US States Research Articles

Low-Budget Households in the Conditions of Digitalization in US Regions

The digitalization of the economy and society of the highly developed countries, along with technological improvements in production and social relations, introduces a number of significant problems associated with the widening income gap and the flow of the economically active population from the knowledge economy to the “traditional activity” sectors. The subjective expression of this process in the 21st century Low Budget Families, an increase in the share of which has been observed in the United States during the period of increased digitalization and reindustrialization, starting in 2010. The growth trend of Low Budget Families in the United States has an intra-country spatial nature, quantitatively and qualitatively different both at the level of subregions and individual states of the country. The regional aspects of the relationship between the growth of the share of Low Budget Families, depending on the level of digitalization of the economy and society, reflected through the corresponding “complex index”, considered in the article, find empirical confirmation, generally characterized by a direct dependence and causality associated with the release of an increasingly significant number of labor potential from the advanced sectors of the economy. The problem of the flow of economically active citizens, who represent the basis of Low Budget Families in which the level of official income, taxes, consumption and savings is declining, is being solved differently in different US states. Based on a comparison of the criteria for identifying Low Budget Families, a priority for the authorities of various regions of the country, a general “spatial picture” of polarization of subregions and states is formed based on the share of Low Budget Families, depending on the level of digitalization and the choice of directions of state regional policy to smooth out the negative problems of inequality and hidden employment, caused by the digital transformation of social relations.

Converging on Institutional Logics: The Expansion of Syringe Service Programs in a Midwest State

ABSTRACT Institutional logics are theoretical constructs that describe how organizations and other actors make sense of, and organize their everyday practices. This paper describes how syringe service programs (SSPs) have incorporated disparate institutional logics in efforts to meet the needs of a stigmatized population. SSPs are a type of human service organization that allows intravenous drug users (IDUs) to obtain unused needles, stemming the spread of bloodborne infections. Using qualitative interviews with 26 SSP employees at 22 SSP programs in a Midwestern US state, we reveal how these individuals understand how their organizations adapt to different logics (community, state, and professional) during changes in the field. We use Skelcher and Smith’s types of organizational hybridity to describe how SSPs incorporate different institutional logics into their work. Implications for understanding what happens at the organizational and field level as external pressures shape organizational activity and logic adoption are discussed.

The energy transition and local government finance: new data and insights from 10 US states

Fossil fuels are the primary contributor to global climate change, and efforts to reach net-zero emissions will require a dramatic curtailment of their extraction and use. However, fossil fuels fund public services at all levels of government, and research has not assessed whether clean energy sources can provide similar scales of revenue. In this paper, we analyze a novel dataset that we have assembled on how fossil fuels and renewable energy contribute to local governments in 79 US counties across 10 states. Revenues from fossil fuels far outweigh renewables in aggregate terms, providing more than $1000 per capita annually in dozens of counties. However, wind and solar in some states generate more local public revenue than fossil fuels per unit of primary energy production. In most counties that depend heavily on fossil fuels for local revenues, solar—but not wind—has the technical potential to replace existing fossil fuel revenues, but this would require dedicating implausibly large portions of developable land (in some cases, more than half) to solar. For counties with less reliance on fossil fuels, wind and solar can more plausibly replace fossil fuel revenue streams. This finding suggests that while renewable energy will provide new revenue streams for communities, fossil fuel–dependent regions will need to build new tax bases well beyond wind and solar, develop other sources of revenue, or risk a decline in public service provision.

Inequality in high-cost borrowing and unemployment insurance generosity in US states during the COVID-19 pandemic.

US consumers may turn to the private market for credit when income and government benefits fall short. The most vulnerable consumers have access only to the highest-cost loans. Prior research on trade-offs of credit with government welfare support cannot distinguish between distinct forms of unsecured credit due to data limitations. Here we provide insight on credit-welfare state trade-offs vis-à-vis unemployment insurance generosity by leveraging a large sample of credit data that allow us to separate credit cards, personal loans and alternative financial services loans and to analyse heterogeneity in credit use by household income. We find that more generous state unemployment insurance benefits were associated with a lower probability of high-cost credit use during the first seven quarters of the coronavirus disease 2019 (COVID-19) pandemic. This inverse association was concentrated among consumers living in low-income households. Our results support theories that public benefits are inversely associated with the use of costly credit.

