Journal of Public Health Management and Practice最新文献

Objective: This study aimed to assess the quality of community health assessments (CHA) and community health improvement plans conducted by Public Health Accreditation Board (PHAB)-accredited local health departments (LHDs) in Kentucky.

Design: Quality assessment of CHAs and community health improvement plan documents using criteria adapted from Pennel et al (2015).

Setting: PHAB-accredited LHDs in Kentucky.

Participants: Seventeen CHAs and community health improvement plan documents from PHAB-accredited LHD.

Main outcome measures: Quality scores based on 17 evaluation criteria, including stakeholder involvement, data examination, plan feasibility, and LHD-hospital collaboration.

Results: The study found significant variation in the quality of CHAs and community health improvement plan documents. The highest scores were for partner involvement, data examination, and plan feasibility. The lowest scores were for LHD-hospital collaboration, use of evidence-based strategies, and plan evaluation. No community variables significantly predicted overall report scores.

Conclusions: The quality of CHAs and community health improvement plan documents varies among Kentucky LHDs, highlighting the need for more robust guidance and standardized criteria. Strengthening hospital-LHD collaboration and focusing on evidence-based strategies can improve public health outcomes.

Implications for policy and practice: Enhancing CHAs and community health improvement plan processes through legislative changes, better guidance, and improved collaboration between hospitals and LHD can lead to more effective public health interventions and outcomes.

Compared with traditional measures of scientific impact, the CDC Science Impact Framework more broadly, directly, and quickly assesses impact of public health science. For 20 CDC-funded HIV prevention projects that were conducted during 2018-2022, health departments documented impact, based on CDC Science Impact Framework domains: Disseminating Science, Creating Awareness, Catalyzing Action, Effecting Change, and Shaping the Future. Health departments reported 282 impacts: the most common were new partnerships (n = 17, Catalyzing Action), capacity building (n = 16, Effecting Change), new projects or initiatives begun (n = 15, Shaping the Future), new collaborations (n = 14, Catalyzing Action), improved program (n = 13, Shaping the Future), new guidelines or practices (n = 13, Effecting Change), and informed persons affected by work (n = 13, Creating Awareness). Health departments documented substantial impact with a simple, timely, and broad approach. Demonstrating impact is important for community-based organizations, funders, and others interested in public health and helps them better understand the value of public health.

Objective: State public health departments use federal funding to examine and address social determinants of health (SDOH) within their communities to improve health and advance health equity. Yet, most federal funding is categorical (ie, funding used for a specific program or narrow purpose), which can create barriers to addressing social and structural drivers of inequity. The Preventive Health and Health Services Block Grant (PHHS Block Grant) is a flexible funding mechanism that provides health departments the latitude to identify and fund initiatives that address local public health needs. It is unclear, however, to what extent health departments use this flexible resource to incorporate SDOH into their programs.

Design: Cross-sectional, descriptive analysis of state health department PHHS Block Grant program administrative data.

Setting: This study examined PHHS Block Grant budgets and workplans for the federal Fiscal Year 2021 to assess whether state health departments aligned their grant-funded program with the national objectives associated with the Healthy People 2030 SDOH Framework.

Participants: Forty-seven states and the District of Columbia were included in this study.

Main outcome measures: Percent of states that used PHHS Block Grant funds to address SDOH; proportion of funding allocated to address SDOH; percentage of programs that addressed SDOH.

Results: Three-fourths (75%) of states allocated funds to 97 programs aligning with at least 1 Healthy People 2030 SDOH-related objective. Fifty of the programs were fully or primarily funded by the PHHS Block Grant. Results also show that as the states' PHHS Block Grant funding level increased so did the percent of states that allocated funding toward SDOH programs.

Conclusion: This study shows that state health departments are using the PHHS Block Grant to address SDOH, and that the grant plays an important funding role for these programs. States are incorporating the grant into their funding strategies to address SDOH.

Context: Laboratory-based hepatitis C virus (HCV) clearance cascades are an important tool for health departments to track progress toward HCV elimination, but a laboratory-based definition of HCV clearance has not yet been validated.

Objective: To compare agreement between a laboratory-based HCV clearance definition with a clinical cure definition.

