State-level Survey Research Articles

Understanding Factors Influencing Nursing Faculty Departure and Intentions.

There is a known shortage of nursing faculty in academia. Understanding factors influencing the shortage will help to develop strategies to reduce it. The purpose was to identify the underlying factors influencing the decisions of current and former nursing faculty to leave or consider leaving their teaching roles. A cross-sectional state-level survey was distributed to licensed registered nurses and advanced practice registered nurses. The survey covered demographics, employment status, compensation, tenure, mentorship experiences, and significant factors affecting their decision-making. Of 496 nursing faculty responses (221 current, 275 former), low compensation, unrealistic workload, retirement, lack of appreciation, and personal/family issues were noted as significant reasons for leaving or considering departure. The study gives voice to various factors influencing nursing faculty's intention to leave and emphasizes the need to address issues of compensation, workload, and mentorship to mitigate faculty shortages.

An integrated abundance model for estimating county-level prevalence of opioid misuse in Ohio.

Opioid misuse is a national epidemic and a significant drug related threat to the United States. While the scale of the problem is undeniable, estimates of the local prevalence of opioid misuse are lacking, despite their importance to policy-making and resource allocation. This is due, in part, to the challenge of directly measuring opioid misuse at a local level. In this paper, we develop a Bayesian hierarchical spatio-temporal abundance model that integrates indirect county-level data on opioid-related outcomes with state-level survey estimates on prevalence of opioid misuse to estimate the latent county-level prevalence and counts of people who misuse opioids. A simulation study shows that our integrated model accurately recovers the latent counts and prevalence. We apply our model to county-level surveillance data on opioid overdose deaths and treatment admissions from the state of Ohio. Our proposed framework can be applied to other applications of small area estimation for hard to reach populations, which is a common occurrence with many health conditions such as those related to illicit behaviors.

The Effect of Physical Activity on the Attitudes toward Engaging in Driving While Impaired by Alcohol

This study investigated the effect of physical activity on the attitudes toward engaging in driving while impaired by alcohol among adults aged 18 years or older who reported consuming alcohol in the 30 days before the interview. This study conducted the multivariate logistic regression to examine the association between health behavior and attitudes toward driving while impaired by alcohol. Data about self-reported alcohol-impaired driving episodes and the majority of the variables presented in this study were taken from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a large-scale national health survey data and a cross-sectional state-level survey data set, collected by the Centers for Disease Control and Prevention (CDC). The empirical results indicated that physical activity was associated with reduced engagement in alcohol-impaired driving. The estimated odds ratios from the multivariate logistic regression results were 0.87, 0.87, and 0.85 for overall, males, and females, respectively. In other words, respondents who participated in physical activities were less likely than respondents who were inactive to operate a motor vehicle when they were impaired by alcohol consumption. In short, physical activity was significantly associated with a decrease in the propensity toward engaging in driving while impaired by alcohol for alcohol drinkers.

Comparison of abortion incidence estimates derived from direct survey questions versus the list experiment among women in Ohio.

Abortion is highly stigmatized in the United States which prevents its accurate measurement in surveys. The list experiment aims to improve the reporting of abortion history. We evaluated whether a list experiment resulted in higher reporting of abortion experiences than did two direct questions. Utilizing data from a representative survey of adult women of reproductive age in Ohio, we examined abortion history using two direct questions and a double list experiment. Through the double list experiment, we asked respondents to report how many of two lists of health items they had experienced; one list included abortion. We compared weighted history of abortion between these measures and by respondent demographic characteristics (age and socioeconomic status). Estimates of abortion history were similar between direct and list experiment questions. When measured with the two different direct question of abortion history, 8.4% and 8.0% of all respondents indicated ever having an abortion and with the list experiment, 8.5% indicated ever having an abortion. In a Midwestern state-level survey, the list experiment did not lead to increases in abortion reporting as compared to the direct questions. Subgroup analyses require larger samples, and future iterations should incorporate related but non-stigmatized control items to reduce misclassification and under-powering of such subgroup analyses.