Antimicrobial use practices in canine and feline patients with co-morbidities undergoing dental procedures in primary care practices in the US.

This study aimed to investigate how the presence of co-morbid conditions influenced antimicrobial usage as presumptive prophylaxis for suspected bacteremia in dogs and cats undergoing dental treatments at primary care veterinary clinics in the United States. In 2020, data was collected from 1076 veterinary clinics across 44 US states. A total of 681,541 general anesthesia dental procedures were conducted on 592,472 dogs and 89,069 cats. This revealed that systemic antimicrobials were administered in 8.8% of dog procedures and 7.8% of cat procedures in the absence of concurrent periodontal disease or extractions. Cefpodoxime, clindamycin, and amoxicillin-clavulanate were the most frequently used antimicrobials in dogs, while cefovecin, amoxicillin-clavulanate, and clindamycin topped the list for cats. Dogs with cardiovascular, hepato-renal, and endocrine co-morbidities, as well as those undergoing concurrent removal of cutaneous or subcutaneous neoplasia, displayed higher antimicrobial use. Similarly, cats with endocrine or hepato-renal disease, retroviral infection (i.e., feline leukemia virus (FeLV), feline immunodeficiency virus (FIV)), and concurrent removal of cutaneous or subcutaneous neoplasia exhibited increased antimicrobial use. Dogs with hepato-renal abnormalities had longer treatment durations compared to those without (10.1 vs. 9.6 days). Conversely, cats with concurrent removal of cutaneous or subcutaneous neoplasia had shorter durations of treatment as compared to those that did not have this procedure performed (8.4 vs 9.2 days). The findings of this study underscore the necessity for further research and collaboration within the veterinary community to develop evidence-based guidelines, promoting responsible antimicrobial use, and advancing the field of veterinary dentistry for enhanced patient outcomes.

The uneven impact of Medicaid expansion on rural and urban Black, Latino/a, and White mortality.

To determine the differential impact of Medicaid expansion on all-cause mortality between Black, Latino/a, and White populations in rural and urban areas, and assess how expansion impacted mortality disparities between these groups. We employ a county-level time-varying heterogenous treatment effects difference-in-difference analysis of Medicaid expansion on all-cause age-adjusted mortality for those 64 years of age or younger from 2009 to 2019. For all counties within the 50 US States and the District of Columbia, we use restricted-access vital statistics data to estimate Average Treatment Effect on the Treated (ATET) for all combinations of racial and ethnic group (Black, Latino/a, White), rurality (rural, urban), and sex. We then assess aggregate ATET, as well as how the ATET changed as time from expansion increased. Medicaid expansion led to a reduction in all-cause age-adjusted mortality for urban Black populations, but not rural Black populations. Urban White populations experienced mixed effects dependent on years after expansion. Latino/a populations saw no appreciable impact. While no effect was observed for rural Black and Latino/a populations, rural White all-cause age-adjusted mortality unexpectedly increased due to Medicaid expansion. These effects reduced rural- and urban-specific Black-White mortality disparities but did not shrink the rural-urban mortality gap. The mortality-reducing impact of Medicaid expansion has been uneven across racial and ethnic groups and rural-urban status; suggesting that many populations-particularly rural individuals-are not seeing the same benefits as others. It is imperative that states work to ensure Medicaid expansion is being appropriately implemented in rural areas.

Cigarette smoking decline among US young adults from 2000 to 2019, in relation to state-level cigarette price and tobacco control expenditure

ObjectiveTo investigate the association of state-level cigarette price and tobacco control expenditure with the large 2000–2019 decline in cigarette smoking among US 18–24 year-olds.MethodsSmoking behaviour was assessed in the 24...

Seroprevalence of Leprosy in Nine-Banded Armadillos (Dasypus novemcinctus) from Tennessee, USA, 2021-22.

The nine-banded armadillo (Dasypus novemcinctus) is currently considered an invasive species in parts of its range in the USA, and this range continues to expand to the north and east. Nine-banded armadillos are one of a handful of mammals known to contract leprosy (also known as Hansen's disease); range expansion thus leads to public health concerns about whether this might increase human exposure to infected animals. We collected blood samples from 61 road-killed armadillos over two summers (2021 and 2022) in Tennessee, a US state near the northern extreme of the species' current range, and screened them for exposure to Mycobacterium leprae, the causative agent of leprosy. All animals were seronegative, providing no evidence that range expansion is increasing the distribution of leprosy in the US.

