Journal of Public Health Management and Practice最新文献

The Centers for Disease Control and Prevention (CDC) conducted 14 rapid community assessments (RCAs) to identify factors affecting COVID-19 vaccine confidence and demand. In May 2022, CDC's COVID-19 Vaccine Task Force conducted case studies of 3 communities to evaluate the RCA's impact and scalability. We convened online semi-structured interviews with 16 health department and community-based organization staff to explore the perceived value of RCAs, suggestions for improving the RCA process, and outcomes. We employed a general inductive analysis method with a priori codes and summarized findings. The CDC's RCA process engaged vaccine-hesitant populations, identified the causes of their hesitancy, and built internal capacity for conducting RCAs and using data effectively. Despite challenges in planning and coordinating across jurisdictions, RCAs proved valuable in enhancing vaccine confidence and demand efforts. Key lessons included allowing up to 2 months for planning, involving culturally competent, bilingual scientists, and offering post-RCA technical assistance to implement recommendations.

Context: Widespread implementation (ie, scale-up) of interventions typically involves providing training, technical assistance, and other implementation strategies to the settings intended to deliver the intervention. Researchers rarely plan for how to provide these strategies beyond the period of research funding. Specifically, they do not develop the infrastructure (ie, workforce, resources) required to sustain scale-up. Our research team addressed this gap by developing the infrastructure needed to sustain scale-up of the Med-South Lifestyle Intervention (Med-South) following the end of 10 years of research funding.

Program: Med-South is a research-tested intervention with demonstrated effectiveness at improving participants' dietary and physical activity behaviors. Existing staff in health departments and community clinics deliver Med-South over a series of 4 monthly counseling sessions and 3 booster phone calls. Implementation strategies (eg, training, technical assistance) also have been developed to support Med-South scale-up.

Implementation: We followed a 3-step process to develop infrastructure to support Med-South scale-up. We assessed existing infrastructure (step 1), identified determinants (ie, barriers and facilitators) of adoption (step 2), and then tailored scale-up to fit existing infrastructure and address determinants (step 3). Scale-up infrastructure included: (1) workforce to support implementation, (2) training curriculum, (3) intervention protocols, (4) data monitoring systems, and (5) communication systems.

Evaluation: We engaged 170 public health practitioners in 3 iterative improvement cycles to refine scale-up infrastructure. We evaluated impact on participants' engagement, perceptions of Med-South acceptability, and confidence to deliver and implement Med-South. A total of 88 public health practitioners engaged in all training sessions (51.8%). Practitioners reported high levels of acceptability and confidence in their ability to deliver and implement Med-South.

Discussion: Findings suggest that our 3-step process has potential for use in developing the infrastructure needed to sustain intervention scale-up following the end of research funding.

Pediatric asthma disparities persist. In a randomized, controlled trial (2017-2022), the Richmond, Virginia (RVA) Breathes program, which was a series of community-based asthma interventions, was tested in a sample of 250 children (5-11 years; 78% African American/Black). Results suggested reduced asthma-related hospitalizations for the full intervention arm (asthma education, home environment remediation, and school intervention). Leveraging detailed costs from program expense reports, this study analyzed the costs of the RVA Breathes full intervention. Five-year costs of the full intervention were $1 922 514 (on average $3314 annually per participating household). Personnel costs contributed the largest share (74.8%), followed by overhead costs (18.9%). Costs for follow-up, outreach staff, and academic leadership were key cost drivers. When restricting these cost drivers collectively, as in a public health implementation approach, average annual costs per participating household decreased by 45.0%. In practice, streamlining the implementation of the RVA Breathes full intervention could improve program affordability.

Background: People coinfected with HIV and hepatitis C (HCV) have complex needs that include pharmaceutical therapy, psychiatric care, and social work. Multidisciplinary care coordination (MCC) is the concerted effort to address health using a diverse team of primary care physicians, mental health specialists, and social workers.

Methods: To determine the effect of MCC in reducing avoidable hospital use, we examined longitudinal data from an academic equity-focused program in Upper Manhattan (CHP). In 2015, CHP implemented MCC, which integrated team members, panel management, and open access (walk-in) activities to better link, engage, and treat those who are coinfected. We compared health care utilization trends before 2015 ("preintervention") to after 2015 ("postintervention").

Results: We found that the implementation of MCC was associated with a decrease in per-year hospital visits among those coinfected.

Conclusion: To assist in future upscaling, we hope to identify strategies that facilitated the implementation of MCC in a setting like CHP.