Centers for Disease Control and Prevention Investments in Adverse Childhood Experience Prevention Efforts

Centers for Disease Control and Prevention Investments in Adverse Childhood Experience Prevention Efforts

INVASIVE EXOTIC PLANT SPECIES AND THEIR INFLUENCE ON THE ENVIRONMENT, ECOSYSTEM SERVICES, ECONOMY AND HEALTH: A SEARCH

Invasive exotic plant species (IEPS) is recognized as threat to the native biodiversity and leads to the loss of habitat for the indigenous species on the earth. Invasions not only tear down the native plant species but have adverse impacts on economy and human health. Many documented records from Western countries connected with alien species revealed altered ecosystem services and socio-economic conditions via diverse mode of actions. Even though, the ecological impacts of alien species were documented, there is a dearth of analysis regarding their economic quantification, livelihood considerations, biotechnological aspects and human health risk assessments are the need of the hour. The noxious exotic invasive plants in India were Ageratum conyzoides, Eupatorium adenophorum, Parthenium hysterophorus, Lantana camara, Mikania micrantha, Argemone mexicana and Eichhornia crassipes. In this context, an attempt was made to enlist the alien species of Kerala and a review to account the impacts of invasive exotic plant species on various aspects of the environment globally. Results regarding the alien species search revealed the following species such as Chromolaena odorata, Senna spectabilis, Hypoestes sanguinolenta, Maesopsis eminii, Eupatorium cannabinum, Mikania micrantha, Sphagneticola trilobata and Acacia mearnsii were intruded in to various ecosystems of Kerala after the repeated floods. They directly affect the germination and survival of local species, damage the quality of soil and affect ground water availability. Nearly 80 species were noted as alien species in Kerala by many state level surveys. Research in the direction of impact of alien species on socio-economic cultural aspects of life and derailment of ecosystem is not yet seriously carried from Kerala. Further, there is a paucity of the ecological models/indicators to establish interrelationship among global environmental changes, biodiversity and health, warranting future researches.

Mapping geographic variability of severe uncontrolled asthma in the United States: Management implications

BackgroundThe US population-level data on asthma morbidity and mortality are available primarily through state-level surveys. We hypothesize that considerable county-level heterogeneity may be obscured by state-level data, thus impeding focused initiatives to improve asthma outcomes. ObjectiveTo assess heterogeneity in the prevalence of uncontrolled, severe, and severe uncontrolled asthma by evaluating state- and county-level morbidity reflected in large administrative claims data sets and identify relationships between pharmacotherapy-based morbidity and the Centers for Disease Control and Prevention's asthma mortality data. MethodsAsthma prevalence and morbidity were identified using medical and pharmacy claims from the IQVIA Longitudinal Access and Adjudication Data database (July 2015–June 2018). Heat maps ranked the prevalence of severe uncontrolled asthma by deciles in all 50 states and the District of Columbia, plus 2935 counties. Mortality in states (2016) and 3147 counties (1999–2018) was similarly mapped and ranked and contrasted with claims-based morbidity. ResultsAmong 4,506,527 individuals with asthma, 640,936 (14.2%) received age-specific therapy for severe asthma. Of those with severe asthma, 144,232 (22.5%) filled 2 or more annual courses of systemic steroids and were designated as having severe uncontrolled asthma. Most states with high mortality had relatively few patients with severe uncontrolled asthma. A marked correlation between mortality and morbidity and trends by urban vs rural and metropolitan status were found at the county level. ConclusionIntrastate heterogeneity in the morbidity and mortality of severe uncontrolled asthma at the county level is not evident in state-level analyses. Increased local awareness of systemic corticosteroid use as an indicator of uncontrolled asthma should prompt regional educational and public health efforts to improve outcomes.