Design: Observational.

Setting: New York City Department of Health and Mental Hygiene HCV surveillance system data and New York City hepatitis C linkage-to-care program data.

Participants: Linkage-to-care program participants who were diagnosed with hepatitis C and enrolled in the linkage-to-care program from July 1, 2016, through June 30, 2020.

Main outcome measure: Percent agreement between a laboratory-based HCV clearance definition (surveillance system) and a clinical cure definition (program data).

Results: Among 591 program participants with known treatment outcome, the laboratory-based HCV clearance definition and clinical cure definition were concordant in 573 cases (97%).

Conclusions: A laboratory-based HCV clearance definition based on public health surveillance data can be a reliable source for monitoring HCV elimination.

Context: The illicit drug landscape in the United States is dynamic, featuring a risky and erratic drug supply. Drug checking programs (DCP) have been successfully implemented and studied extensively in Canada and Europe but are scarce in the United States. Integrating DCP at harm reduction programs provides an opportunity to engage people at the point-of-care and deliver a combination of harm reduction services, access to healthcare services, and linkages to treatment.

Program: The New York State Department of Health (NYSDOH) developed and supports operation of 8 pilot community DCP sites throughout the state. The DCP were trained to utilize Fourier-transform infrared spectroscopy (FTIR) technology to deliver real-time results to participants.

Implementation: The NYSDOH community DCP pilot began development in 2022. Partnerships were formed across multiple domains including other DCP, universities, forensic laboratories, syringe service and harm reduction programs, and legal and regulatory offices within the NYSDOH. The first pilot sites began operating in mid-2023 and program expansion is on-going.

Evaluation: Evaluation staff were extensively engaged in development and implementation phases. Qualitative evaluation focused on barriers, facilitators, and lessons learned from program staff and technicians. Quantitative evidence was gathered to assess the reach of the DCP and accuracy of results attained by drug checking technicians during their training periods. Drug checking results helped characterize the illicit drug supply.

Discussion: Development and implementation of DCP in NYS was facilitated by strong partnerships across sectors including public health and harm reduction. DCP may involve diverse partners who do not regularly collaborate, and health departments are positioned to build relationships and convene partners for program implementation. Evaluation findings highlight the importance of facilitating on-going training and technical assistance to DCP for quality assurance. The initial successes and lessons learned from the NYSDOH DCP demonstrate state public health departments' ability to successfully deploy this innovative harm reduction strategy.

Context: There are currently no national estimates of how many people die while unhoused in the US. Local jurisdictions have developed their own approaches for estimating homeless mortality.

Objective: We aimed to examine these local approaches, document what is known about homeless mortality, and summarize local methodologies.

Design: We reviewed 17 publicly available homeless mortality reports (ie, gray literature).

Setting: Reports were sought from government, Health Care for the Homeless, coalition to end homelessness, and other advocacy and social service websites.

Main outcome: From each report, we extracted the number of homeless deaths, dates of observation, data source(s) used, determination of homeless status, manners and causes of death, and decedent demographics.

Results: Data collection and reporting on homeless mortality varied greatly across reports. This variation limits aggregation across reports. Medical examiner data was the most used data source. Manner of death was the most consistently collected field, with accidental deaths reported as the most prevalent manner of homeless deaths. Not all reports listed specific causes of death, but those that did reported toxicity (eg, overdose) and cardiovascular causes as most prevalent. The most granular age category of most homeless decedents was 40 to 60 years. On average, 80% of decedents were of male sex. While over half of reports included race and ethnicity information, disparities could not be estimated without suitable denominators.

Conclusions: Standardized data collection and reporting guidance is needed for homeless mortality. Health departments can work with local Health Care for the Homeless programs and Continuums of Care to establish data sharing processes. Matching vital statistics with homeless service utilization records may be one opportunity to improve these efforts. Until there is federal or national guidance on these standards, localities can consider adding housing or homelessness variables as optional or mandatory fields in electronic death reporting systems.