Context: Vision Zero (VZ) is a road safety initiative that seeks to address the problem of road fatalities using a Safe System approach, a holistic endeavor embedded in public health principles that seeks to build layers of protection across transportation systems to eliminate road fatalities and serious injuries. Since 2020, a multidisciplinary research team established a statewide collaborative to support communities pursuing VZ initiatives across North Carolina.

Program: The North Carolina VZ collaborative "support model" was created to meet the need for community-based, multisector efforts using a Safe System approach. The support model aims to increase community capacity to more effectively build cross-disciplinary coalitions, pool needed resources, and strengthen adaptive leadership skills to reduce roadway fatalities.

Implementation: The support model approach is used to engage communities in building skills in cross-sector collaboration, adaptive leadership, and evidence-based safety procedures. This is accomplished through structured monthly touchpoint meetings with small groups of community partners for peer learning, quarterly "all-hands" meetings to coordinate efforts across the state and provide resources, and an annual team-based multiday Leadership Institute.

Evaluation: From 2020 to 2025, there was notable growth in community participation, from 7 to 33 communities. Of communities with more than 1 year of participation (n = 19), more than half advanced VZ implementation with communities moving from an exploration stage to an installation (n = 8) or initial implementation (n = 2) stage. In 2023, interviews with partner community leads (n = 15) indicated that partners utilized resources provided, applied skills they learned at the Leadership Institute, benefited from the peer network, and identified opportunities for increasing the benefits of the support model.

Discussion: The support model demonstrates a promising practice for increasing capacity building and cross-sector collaboration for road safety initiatives requiring complex systems change such as VZ.

Context: The use of traditional glazed-clay pottery is associated with elevated blood lead levels and is one of the main factors of nonoccupational lead exposure in the Mexican population. Most of the traditional Mexican foods are acidic. Lead leaching from pottery into acidic foods increases the potential for lead exposure in individuals consuming food cooked in these items.

Objective: To explore the possibility that cooking traditional Mexican acidic dishes in lead-glazed pottery cookware enhances lead leaching compared to nonacidic dishes.

Methods: A sample of 33 glazed-clay pottery items sold in Reynosa City, Tamaulipas, Mexico, was collected. The official Mexican regulatory test for lead leaching was conducted using 8 cookware items. Twenty-five lead-glazed ceramic items were used to evaluate the soluble lead by testing the leaching ability of acidic (13 cookware items) and nonacidic (12 cookware items) traditional Mexican dishes. Similarly, acidic and nonacidic foods were cooked in standard cookware for comparison. The lead content in food was determined by atomic absorption spectrophotometry after acid digestion.

Results: Only 1 of the cookware items met the lead leaching standards established by the Mexican regulatory guidelines, whereas the other 7 exceeded the maximum permissible level of leached lead. Acidic food cooked on glazed pottery showed a median lead concentration of 103.4 mg/kg (IQR = 14.8-186.1), whereas nonacidic food cooked on glazed pottery showed a median lead concentration of 11.19 mg/kg (IQR = 2.17-27.82 mg/kg; P < .05), indicating that acidic food extracted 9 times lead compared to nonacidic food when cooked in traditional ceramics.

Conclusion: Cooking acidic dishes with earthen pottery cookware resulted in significantly higher lead leaching than cooking nonacidic foods. The consumption of a single portion of acidic food prepared in lead-glazed ceramics produces a significant increase in blood lead levels and resulting health consequences.

Context: Chronic underfunding limits the capacity of governmental State, Tribal, Local, and Territorial health agencies (STLTs) to respond to public health needs. Nongovernmental entities such as Public Health Institutes (PHIs) have the flexibility, staffing, expertise, and relationships to provide training and technical assistance (TTA) to address workforce gaps. The time it takes to build connections and execute contracts creates inefficiencies in how public funds are spent. Efforts to reduce these barriers to efficiently address both existing and emerging public health needs are understudied and/or infrequently publicly shared.

Program: The National Network of Public Health Institutes (NNPHI) developed the TTA Hub model to quickly deploy adaptable public health expertise, minimize duplication, and improve service delivery efficiency. Regional hubs coordinate local support for STLTs, with NNPHI acting as the central coordinator. As the central hub, NNPHI simplifies the contracting process, links expertise across regions, detects emerging needs, and promotes the sharing of best practices among localities, thereby aiding in system-wide alignment of public health strategies.