Seroprevalence of Bovine Viral Diarrhea Virus in Wild Pigs (Sus scrofa) in 17 States in the USA.

Wild pigs (Sus scrofa) are among the most detrimental invasive species in the USA. They are damaging to crops and agriculture, pose a public health risk as reservoirs of zoonotic pathogens, and may also spread disease to livestock. One pathogen identified in wild pigs is bovine viral diarrhea virus (BVDV), a virus that causes an economically important disease of cattle (Bos taurus and Bos indicus). We sought to determine the BVDV seroprevalence in wild pigs in 17 states across the US and to determine whether age category, sex, or location were associated with a positive antibody titer. Serum samples from 945 wild pigs were collected from 17 US states. Virus neutralization assays were performed to determine antibody titers against BVDV-1b and BVDV-2a. Total BVDV seroprevalence for the study area was 5.8% (95% confidence interval [CI], 4.11-8.89). Seroprevalence across all evaluated states was determined to be 4.4% (95% CI, 2.48-6.82) for BVDV-1b and 3.6% (95% CI, 1.54-5.60) for BVDV-2a. The seroprevalence for individual states varied from 0% to 16.7%. There was no statistical difference in median antibody titer for BVDV-1b or BVDV-2a by sex or age category. State seroprevalences for both BVDV-1b and BVDV-2a were associated with wild pig population estimates for those states.

US State Restrictions and Excess COVID-19 Pandemic Deaths

Despite considerable prior research, it remains unclear whether and by how much state COVID-19-related restrictions affected the number of pandemic deaths in the US. To determine how state restrictions were associated with excess COVID-19 deaths over a 2-year analysis period. This was a cross-sectional study using state-level mortality and population data from the US Centers for Disease Control and Prevention for 2020 to 2022 compared with baseline data for 2017 to 2019. Data included the total US population, with separate estimates for younger than 45 years, 45 to 64 years, 65 to 84 years, and 85 years or older used to construct age-standardized measures. Age-standardized excess mortality rates and ratios for July 2020 to June 2022 were calculated and compared with prepandemic baseline rates. Excess death rates and ratios were then regressed on single or multiple restrictions, while controlling for excess death rates or ratios, from March 2020 to June 2020. Estimated values of the dependent variables were calculated for packages of weak vs strong state restrictions. Behavioral changes were investigated as a potential mechanism for the overall effects. Data analyses were performed from October 1, 2023, to June 13, 2024. Age and cause of death. Excess deaths, age-standardized excess death rates per 100 000, and excess death ratios. Mask requirements and vaccine mandates were negatively associated with excess deaths, prohibitions on vaccine or mask mandates were positively associated with death rates, and activity limitations were mostly not associated with death rates. If all states had imposed restrictions similar to those used in the 10 most restrictive states, excess deaths would have been an estimated 10% to 21% lower than the 1.18 million that actually occurred during the 2-year analysis period; conversely, the estimates suggest counterfactual increases of 13% to 17% if all states had restrictions similar to those in the 10 least-restrictive states. The estimated strong vs weak state restriction difference was 271 000 to 447 000 deaths, with behavior changes associated with 49% to 79% of the overall disparity. This cross-sectional study indicates that stringent COVID-19 restrictions, as a group, were associated with substantial decreases in pandemic mortality, with behavior changes plausibly serving as an important explanatory mechanism. These findings do not support the views that COVID-19 restrictions were ineffective. However, not all restrictions were equally effective; some, such as school closings, likely provided minimal benefit while imposing substantial cost.

Health Outcomes around Pregnancy and Exposure to HIV/Antiretrovirals (HOPE) study protocol: a prospective observational cohort study of reproductive-aged women living with HIV

IntroductionOver 265 000 women are living with HIV in the USA, but limited research has investigated the physical, mental and behavioural health outcomes among women living with HIV of reproductive...