VARIATIONS HIGHLIGHTED IN HYPERLOCAL HEATMAPS CAN ADDRESS UNMET NEED AND ALLOCATION OF RESOURCES IN COPD

TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Population data for chronic obstructive pulmonary disease (COPD) prevalence and morbidity in the US are available primarily through state-level surveys. Acquisition of regional (or subnational) data on unstable COPD (uCOPD; i.e., ≥ 2 annual steroid-treated exacerbations) is possible through secondary use of national claims datasets. We sought to define the prevalence of uCOPD by examining state- and county-level morbidity in large medication claims datasets, thereby reducing the inaccuracies associated with survey model-based approaches. METHODS: COPD and uCOPD were identified using medical and pharmacy claims from the IQVIA Longitudinal Access and Adjudication Data database for US patients from all payer groups from 2017 to 2019. Patients with a COPD claim who were <40 years of age, had <1 annual maintenance or rescue inhaler prescription, had other respiratory disorders, or had other chronic diseases that use corticosteroids were excluded. Heatmaps were generated to summarize the relative ranking of all 50 states and 3143 counties based on the number and percentage of uCOPD patients. States and counties were divided into quartiles according to the range of patients with uCOPD (eg, in states classified as Quartile 1, the number of uCOPD patients fell within the bottom quarter of the range of uCOPD patients across all 50 states). Quartiles 1 and 4 referred to the fewest and greatest number of patients with uCOPD, respectively. RESULTS: Of 13.1 million individuals with a COPD claim in 2019, 3.1 million met selection criteria for COPD and 0.8 million (~26%) met selection criteria for uCOPD. The percentage of patients with uCOPD was 28.4% in 2017, 28.4% in 2018, and 26.8% in 2019. During this period, patients with COPD received an average of 2 systemic corticosteroid, 4.2 rescue inhaler, and 4.7 maintenance prescriptions annually. In 2019, the 13 states in Quartile 4 accounted for 60.1% of all uCOPD patients, and the 767 counties (from all 50 states, predominantly in Midwest, Southeast, and Mid-Atlantic regions) in Quartile 4 accounted for 74.1% of all uCOPD patients. The percentage of patients with uCOPD declined between 2017 and 2019 by 0.9%, 1.0%, 1.4%, and 1.7% in Quartiles 1-4, respectively. Within Quartile 4, 598 counties showed a decline of 2.4% in patients with uCOPD and 141 showed an increase of 1.2%. CONCLUSIONS: State- and county-level heatmaps using data from a large administrative and medication claims database reveal that although year-to-year fluctuations occur, overall there is an imbalance in the distribution of patients with uCOPD and/or standard of care across different states and counties, with high burden counties in states with overall low prevalence. CLINICAL IMPLICATIONS: Hyperlocal COPD data can help optimize allocation of resources to address localized unmet need in COPD. Long term sustained improvements in the rate of uCOPD can only be accomplished through local insights. DISCLOSURES: Consultant relationship with AstraZeneca Please note: >$100000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with Genentech Please note: $20001 - $100000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with Genzyme Corporation Please note: $5001 - $20000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with Novartis Please note: $5001 - $20000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with Circassia Please note: $1001 - $5000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with Boehringer Ingelheim Please note: $1001 - $5000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Consultant relationship with GlaxoSmithKline Please note: $1-$1000 by Geoffrey Chupp, source=Web Response, value=Consulting fee Employee relationship with AstraZeneca Pharmaceuticals LP Please note: >$100000 Added 04/16/2021 by Norbert Feigler, source=Web Response, value=Salary Employee relationship with Astrazeneca Please note: >$100000 by Hitesh Gandhi, source=Web Response, value=Salary My spouse/partner as a Employee relationship with Pfizer Please note: >$100000 by Hitesh Gandhi, source=Web Response, value=Salary

Understanding racial differences in attitudes about public health efforts during COVID-19 using an explanatory mixed methods design

Efforts to mitigate the spread of COVID-19 rely on trust in public health organizations and practices. These practices include contact tracing, which requires people to share personal information with public health organizations. The central role of trust in these practices has gained more attention during the pandemic, resurfacing endemic questions about public trust and potential racial trust disparities, especially as they relate to participation in public health efforts.Using an explanatory mixed methods design, we conducted quantitative analysis of state-level survey data in the United States from a representative sample of Michigan residents (n = 1000) in May 2020. We used unadjusted and adjusted linear regressions to examine differences in trust in public health information and willingness to participate in public health efforts by race. From July to September 2020, we conducted qualitative interviews (n = 26) to further explain quantitative results.Using unadjusted linear regression, we observed higher willingness to participate in COVID-19 public health efforts among Black survey respondents compared to White respondents. In adjusted analysis, that difference disappeared, yielding no statistically significant difference between Black and White respondents in either trust in public health information sources or willingness to participate. Qualitative interviews were conducted to explain these findings, considering their contrast with assumptions that Black people would exhibit lower trust in public health organizations during COVID-19.Altruism, risk acknowledgement, trust in public health organizations during COVID-19, and belief in efficacy of public health efforts contributed to willingness to participate in public health efforts among interviewees. Our findings underscore the contextual nature of trust, and the importance of this context when analyzing protective health behaviors among communities disproportionately affected by COVID-19. Assumptions about mistrust among Black individuals and communities may be inaccurate because they overlook the specific context of the public health crisis. These findings are important because they indicate that Black respondents are exhibiting strategic trust during COVID-19 despite systemic, contemporary, and historic barriers to trust. Conceptual specificity rather than blanket generalizations is warranted, especially given the harms of stereotyping and discrimination.

