2015–2018, 8 plasmid-mediated, mobile colistin resistance genes (mcr-1 to mcr-8) were each found in one or more clinical, animal, food, and environmental bacterial sources. We describe the epidemiology of mcr genes in enteric pathogens from US patients.MethodsState public health laboratories have performed whole-genome sequencing on enteric bacterial pathogens since 2015, and some have sequenced older isolates. We screened sequences of isolates collected through 2019 for mcr genes using a workflow based on ResFinder 3.0. State health officials interviewed patients for clinical and epidemiologic information, including demographics, hospitalization, and travel history.ResultsWe identified 41 patient isolates with mcr genes collected from stool, urine, and blood during 2008–2019. These included 37 nontyphoidal Salmonella (31 mcr-1, 6 mcr-3), 2 Vibrio (both mcr-4), and 2 Shiga toxin-producing E. coli (both mcr-1). The median patient age was 34 years (interquartile range: 24–54) and 54% were female. Of 23 patients with comorbidity data, 2 (9%) had immunodeficiency, 2 (9%) had past abdominal surgeries, and 1 (4%) had cancer. Patients sought care at doctor’s offices (46%), emergency rooms (35%), and urgent care clinics (19%); 24% were hospitalized for the enteric illness. None died. Among 36 with information, 35 (97%) travelled internationally in the 12 months before illness; 30 (94%) of 32 traveled in the 7 days before. Only 4 (15%) of 27 had contact with a healthcare setting during their trip; common destinations were the Dominican Republic (35%), Vietnam (24%), Thailand (15%), and China (12%).ConclusionThe data strongly suggest that many patients acquired infection abroad. Nearly one in four were hospitalized, raising concerns that plasmids carrying mcr genes could spread among patients hospitalized with infections caused by multidrug-resistant pathogens for which colistin is the only available treatment. The acquisition of mcr genes by US travelers highlights the need for a global approach to antimicrobial stewardship.Disclosures All Authors: No reported disclosures

CDC Healthy Brain Initiative Action Institutes: Innovative Planning and Lessons Learned

This presentation will demonstrate an innovative strategic planning effort, coined Action Institutes (AI’s), which are designed to promote the implementation of CDC’s “The Healthy Brain Initiative’s State and Local Public Health Partnerships to Address Dementia” and the “Road Map for Indian Country.” Both of these documents outline how the champions of public health and their partners can create a statewide effort to promote brain health, increase early diagnosis, address cognitive impairment for individuals living in the community, and help meet the needs of care partners. The purpose of these 1-2-day AI’s is to familiarize leaders with the topic, encourage their adoption into current priority setting, and guide participants in creating action plans. The CDC’s Alzheimer’s Disease and Healthy Aging Program is conducting a series of these AIs, which are made possible through partnerships with the Association of State and Territorial Health Officials and the National Indian Health Board.

#Ebola: Emergency Risk Messages on Social Media.

Public health threats require effective communication. Evaluating effectiveness during a situation that requires emergency risk communication is difficult, however, because these events require an immediate response and collecting data may be secondary to more immediate needs. In this article, we draw on research analyzing the effectiveness of social media messages during times of imminent threat and research analyzing the emergency risk communication conceptual model in order to propose a method for evaluating emergency risk communication on social media. We demonstrate this method by evaluating 2,915 messages sent by local, state, and federal public health officials during the 2014 Ebola outbreak in the United States. The results provide empirical support for emergency risk communication and identify message strategies that have the potential to increase exposure to official communication on social media during future public health threats.

Containing COVID-19 Through Contact Tracing

Containing coronavirus disease 2019 (COVID-19) through case investigation and contact tracing is a crucial strategy for governmental public health agencies to control the spread of COVID-19 infection in the United States. Because of the recency of the pandemic, few examples of COVID-19 contact-tracing models have been shared among local, state, and federal public health officials to date. This case study of the Anne Arundel County Department of Health (Maryland) illustrates one model of contact-tracing activity developed early in the outbreak. We describe the contact-tracing effort’s place within the broader county health agency Incident Command System, as well as the capabilities needed, team composition, special considerations, and major lessons learned by county health officials. Other local, state, tribal, territorial, and federal health officials and policy makers can use this case study to innovate, iterate, and further refine contact-tracing efforts to prevent the spread of COVID-19 infection and support community members in isolation or quarantine.