Context: The COVID-19 pandemic exposed governmental public health's outdated information technology and insufficient data science and informatics workforce capacity. The Centers for Disease Control and Prevention's Public Health Informatics Fellowship Program (PHIFP) is well positioned to strengthen public health data science and informatics workforce capacity.

Program: Established in 1996, PHIFP is a 2-year, full-time, on-the-job training program. PHIFP includes a didactic curriculum, applied learning through informatics projects completed at the assigned host site, short-term technical assistance projects, and a final capstone project.

Evaluation: Fellows have learned from and bolstered host site informatics capacity through the development or enhancement of information systems, evaluations, data integration, data visualization, and analysis. Among recent graduates, 54% are employed at Centers for Disease Control and Prevention and 16% are employed at other public health organizations, including local health departments.

Discussion: Fellowships such as PHIFP, which recruit and train promising scientists in public health informatics, are important components of efforts to strengthen public health workforce capacity.

Background: Existing surveillance systems monitor nonfatal and fatal opioid overdoses but do not monitor severe nonfatal overdoses that require intensive medical interventions.

Methods: The Centers for Disease Control and Prevention's Drug Overdose Surveillance and Epidemiology system was used to query emergency department data from local syndromic systems and the National Syndromic Surveillance Program from January 2019 to August 2022. Opioid overdoses were classified as not severe or severe using a definition from the patient's chief complaint terms and discharge diagnosis codes. The percentage of opioid overdoses treated in emergency departments classified as severe was described by patient demographics, US Census region, and month.

Results: Among 503 156 opioid overdoses in 29 states and Washington, DC, from January 2019 to August 2022, 17.4% were classified as severe. Common key terms found among severe opioid overdoses were hypoxia (34.8%), unresponsive (32.9%), and naloxone/Narcan (20.9%). The largest severity percentage was in the South Census region (19.6%). The trends of severe opioid overdoses remained stable during the study period.

Discussion: Based on the severe opioid overdose definition, there was minimal change in the severity of opioid overdoses during the study period. This definition can help monitor trends of severe opioid overdoses, guiding public health action such as focusing on naloxone and fentanyl test strip distribution to areas of need.

As part of CDC's Partnering for Vaccine Equity Program, the Association of State and Territorial Health Officials worked with the National Community Action Partnership and five community action agencies (CAAs) to address disparities in adult immunization among racial and ethnic minority populations. CAAs leveraged partnerships with public health, healthcare, and other local entities to increase uptake of COVID-19 and other vaccines, while simultaneously addressing related social determinants of health. With over 1000 agencies across the United States, including state associations, CAAs are accessible partners to nearly all state and local health departments. Collaboration between public health and community action is a promising model that can be used to cultivate trust, build and support resiliency, and address systemic disparities to advance health equity within communities.

Context: The COVID-19 pandemic led to the closure of prekindergarten to grade 12 schools and an inequitable return to full-time in-person learning.

Objective: To explore how ethnic and racial differences across school districts in Massachusetts correlate with parents' attitudes, beliefs, and trusted sources of information about COVID-19 and mitigation strategies.

Design: An electronic survey was distributed by school administrators to parents and guardians in November and December 2021 using existing school district contact lists and established methods of communication (email in 2 school districts; email and text message in 1 district).

Setting: Three school districts in Massachusetts (Chelsea, Medford, and Somerville).

Participants: Parents of prekindergarten to grade 12 school students attending public schools.

Main outcome measures: Parental attitudes and beliefs regarding mitigation strategies for COVID-19 (surveillance testing, masking, and vaccination); trusted information sources about COVID-19; preferred methods of communication from schools.

Results: A total of 1496 survey responses were analyzed. Chelsea respondents were predominantly Hispanic/LatinX (88%); Medford and Somerville were predominantly White/non-Hispanic (80% and 68%, respectively). Testing, masks, and vaccination were supported by >80% of parents/guardians across districts. However, there were statistically significant differences between school districts regarding participation in testing programs, implications of a child testing positive, vaccination of young children, communication preferences, and trusted sources of information.

Conclusions: Although primarily focused on COVID-19, these results highlight opportunities for public health personnel and school administrators to work directly with parents and guardians in their school districts to improve communication strategies and be a trusted source of information for a variety of public health issues.