Implementation: NNPHI has deployed the TTA Hub Model 3 times. Each version of the model is detailed, including similarities, differences, and key lessons learned. Process evaluation data indicate that the model effectively manages resources and aligns with best practices for TTA delivery. An outcome evaluation of the current model version is in progress.

Conclusion: Process evaluation data indicate that STLTs value the TTA Hub Model. Centralized contracting, communication, and keeping local experts on retainer reduce time inefficiencies. The hub structure ensures that local knowledge is leveraged to address local problems, while the national reach of NNPHI decreases service duplication, accelerates the scaling up of best practices, and creates opportunities to build trust among key actors. However, the model's success depends on sustainable and flexible funding to support collaboration and partnerships across national, regional, state, and local levels.

Objectives: To assess differences in health care utilization, mortality, and incidence of health conditions nearly 2 years after a fertilizer plant fire near a residential area.

Design: We performed a longitudinal cohort study.

Participants: Residents who lived within a 1-mile radius of the fertilizer plant (exposed cohort, N = 2546) were compared to 2 matched control cohorts based on neighborhood (N = 10 043) or participant-level (N = 10 001) characteristics.

Setting: We extracted electronic health record data from January 31, 2020, to November 21, 2023, comprising the "pre" time period from January 31, 2020, to January 31, 2022, and the "post" time period from February 1, 2022, to November 21, 2023.

Main outcome measures: Outcomes included health care utilization (number of outpatient clinic visits, ED visits, and hospitalizations in the pre- and postfire periods), mortality (measured for each participant in each cohort in the postperiod only), and incidence of health conditions (development of asthma, cancer, chronic heart disease, diabetes, migraines, nausea, and neurocognitive disorders in the postperiod).

Results: Health care utilization was highest among the cohort that was exposed to the fire in pre- and postfire periods and decreased over time for all cohorts. There were no significant differences between cohorts with respect to mortality or incidence of health conditions.

Conclusions: We did not identify statistically significantly differences in health outcomes among the exposed, compared to neighborhood- and participant-level matched cohorts. Policymakers and funders should have mechanisms available for rapid funding opportunities for disaster evaluation to follow cohorts and assess long-term health effects.

Background: Food Is Medicine (FIM) interventions are on the rise nationally to address high rates of diet-related chronic disease. As a result, partnerships between the charitable food and health care sectors are emerging to support food access needs among food insecure patients managing chronic disease.

Objective: Evaluating FIM programming partnerships between a midwestern regional food bank and its health care partners examining program components and partnership satisfaction.

Design: Cross-sectional research design via an electronic survey among charitable food and health care partners engaged in FiM programming.

Setting: A large midwestern regional food back and their health care partners.

Participants: include both charitable food and health care staff involved in collaborative FIM interventions.

Main outcome measures: Program components of collaborative FIM programs, collaborator satisfaction, differences in satisfaction between the 2 stakeholder groups (charitable food and health care partners).

Results: The study included 23 participants (health care [n = 11], charitable food [n = 12]). Majority of FIM programs were on-site pantries (62%) or pre-prepared food boxes (38%). When combined, both stakeholder groups demonstrated a relatively high level of partnership satisfaction with a score of 3.96 out of 5. Charitable food partners had a statistically significantly higher rate of agreement ( = 4.00) that the partnership contributed to their ability to achieve higher funding compared to the health care group ( = 3.00).

Conclusions: This study begins to explore a potential evaluation tool for multi-sector FIM partnerships. More research is needed to understand how these partnerships are evolving in practice and how to effectively evaluate them.

In 2025, an estimated 7.2 million Americans aged ≥65 years had Alzheimer's disease. Subjective cognitive decline (SCD) is an early indicator of possible future dementia. Using 2023 Behavioral Risk Factor Surveillance System data, this study described the SCD prevalence among US adults aged ≥45 years. Estimates were examined by selected characteristics, state, and SCD-related features, including worry, functional limitations, and discussions about SCD with a health care provider. Overall, SCD prevalence was 16.9% (95% confidence interval [CI] = 16.5-17.3). Among those reporting SCD, 59.3% (95% CI = 57.9-60.7) were worried about it and 42.8% (95% CI = 41.4-44.1) reported having discussed SCD with a health care provider. Engaging health care providers about concerns related to memory loss or increasing confusion is a key to early identification, diagnosis, and management. These findings emphasize the need for targeted public health efforts to support individuals with SCD-especially among high-risk populations.