Quality, Spending, Utilization, and Outcomes Among Dual-Eligible Medicare-Medicaid Beneficiaries in Integrated Care Programs

Most dual-eligible Medicare-Medicaid beneficiaries are enrolled in bifurcated insurance programs that pay for different components of care. Therefore, policymakers are prioritizing expansion of integrated care plans (ICPs) that manage both Medicare and Medicaid benefits and spending. To review evidence of the association between ICPs and health care spending, quality, utilization, and patient outcomes among dual-eligible beneficiaries. A search was conducted of PubMed/MEDLINE (January 1, 2010, through November 1, 2023) and Google Scholar (January 1, 2010, through October 1, 2023) and augmented with reports from US federal and state government websites. Three categories of ICPs were evaluated: Programs of All-Inclusive Care for the Elderly (PACE), Medicare-Medicaid Plans (MMPs), and Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) and related models aligning Medicare and Medicaid coverage. The review included studies that evaluated beneficiaries dually eligible for and enrolled in full Medicaid; compared an ICP to a nonintegrated arrangement; and evaluated utilization, spending, care coordination, patient experience, or health for 100 or more beneficiaries. In all, 26 ICP evaluations met the inclusion criteria and were included in the analysis: 5 of PACE, 13 of MMPs, and 8 of FIDE-SNPs and other aligned models. Evidence generally showed associated reductions in long-term nursing home stays in PACE (3 of 4 studies) and FIDE-SNPs and related aligned models (3 of 5 studies) but was mixed in evaluations of MMPs. Four of 9 studies of MMPs and 2 of 3 studies of FIDE-SNPs found higher outpatient use, although other studies showed no difference. Evidence on Medicaid spending was limited, whereas 8 of 10 studies of MMPs showed an association between these plans and higher Medicare spending. Evidence was mixed or inconclusive regarding care coordination and hospitalizations, and it was insufficient to evaluate patient satisfaction, health, and outcomes in beneficiary subgroups (eg, those with serious mental illness). Furthermore, studies had limited ability to control for bias from unmeasured differences between enrollees of ICPs compared with nonintegrated models. This systematic review found variability and gaps in evidence regarding ICPs and spending, quality, utilization, and outcomes. Studies found some ICPs were associated with reductions in long-term nursing home admissions, and several identified increases in outpatient care. However, MMPs were primarily associated with higher Medicare spending. Evidence for other outcomes was limited or inconclusive. Research addressing these evidence gaps is needed to guide ongoing efforts to integrate coverage and care for dual-eligible beneficiaries.

Challenging deficit ideologies in Spanish heritage language policies and programs

AbstractThis study analyzes the programs and policies for Spanish heritage language (SHL) students in Iowa high schools. Previous research suggests that SHL students do not enjoy equitable educational experiences in Spanish language classrooms, which are often taught by and designed for traditional second language learners. In US states like Iowa, there is no language policy that provides a facilitative structure for Heritage language education, so issues of educational opportunity for SHL students are addressed locally. Teachers are, therefore, particularly influential language policy and education arbiters. In this paper, we analyze (1) how Iowa language policy is interpreted and appropriated by high school Spanish teachers and (2) the perspectives of high school Spanish teachers about Heritage language education. Findings reveal that many teachers reject the monoglossic ideologies popular in Spanish language classrooms and instead celebrate the unique verbal repertoires of their SHL students. Implications for language policy and practice are discussed.

Patient experiences switching from in-clinic to self-administration of injectable contraception in two Western US states.

We describe the experiences and preferences of women who switched from clinic-administered intramuscular depot medroxyprogesterone acetate (DMPA-IM) to self-administered subcutaneous DMPA (DMPA-SC) in the context of the COVID-19 pandemic. We conducted interviews with women in California and Washington about their experiences with self-administered DMPA-SC. We interviewed women after their first or second self-administered DMPA-SC injection and conducted follow-up interviews after their third or fourth injection. We performed both thematic and descriptive content analyses. We completed 29 interviews with 15 women. Most participants (n = 10) were between the ages of 20 and 39 and the majority (n = 12) used DMPA primarily for contraception. Most (n = 13) described self-administered DMPA-SC as "very easy" or "somewhat easy" to use and reported greater convenience, decreased pain, fewer logistical and financial challenges, increased privacy, and improved comfort with injection compared to DMPA-IM. Participants identified difficulties obtaining DMPA-SC from pharmacies and safe needle disposal as barriers. Most (n = 13) would recommend DMPA-SC to a friend and desired to continue self-administration beyond the COVID-19 pandemic. Participants recommended counseling all patients about this option alongside other contraceptive methods, and offering clinician supervision, if desired. Women who switched from in-clinic DMPA-IM to self-administered DMPA-SC during the COVID-19 pandemic preferred the latter and intended to continue self-administration. Self-administration of DMPA-SC should be routinely offered and easily accessible to patients.