Variations in RTI Literacy Implementation in Grades 6-12: A National Study

ABSTRACT Despite the need for Response to Intervention (RTI) in secondary grades, research is scant with most studies exploring state-level policy guidance and RTI implementation surveys in classrooms. Additionally, state and federal policy has generally been vague regarding specific information for RTI implementation in literacy. Our national survey reports data on RTI implementation from 209 secondary grade teachers. Response profiles and statistical significance tests were conducted, determining that many secondary level classrooms are using research-based recommendations for RTI implementation and practice across the country. However, significant regional differences exist in how RTI is being resourced and implemented.

Improved mapping and change detection of the start of the crop growing season in the US Corn Belt from long-term AVHRR NDVI

Long-term monitoring of crop phenology is a critical process to understand changes in cropland vegetation dynamics related to climate and human management. During the last four decades, seasonal changes in vegetation have been measured by satellite instruments, the Advanced Very High Resolution Radiometers (AVHRRs). However, an acceptable detection of crop phenology has been prevented due to its coarse spatial resolution (~8 km) pixels in which croplands are frequently mixed with non-cropland. This study introduces a novel method for detecting the start of the growing season in cropland (SOSC) from the AVHRR Normalized Difference Vegetation Index (NDVI) to examine the long-term changes in SOSC at the 8-km pixel level across the core cropping regions of the Midwestern United States (the so-called ‘the Corn Belt’) for 1982–2015. The AVHRR-based SOSC was compared with the SOSC retrieved from the pixels covering mostly croplands of the 250-m Moderate Resolution Imaging Spectroradiometer (MODIS) NDVI. These two satellite-based SOSC shows reasonable correspondence in spatial patterns so that the annual values of the root mean square difference ranges from 3.6 to 7.4 days during the overlapping period of 2008–2015. Also, an acceptable correspondence was found between the interannual variations in the AVHRR SOSCs and in the state-level survey of crop stages. For sowing stages, correlation coefficients ranged from 0.43 to 0.68; for flowering stages those ranged from 0.51 to 0.83. By analyzing long-term SOSC changes with climate factors, we found a strong tendency that warmer pre-season condition is accompanied with earlier SOSC. In addition, larger pre-season precipitation tends to postpone SOSC as strongly as the pre-season temperature affects SOSC in a considerable portion of the core cropland. This study suggests that the postponing of sowing due to larger precipitation, which has rarely been highlighted in previous studies, requires more attentions in order for better understanding of vegetation dynamics in agriculture-climate studies.

Medicaid expansion, health insurance coverage, and cost barriers to care among low-income adults with asthma: the Adult Asthma Call-Back Survey

Objective To examine Medicaid expansion (ME) effects on health insurance coverage (HIC) and cost barriers to medical care among people with asthma. Method We analyzed 2012–2013 and 2015–2016 data from low-income adults with current asthma aged 18–64 years in the Behavioral Risk Factor Surveillance System Asthma Call-Back Survey (state-level telephone survey). We calculated weighted percentages and 95% confidence intervals from ME and non-ME jurisdictions (according to 2014 ME status). Outcomes were HIC and cost barriers to buying asthma medication (MED), seeing a health care provider for asthma (HCP), or any asthma care (AAC). Using SUDAAN, we performed survey-weighted difference-in-differences analyses, adjusting for demographics. Subgroup analyses were stratified by demographics. Results Our study population included 6445 participants from 25 states plus Puerto Rico. In 2015–2016 compared to 2012–2013, HIC was more common in ME jurisdictions (P < 0.001) but unchanged in non-ME jurisdictions. Adjusted difference-in-differences analyses showed ME was associated with a statistically significant 13.36 percentage-point increase in HIC (standard error = 0.053). Cost barriers to MED, HCP, and AAC did not change significantly for either group in descriptive and difference-in-differences analyses. In subgroup analyses, we noted variation in outcomes by demographics and 2014 ME status. Conclusions We found ME significantly affected HIC among low-income adults with asthma, but not cost barriers to asthma-related health care. Strategies to reduce cost barriers to asthma care could further improve health care access among low-income adults with asthma in ME jurisdictions.

