Public Health Reports最新文献

Objectives: The Centers for Disease Control and Prevention (CDC) supports health departments in meeting public health accreditation standards, but how cumulative investments in these activities are related to growth in accreditation nationwide has not been documented. We analyzed CDC funding for accreditation activities for an 18-year period to determine cumulative investment relative to reach and coverage of the US population by accredited health departments.

Methods: We conducted a secondary analysis of Public Health Accreditation Board (PHAB) data to examine changes in the percentage of state health departments (SHDs) and local health departments (LHDs) that were accredited during 2005-2023.

Results: During 2005-2023, CDC distributed $248 million to 3 recipient types for accreditation activities, including health departments, PHAB, and other partner organizations. During this time, the number of accredited SHDs increased from 2 of 51 (4%) in 2013 to 41 of 51 (80%) in 2023, and the number of accredited LHDs increased from 20 of 2297 (1%) in 2013 to 395 of 2297 (17%) in 2023. In 2023, 83% of the US population was served by an accredited SHD and 43% by an accredited LHD. Among the 395 accredited LHDs nationwide, 322 (82%) were in states that provided funds to localities for accreditation activities from investments we analyzed.

Conclusions: Sustained funding for multicomponent accreditation activities was followed by growth in accredited SHDs and LHDs. States that allocated CDC funding to support local accreditation had more accredited LHDs than states that did not allocate such funding. Further research is needed to understand how accreditation of health departments changes in relation to other funding sources and supports.

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.

Objectives: Since 2000, leprosy has not been notifiable in Washington State, and statewide leprosy data have not been reported. We sought to increase our understanding of leprosy epidemiology in Washington State since 2001.

Methods: We reviewed data from the National Hansen's Disease Program to identify clinically diagnosed leprosy cases from 2001 through 2023 among Washington State residents. We analyzed cases over time, by county of residence, disease type, and global birth region. We used Poisson regression to estimate rates by birth region and incidence rate ratios to compare rates among US-born residents and those from other global birth regions.

Results: We identified 131 cases of leprosy in Washington State from 2001 through 2023. Most cases were among non-US-born people (95%), males (72%), and adults aged 18 to 64 years (87%); one-third were among Micronesian or Marshallese people. As compared with US-born people (0.2 per 1 000 000 population), the leprosy rate was 1064 times (95% CI, 466-3069) higher among people born in Oceania (215 per 1 000 000 population). Incidence rate ratios for other birth regions ranged from 301 (95% CI, 43-1396) for South America to 28 (95% CI, 11-82) for Asia.

Conclusions: Focused public health interventions, including increased physician awareness of leprosy and its stigma for populations at high risk, may reduce the incidence of leprosy among Washington State residents born in Oceania, who had a disproportionately high disease rate.

Objectives: Understanding patterns of hospital admissions and emergency department (ED) visits among people with sickle cell disease is critical for improving care and access to care for this population. The objective of this study was to characterize acute care use among people with sickle cell disease and identify patterns of use across age groups and sex using 2018 data.

Methods: We conducted a cross-sectional study using population-based data from 8 states participating in the Centers for Disease Control and Prevention's Sickle Cell Data Collection program. The sample population consisted of children, adolescents, and adults with a confirmed or probable diagnosis of sickle cell disease, regardless of acute care use, in 2018. We analyzed data on hospital admissions, ED treat-and-release (T/R) visits, and readmissions after ED T/R or inpatient discharge, aggregated from each participating state.

Results: The 2018 cohort of the Sickle Cell Data Collection program consisted of 27 034 people; 40.2% had ≥1 hospital admission, and 57.0% had ≥1 ED T/R visit. Of the 98 617 people using acute care, 93.6% (n = 92 305) involved the ED in some capacity.

Conclusions: Hospital admissions were frequent and occurred in less than half of the study population. More than half used the ED, with most hospital admissions initiated in the ED. Our findings call for further research to better understand differences in acute care use, high rates of ED T/R visits, and treatment of sickle cell disease in an outpatient setting.

Objectives: Public health nurses (PHNs) are one of the largest public health occupation groups, bringing important expertise to the activities of public health; however, their roles and distribution differ across the country. The objective of this study was to estimate the relative need for, supply of, and priority areas for PHNs at the county level.

Methods: We used a cross-sectional design with national data sources available at the county level to measure the local need for, supply of, and priority areas for PHNs. We estimated need through a newly developed index based on 4 domains: demographic characteristics, economic characteristics, health care context, and health outcomes within the county. We estimated supply by using registered nurse staffing data from local health departments. We identified priority tiers of PHN deserts as counties with relatively high need and low supply. We conducted the study in 2024-2025.