Exposure to structural racism-related state laws is associated with worse cardiovascular health among US adults, BRFSS 2011 and 2013.

The objective of this study was to determine whether exposure to structural racism-related state laws is associated with cardiovascular health among a racially and ethnically diverse sample of US adults. Data were from the Database of Structural Racism-Related State Laws and the Behavioral Risk Factor Surveillance System (BRFSS). The sample included 958,019 BRFSS 2011 and 2013 respondents aged 18+ from all 50 US states. The exposure was a summary index of 22 state laws related to the criminal legal system, economics and labor, education, healthcare, housing, immigration, and political participation. The outcome was the American Heart Association's Life's Simple 7 (LS7), a summary index of seven cardiovascular health indicators. Linear regression models included fixed effects for year and state to control for time trends and unmeasured time-invariant state-level contextual factors. In the full sample, a one standard deviation increase in the structural racism state legal index was associated with a 0.06-unit decrease in the LS7 (b=-0.06; 95% CI:-0.09, 0.02; p=0.001), controlling for individual- and state-level covariates. Contrary to expectations, stratified models revealed no statistically significant differences by race and ethnicity in the association between the structural racism state legal index and the LS7.

Characterization of highly pathogenic avian influenza virus in retail dairy products in the US.

In March 2024, clade 2.3.4.4b H5N1 highly pathogenic avian influenza virus (HPAIV) was detected in dairy cattle in the US, and it was discovered that the virus could be detected in raw milk. Although affected cow's milk is diverted from human consumption and current pasteurization requirements are expected to reduce or eliminate infectious HPAIV from the milk supply, a study was conducted to characterize whether the virus could be detected by quantitative real-time RT-PCR (qrRT-PCR) in pasteurized retail dairy products and, if detected, to determine whether the virus was viable. From 18 April to 22 April 2024, a total of 297 samples of Grade A pasteurized retail milk products (23 product types) were collected from 17 US states that represented products from 132 processors in 38 states. Viral RNA was detected in 60 samples (20.2%), with qrRT-PCR-based quantity estimates (non-infectious) of up to 5.4log1050% egg infectious doses per mL, with a mean and median of 3.0log10/mL and 2.9log10/mL, respectively. Samples that were positive for type A influenza by qrRT-PCR were confirmed to be clade 2.3.4.4 H5 HPAIV by qrRT-PCR. No infectious virus was detected in any of the qrRT-PCR-positive samples in embryonating chicken eggs. Further studies are needed to monitor the milk supply, but these results provide evidence that the infectious virus did not enter the US pasteurized milk supply before control measures for HPAIV were implemented in dairy cattle.IMPORTANCEHighly pathogenic avian influenza virus (HPAIV) infections in US dairy cattle were first confirmed in March 2024. Because the virus could be detected in raw milk, a study was conducted to determine whether it had entered the retail food supply. Pasteurized dairy products were collected from 17 states in April 2024. Viral RNA was detected in one in five samples, but infectious virus was not detected. This provides a snapshot of HPAIV in milk products early in the event and reinforces that with current safety measures, infectious viruses in milk are unlikely to enter the food supply.

Healthcare system resilience and adaptability to pandemic disruptions in the United States.

Understanding healthcare system resilience has become paramount, particularly in the wake of the COVID-19 pandemic, which imposed unprecedented burdens on healthcare services and severely impacted public health. Resilience is defined as the system's ability to absorb, recover from and adapt to disruptions; however, despite extensive studies on this subject, we still lack empirical evidence and mathematical tools to quantify its adaptability (the ability of the system to adjust to and learn from disruptions). By analyzing millions of patients' electronic medical records across US states, we find that the COVID-19 pandemic caused two successive waves of disruptions within the healthcare systems, enabling natural experiment analysis of the adaptive capacity of each system to adapt to past disruptions. We generalized the quantification framework and found that the US healthcare systems exhibit substantial adaptability (ρ = 0.58) but only a moderate level of resilience (r = 0.70). When considering system responses across racial groups, Black and Hispanic groups were more severely impacted by pandemic disruptions than white and Asian groups. Physician abundance was the key characteristic for determining healthcare system resilience. Our results offer vital guidance in designing resilient and sustainable healthcare systems to prepare for future waves of disruptions akin to COVID-19 pandemics.

