Public Health Reports最新文献

Objectives: Few analyses have differentiated locally acquired Lyme disease infection from travel-associated infection, limiting the ability to interpret whether case counts reflect true in-state transmission or increased detection among mobile populations. We analyzed and compared trends in Lyme disease incidence at the national level and in the state of Florida.

Methods: We primarily used Lyme disease surveillance data from the Centers for Disease Control and Prevention from 2010 through 2023. The data included total case numbers, demographic characteristics, and county-level distribution maps. We stratified data by age, sex, and county in Florida. We conducted a Pearson correlation analysis to examine the association between Florida's mean annual temperature and Lyme disease incidence from 2010 through 2023.

Results: Florida recorded 84 Lyme disease cases in 2010 and 271 cases in 2023; incidence per 100 000 residents rose from 0.4 in 2010 to 1.2 in 2023. Older adults had the highest incidence of reported Lyme disease in Florida. Lyme disease incidence was slightly higher among females than among males. North Florida was a hotspot for Lyme disease transmission, and the North Central region (roughly from Jacksonville to Tallahassee) consistently yielded most of the Florida-acquired tickborne disease cases.

Conclusion: Early detection and timely action to reduce the spread of Lyme disease is important for several intertwined clinical, economic, and ecological reasons. Further research is needed to differentiate infections acquired outside the state to clarify their influence on state trends. Establishing proactive measures in Florida's public health and education sectors for tickborne disease prevention is necessary to reduce risk as Lyme disease cases continue to increase in Florida.

Objectives: In 2024, the Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists suggested approaches, including upskilling and recruitment/hiring, to strengthen the workforce capacity in public health data science. We estimated the number of recently graduated data scientists who might be eligible for and potentially hirable into government public health jobs as a step toward filling data gaps in workforce planning.

Methods: We used data from the National Center for Education Statistics to calculate the number of data science graduates in 2023. As a proxy for interest in government public health among graduates, we used data from the Association of Schools and Programs of Public Health (graduation years 2015-2022). We multiplied the number of data science graduates from US academic institutions (from National Center for Education Statistics data) by the percentage of public health graduates who entered government public health employment (from Association of Schools and Programs of Public Health data) to estimate the number of data science graduates who might be eligible for and interested in government public health employment.

Results: In 2023, 467 435 graduates were awarded a data science degree from a US institution. Depending on the government employment criteria, 8.3% to 15.7% of 96 578 public health graduates reported first-destination employment in government public health. The total number of data science graduates who might be eligible for and interested in government public health employment ranged from nearly 29 000 to >57 000.

Conclusions: These data contribute to the evidence base for public health workforce planning but are likely to be overestimates of supply. If the estimated supply of data scientists falls short of demand projections, staff data science upskilling and changes to academic curricula could be emphasized.

Objectives: Fentanyl overdose deaths are a critical public health issue in the United States. Rhode Island, an early epicenter of the fentanyl crisis, has seen fentanyl overdose deaths increase 30-fold since 2009. In response, harm reduction tools such as fentanyl test strips (FTSs) have been introduced to help people who use drugs (PWUD) detect fentanyl in their substances. We analyzed FTS use among PWUD in Rhode Island from 2021 through 2023 and identified characteristics associated with their use.

Methods: We conducted a pooled cross-sectional analysis using aggregate data from the Rhode Island Harm Reduction Surveillance System. We used bivariate Pearson χ² tests to assess the relationship between past-month FTS use and demographic and behavioral characteristics. Because analyses were limited to unadjusted comparisons, these findings are exploratory and hypothesis generating.

Results: Of 498 survey respondents, most identified as male (n = 328; 65.9%), non-Hispanic White (n = 204; 41.0%), straight (n = 400; 80.3%), and aged 25 to 44 years (n = 288; 57.8%). The most frequently reported substances used were crack (n = 355; 71.3%), cocaine (n = 219; 44.0%), and fentanyl/heroin (n = 196; 39.4%). Only 31.7% of individuals reported FTS use in the past 30 days. FTS use was significantly associated with age, race and ethnicity, witnessing an overdose, possessing naloxone, and recent fentanyl/heroin use (all P < .05).