Results: The need for and supply of PHNs varied across the country, with little correlation (+0.26). For example, average need was highest in the southeastern United States (mean need score, 68.3 of 100; median need score, 76.0 of 100) and lowest in the upper northeastern United States (mean need score, 19.8 of 100; median need score, 13.5 of 100).

Conclusions: The combination of local-level PHN need and supply can be used to identify potential gaps in PHN availability and can inform investment, recruitment, training, or allocation of other resources to address the PHN workforce needs of local health departments.

Objective: Teenage pregnancy rates are high in the United States. Teenagers with epilepsy are at a particular health risk due to challenging transitions of care and unique considerations for contraception as well as at increased risk for fetal and maternal complications in pregnancy. The objective of this study was to explore the live birth rate among teenaged girls with epilepsy in Michigan.

Methods: In this retrospective open-cohort epidemiological study, we estimated the live birth rate and identified predictors for births among Medicaid-insured teenaged girls (aged 15-19 y) with epilepsy in Michigan, using administrative data from the Michigan Children's Special Health Care Services Program from 2016-2022.

Results: Among teenaged girls with epilepsy in Michigan, the birth rate was 1.6 per 100 population. Significant factors associated with giving birth (vs not) included use of fewer antiseizure medications, lack of contraceptive use, and low annual household income.

Conclusion: Given the risk factors identified (eg, no use of contraceptives, low income), teenaged girls with epilepsy may need greater access to care, resources, and/or support than teenaged girls without epilepsy. Our data suggest that targeted interventions to facilitate access to contraceptives could be beneficial. Improving data tracking and diagnosis coding practices will be important for the future study of the birth rate among teenaged girls with epilepsy.

Characterizing high-volume co-prescribing of antibiotics and opioids can inform interventions that improve prescribing practices. Using 2021 Medicare Part D data, we conducted a cross-sectional analysis to assess concordance between high-volume prescribing of antibiotics and opioids and characterize associations between prescriber-level factors and high-volume co-prescribing of antibiotics and opioids. High-volume antibiotic prescribers accounted for 12.5 million (36.0%) antibiotic prescriptions, and high-volume opioid prescribers accounted for 22.3 million (51.9%) opioid prescriptions. We found fair concordance between being a high-volume prescriber of antibiotics and a high-volume prescriber of opioids (κ = 0.30). Prescribers in the South (adjusted odds ratio [AOR] = 3.67; 95% CI, 3.46-3.90) and in rural areas (AOR = 2.32; 95% CI, 2.12-2.54) were more likely to be high-volume co-prescribers of antibiotics and opioids than prescribers in the West and in urban areas, respectively. Public health and professional organizations can partner to provide support to optimize antibiotic and opioid prescribing practices and improve patient safety.

Objectives: Health Extension for Diabetes (HED) is a community-based diabetes self-management support program facilitated by trained rural health and nutrition agents who lead 8 biweekly educational sessions supported by a diabetes clinical expert. We evaluated the program using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.

Methods: Since the HED program's conception in 2017, ongoing longitudinal evaluation has measured participant knowledge, self-efficacy, and other health behaviors via pre- and postsurveys (at program completion, at 1 year, and at 2 years). We used paired-sample t tests to assess significant changes in effectiveness outcomes from pre- to postintervention.

Results: Of 1526 participants enrolled in the HED program from 2018 to 2024, 1434 (94.0%) graduated. Mean physical health-related quality-of-life scores rose from 42.8 to 45.1, and mental health scores increased from 51.4 to 52.9 (on a 100-point scale). We assessed weekly diabetes self-care activities and found improvements in general diet (from 4.1 to 5.0 days/week), specific diet (from 3.9 to 4.7 days/week), exercise (from 2.6 to 3.7 days/week), blood glucose testing (from 4.2 to 5.2 days/week), and foot care (from 3.4 to 4.6 days/week). Average diabetes knowledge increased from 76.4% to 85.0%, and self-efficacy increased from 7.1 to 8.2 on a 10-point scale. Participants had reductions in weight (-3.4 pounds), body mass index (from 34.3 kg/m² to 33.7 kg/m²), and self-reported hemoglobin A_1c (from 7.5% to 7.0%). All pre- to postsurvey changes were significant at α = .05.

Conclusions: The HED program offers a scalable and sustainable approach to community-based diabetes self-management support. Program expansion and replication should leverage key implementation strategies identified via this RE-AIM framework evaluation.