Expenditures and Use of Hypofractionated Radiation Therapy Treating Breast Cancer Among Medicare Advantage Enrollees, 2009 to 2017

Technology advances in cancer care have paralleled rapidly increasing expenditures in radiation therapy. The use and costs of shorter cancer radiation therapy offer potential utility in clinical practice. We evaluate use and expenditures of Medicare Advantage (MA) beneficiaries receiving hypofractionated whole breast irradiation (HF-WBI) compared with conventionally fractionated whole breast irradiation (CF-WBI) in the United States and examine the relationship of patient characteristics with HF-WBI use. We performed a retrospective analysis of radiation therapy in MA beneficiaries using private employer-sponsored insurance claims for a pooled cross-sectional evaluation from 2009 to 2017. The study population included female MA beneficiaries with early-stage breast cancer treated with lumpectomy and whole breast irradiation. A total of 9957 women received HF-WBI, and 18,920 received CF-WBI. Older age, greater distance from home to treatment facility, and a higher proportion of college graduates in the community of residence were associated with increased HF-WBI use. Mean insurer-paid radiation therapy expenditures were significantly lower for HF-WBI versus CF-WBI (adjusted difference, $4113; 95% CI, $4030-$4,197). Mean patient out-of-pocket expenditure for HF-WBI was $426 less than that of CF-WBI. Across US states, geographic variation existed in the ratio of costs for HF-WBI relative to CF-WBI (range, 0.41-0.87). HF-WBI use among MA beneficiaries with breast cancer has dramatically increased over time, surpassing CF-HBI as the dominant form of radiation therapy. HF-WBI clinical adoption has outpaced any continual cost decrease, despite wide variation across US states for this shorter radiation therapy treatment. As MA enrollment continues to expand, identifying the drivers of HF-WBI use and the sources of variation in costs of HF-WBI will help direct the quality of cancer care delivered to Medicare beneficiaries.

A Marginalized Zero-Inflated Negative Binomial Model for Spatial Data: Modeling COVID-19 Deaths in Georgia.

Spatial count data with an abundance of zeros arise commonly in disease mapping studies. Typically, these data are analyzed using zero-inflated models, which comprise a mixture of a point mass at zero and an ordinary count distribution, such as the Poisson or negative binomial. However, due to their mixture representation, conventional zero-inflated models are challenging to explain in practice because the parameter estimates have conditional latent-class interpretations. As an alternative, several authors have proposed marginalized zero-inflated models that simultaneously model the excess zeros and the marginal mean, leading to a parameterization that more closely aligns with ordinary count models. Motivated by a study examining predictors of COVID-19 death rates, we develop a spatiotemporal marginalized zero-inflated negative binomial model that directly models the marginal mean, thus extending marginalized zero-inflated models to the spatial setting. To capture the spatiotemporal heterogeneity in the data, we introduce region-level covariates, smooth temporal effects, and spatially correlated random effects to model both the excess zeros and the marginal mean. For estimation, we adopt a Bayesian approach that combines full-conditional Gibbs sampling and Metropolis-Hastings steps. We investigate features of the model and use the model to identify key predictors of COVID-19 deaths in the US state of Georgia during the 2021 calendaryear.

Zoonoses-specific resources, collaborative networks, and enhanced communication can help US veterinarians tackle zoonotic diseases: results from a national survey.

Increased incidence of zoonoses, coupled with veterinarians' occupational exposure, led to this study examining the knowledge of licensed US veterinarians on zoonoses and their disease prevention practices. This online survey supported by the National Association of State Public Health Veterinarians received 466 responses from 36 US states; 67% of the respondents were female, and 72.5% were small animal medicine practitioners. The One Health concept was familiar among 82% of respondents, 51.3% knew of continuing education training on zoonoses, and 68% had attended such a training in the last 5 years. Respondents were unaware of which zoonoses to report to public health departments. For 3 out of 8 questions on standard operating procedures, statistically significant differences in protocols followed among small, large, and mixed animal medicine practitioners were observed. Most respondents believed they play a critical role in zoonoses prevention but would like more information on zoonotic diseases. Results indicate that assisting veterinarians with regularly updated information on zoonoses, providing targeted education and training to adhere to standardized infection control measures, and increasing communication with public health agencies and physicians may help prevent and reduce incidence of zoonoses.