Conclusions: Despite FTS distribution efforts and overdose risk, FTS uptake in Rhode Island was low. Future research should assess barriers to FTS adoption and consider integrating FTS distribution within naloxone programs.

Objective: Routine childhood vaccination rates declined nationwide among children born during 2020-2021 compared with prior birth cohorts. We identified sociodemographic risk factors associated with incomplete 7-vaccine series among children born during widespread health care disruptions due to the COVID-19 pandemic.

Methods: We retrieved childhood vaccination data from Louisiana's Immunization Information System for children born from March 1, 2020, through July 1, 2021, to identify completion status of the 7-vaccine series by age 24 months. After geocoding home addresses, we used regression analyses and machine-learning models to identify social vulnerability factors at the individual and census-tract levels that were associated with 1 or more missing vaccine doses.

Results: Children residing a greater distance from the vaccinating facility (adjusted odds ratio [AOR] = 1.12; 95% CI, 1.05-1.19; P = .002) and in a census tract with a larger low-income population than the statewide median (AOR = 1.14; 95% CI, 1.05-1.23; P = .006) had significantly higher odds of being 1 dose short of 7-vaccine series completion by age 24 months. Similarly, children residing in areas with a larger low-income (AOR = 1.18. 95% CI, 1.14-1.23; P < .001) and non-White (AOR = 1.07; 95% CI, 1.02-1.11; P = .04) population than the statewide median had higher odds of missing multiple doses of the 7-vaccine series by age 24 months.

Conclusion: We need further research to identify and implement best practices that help socially vulnerable communities retain access to routine health care, such as childhood immunizations, during future public health emergencies.

From 2010 to 2023, the Smoking Cessation Leadership Center partnered with the Substance Abuse and Mental Health Services Administration to launch the State Leadership Academies (hereinafter, Leadership Academies) to address tobacco use in populations with behavioral health conditions in the United States. The Leadership Academies were a facilitated convening of leaders in tobacco control, behavioral health, and public health who were tasked with creating action plans to reduce the high rates of tobacco use in populations with behavioral health conditions in their states. State partners convened for a 2-day summit between 2010 and 2023, created an action plan, and, in the subsequent 3 to 5 years, implemented and evaluated the action plan in the areas of data, systems, education, or policy. Using a multimethods evaluation approach, we describe short-term outcomes (collaborations), intermediate outcomes (examples of integration of tobacco treatment and policy), and long-term outcomes (decline in tobacco use prevalence) of the Leadership Academies, focusing on 4 state case studies. The case studies highlighted unique partnerships, impactful strategies, the harnessing of state-level infrastructure, and the importance of political will to achieve state-level reductions in tobacco use in populations with behavioral health conditions. The 4 states showed a mean decline of 5.2% in smoking prevalence among people with frequent poor mental health and 6.2% among people with heavy drinking during their Leadership Academy tenure. The case demonstrated the importance of cross-sector collaboration, leadership buy-in, and the creation of sustainable funding structures to support the scaling up of promising projects. Leadership Academies were an effective engagement model to reduce the prevalence of tobacco use in populations with behavioral health conditions.

Objective: Some refugee children in the United States have an elevated blood lead level (EBLL), which can result in neurologic disease and developmental delays. Little has been published on EBLLs in immigrant infants and children whose families are seeking humanitarian protections outside the refugee program. We evaluated lead testing and anemia in this population.