Nurse Faculty Workload Characteristics: A State-Level Survey

Introduction National data and research on faculty characteristics, including workload, satisfaction, and mentoring, are available; however, state-level data to inform regional efforts are limited. A state-level survey identifying faculty job characteristics and faculty mentoring practices can assist nursing programs with the development of recruitment and retention initiatives to influence regional shortages. Aims The aim of this study is to report the characteristics of New Hampshire (NH) nurse faculty to inform regional initiatives to support recruitment, role transition, and retention of nurse faculty. Methods An online survey was sent to 211 NH nurse faculty to determine job satisfaction, workload, intent to leave, and presence and characteristics of mentoring programs. Results Seventy-eight surveys (37%) were completed. More than 65% of respondents (n = 49) were older than 50 years. Respondents were most satisfied with professional autonomy and least satisfied with salary. More than 60% indicated their institution provided formal mentorship support; however, less than 40% reported participating. Conclusions NH nurse faculty concerns mirror national concerns, including an aging workforce and salary dissatisfaction. Recommendations to address NH nurse faculty workforce needs include formal mentorship programs and workload flexibility initiatives.

Impact of state weights on national vaccination coverage estimates from household surveys in Nigeria

National vaccination coverage estimates from household surveys are widely used in monitoring and planning of immunization programs. In Nigeria, survey-reported national coverage estimates have shown large fluctuations in the past few years. In this paper, we examine the impact of state-level survey weighting on Nigeria’s national vaccination coverage estimation. In particular, we focus three vaccination-related outcomes among children aged 12–23 months: the coverage of the third dose of diphtheria, pertussis, and tetanus vaccine (DPT3); the coverage of the first dose of measles-containing vaccine (MCV1); and the availability rate of home-based vaccination record (HBR). We compare the sample selection and weight assignment of three major survey programs in Nigeria, and show that considerable portions of the changes in survey-reported national coverage estimates can be explained by shifts in state-level weights. Our analysis demonstrates the importance of state weighting method in estimating aggregated national coverage figures and provides important context for interpreting changes in coverage estimates between surveys in the future.

Distribution of herbicide-resistant Palmer amaranth (Amaranthus palmeri) in row crop production systems in Texas

AbstractA state-level survey was conducted across major row-crop production regions of Texas to document the level of sensitivity of Palmer amaranth to glyphosate, atrazine, pyrithiobac, tembotrione, fomesafen, and dicamba. Between 137 and 161 Palmer amaranth populations were evaluated for sensitivity to the labelled field rate (1X), and rated as resistant (≤49% injury), less sensitive (50% to 89% injury), or susceptible (90% to 100% injury). For glyphosate, 62%, 19%, 13%, and 13% of the populations from the High Plains, Central Texas, Rio Grande Valley, and Lower Gulf Coast, respectively, were resistant. Resistance to atrazine was more common in Palmer amaranth populations from the High Plains than in other regions, with 16% of the populations resistant and 22% less sensitive. Approximately 90% of the populations from the High Plains that exhibited resistance to atrazine POST also were resistant to atrazine PRE. Of the 160 populations tested for pyrithiobac, approximately 99% were resistant or less sensitive, regardless of the region. No resistance was found to fomesafen, tembotrione, or dicamba. However, 22% of the populations from the High Plains were less sensitive to 1X (93 g ai ha−1) tembotrione, but were killed at 2X, illustrating the background variability in sensitivity to this herbicide. For dicamba, three populations, all from the High Plains, exhibited less sensitivity at the 1X rate (controlled at the 2X rate; 1X = 560 g ae ha−1). One population exhibited multiple resistance to three herbicides with distinct sites of action (SOAs) involving acetolactate synthase, 5-enolpyruvylshikimate-3-phosphate synthase, and photosystem II inhibitors. Palmer amaranth populations exhibited less sensitivity to approximately 15 combinations of herbicides involving up to five SOAs. Dose-response assays conducted on the populations most resistant to glyphosate, pyrithiobac, or atrazine indicated they were 30-, 32-, or 49-fold or more resistant to these herbicides, respectively, compared with a susceptible standard.