Methods: We performed a cross-sectional analysis of lead testing and anemia in infants and children whose families were seeking humanitarian protection (eg, asylum) and treated in clinics in Chelsea, Massachusetts (September 30, 2022-June 30, 2024) and New York City (January 1-November 30, 2023). We extracted demographic and clinical data from the medical records of clinics serving families who received emergency assistance with sheltering. We evaluated the proportion who completed lead testing and the prevalence of EBLL (≥3.5 µg/dL). We used Pearson χ² and Kruskal-Wallis tests to determine factors significantly associated with EBLL.

Results: Among 882 children (most from Venezuela [29.5%], Ecuador [22.0%], Colombia [16.2%], and Peru [6.7%]), 693 (78.6%) completed testing for lead. Lead testing was more common among children aged <5 years than among older children (P < .001). Nine of 693 children (1.3%; 95% CI, 0.6%-2.5%) had EBLL; the mean blood lead level was 5.31 µg/dL. Eight of the 9 children with EBLL were boys (P = .06). Of 882 children, 146 (16.6%) had anemia; 2 children with EBLL had anemia. We did not find a statistically significant association between country of origin and EBLL (P = .23).

Conclusion: Clinicians and public health professionals serving newcomer populations should enhance efforts to prevent and screen for EBLL and anemia.

Objectives: People with HIV (PWH) who transition back into the community after incarceration often experience treatment disruptions, increasing the risk of poor outcomes. We examined factors associated with sustained viral suppression (SVS) after release.

Methods: We analyzed 2015-2022 data from a nationally representative sample of PWH (N = 1012). We used weighted percentages and 95% CIs to describe the characteristics of recently incarcerated PWH by postrelease SVS status. We calculated prevalence ratios (PRs) to identify factors associated with SVS.

Results: Among PWH who were incarcerated at least once in the past 12 months, only 30.0% achieved SVS postrelease. PWH aged 18 to 29 years (PR = 1.16; 95% CI, 1.01-1.32) and 30 to 39 years (PR = 1.20; 95% CI, 1.06-1.35) were significantly more likely to not have SVS than PWH aged ≥50 years. PWH released within 180 days (≤60 days: PR = 1.44; 95% CI, 1.29-1.61; 61-180 days: PR = 1.18; 95% CI, 1.03-1.34) were significantly more likely to not have SVS than PWH released after ≥181 days. PWH with ≥3 incarcerations within the past 12 months were significantly more likely to not have SVS than PWH who were incarcerated once (PR = 1.25; 95% CI, 1.12-1.39). PWH with SVS were significantly more likely to be retained in HIV care (PR = 1.55; 95% CI, 1.40-1.70), taking antiretroviral therapy (ART) (PR = 1.20; 95% CI, 1.14-1.28), or adherent to ART (PR = 1.34; 95% CI, 1.15-1.56) than PWH without SVS.

Conclusions: SVS outcomes among recently incarcerated PWH could improve through adherence support, discharge planning, and postrelease support, particularly for young or frequently incarcerated individuals.

In 2014, the Centers for Disease Control and Prevention (CDC) expanded capacity to conduct infectious disease and economic modeling through the National Center for HIV, Viral Hepatitis, STD, and TB Prevention Epidemiologic and Economic Modeling Agreement (NEEMA). NEEMA brought together CDC scientists, academic partners, and public health practitioners at state and local levels to use epidemiologic and economic modeling to support the understanding of the efficiency, outcomes, cost-effectiveness, return on investment, and impact of programs and policies related to the center's disease foci, priority populations, and settings. In collaboration with state and local health departments, NEEMA activities included the development of tools to aid forecasting and decision-making. This article summarizes the scientific contributions and lessons learned from the NEEMA collaboration. During 2014-2024, NEEMA produced 136 peer-reviewed studies and 8 decision support tools. These studies have been cited 2697 times in peer-reviewed literature and referenced more than 70 times in policy documents. NEEMA has expanded the knowledge base on effective and cost-effective high-impact interventions for HIV, viral hepatitis, STD, and tuberculosis programs and continues to be responsive to changing needs for evidence to inform decision-making and policy.