State-level estimation of diabetes and prediabetes prevalence: Combining national and local survey data and clinical data.

Many statisticians and policy researchers are interested in using data generated through the normal delivery of health care services, rather than carefully designed and implemented population-representative surveys, to estimate disease prevalence. These larger databases allow for the estimation of smaller geographies, for example, states, at potentially lower expense. However, these health care records frequently do not cover all of the population of interest and may not collect some covariates that are important for accurate estimation. In a recent paper, the authors have described how to adjust for the incomplete coverage of administrative claims data and electronic health records at the state or local level. This article illustrates how to adjust and combine multiple data sets, namely, national surveys, state-level surveys, claims data, and electronic health record data, to improve estimates of diabetes and prediabetes prevalence, along with the estimates of the method's accuracy. We demonstrate and validate the method using data from three jurisdictions (Alabama, California, and New York City). This method can be applied more generally to other areas and other data sources.

A class act? Social background and body modifications in Australia

Are we witnessing the democratisation of body modification in Australia? The prevalence and social background of body modifications is examined using national and state-level survey data from Australia. We find body modifications to be more prevalent among younger, less educated, working-class, non-conservative Australians. Women are far more likely than men are to have body piercings, although in Queensland, young women are more likely than young men to be tattooed. Important life events such as pregnancy, separating from a long-term partner or experiencing violence are also associated with body modifications. While body modifications may be on the rise, social factors still influence the uptake of body modification practices in Australia, suggesting these are socially circumscribed taste-based practices, and should not yet be described as normative.

Health-related quality of life in consequences from frequency-quantity measures of alcohol consumption patterns

This study examines the effect of frequency and quantity measures of alcohol consumption patterns on health-related quality of life (HRQOL). The data, a cross-sectional state-level survey, is obtained from the behavioural risk factor surveillance system (BRFSS) collected by the centres for disease control and prevention (CDC) from 2004 to 2014. The cross-sectional time series multiple regression analyses are conducted for the analyses. The empirical results indicate respondents who are current drinkers regardless of their alcohol consumption patterns are less likely to have physically unhealthy days than respondents who are non-drinkers. The results also suggest HFLQ drinkers are the biggest beneficiary from their alcohol use for physical health. Contrarily, this study observes that alcohol consumption has a negative association with mental health outcomes except LFLQ drinkers. Low-quantity alcohol drinkers have no significant differences in mentally unhealthy days from non-drinkers regardless of alcohol consumption frequency.

State-Level Surveillance of Underinsurance and Health Care-Related Financial Burden

The Affordable Care Act (ACA) has reduced uninsurance, but underinsurance, health care-related financial burden, and dental uninsurance may not follow suit. Underinsurance is associated with reduced access to care, household debt, and bankruptcy but has been difficult to track without economic data. We used readily available state-level survey data to build a model that states can adopt to implement surveillance over underinsurance and health care-related financial burden, as well as assess related disparities and health profiles. The state prevalence of underinsurance and dental uninsurance did not change in the first year of the ACA's individual mandate. Underinsurance was associated with poorer health-related quality-of-life measures: compared with the fully insured, underinsured adults had an adjusted odds ratio of 2.40 (95% CI, 1.71-3.38) of fair or poor general health. Tracking underinsurance and medical debt can help public health and health care access stakeholders evaluate which mechanisms (deductibles, co-pays, uncovered services, or is proportionately priced health care services and products) are barriers to care and improved health outcomes.

How to Choose? Using the Delphi Method to Develop Consensus Triggers and Indicators for Disaster Response

To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency. A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators. In the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster. The identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467-472).