Journal of Public Health Management and Practice最新文献

Objective: To examine the association between a state-funded program in North Carolina (NC) to increase access to long-acting reversible contraception (LARC) through local health departments and to reduce preterm birth (PTB) and low birthweight (LBW).

Design: This population-based cohort study used a difference-in-differences approach to determine if PTB and LBW in the postintervention period (2018-2019) differed from the preintervention period (2013-2015) comparing treatment to comparator counties.

Setting and intervention: Improving Community Outcomes for Maternal and Child Health funding began in June 2016 in 13 counties to improve access to LARC.

Outcome measures: PTB and LBW data came from the NC Consolidated Linked Birth File, live birth certificate data probabilistically linked with other public health sources.

Results: Our sample included 150 045 births from 13 treatment counties grouped into three treatment groups and 249 173 births from 56 comparator counties. There was no statistically significant decrease in PTB, and a 0.4 percentage point decrease in LBW (95% CI, -0.7, -0.1) comparing all ICO4MCH counties to comparators. We observed a one-percentage point decrease in PTB in two of the three ICO4MCH groups compared to comparator counties [Durham: -1.0 (95% CI, -1.7, -0.2) and High Country-Robeson-Sandhills: -0.9 (95% CI, -1.5, -0.4)]. For LBW, in the more rural treatment counties, there was a 1.2 percentage point difference (95% CI, -1.7, -0.8) in average predicted prevalence comparing the post- to preintervention period compared to the comparator counties. There was a statistically significant reduction in LBW for White and Black mothers in the more rural treatment counties compared to counterparts in comparator counties.

Conclusions: Findings from this evaluation showed a small reduction in PTB and LBW at the population level, particularly in rural counties and among Black or African American women residing in rural counties.

Context: Many foreign-born residents of the United States are food insecure and are not eligible for government assistance programs that can improve food security, like the Supplemental Nutrition Assistance Program (SNAP).

Objectives: This evaluation aimed to assess the implementation and impact of bi-weekly grocery store vouchers on household food security among New York City foreign-born residents at risk of food insecurity.

Design: We employed a pre-post-test evaluation design among program participants with a baseline assessment and a follow-up assessment 8 weeks later.

Setting: This program was implemented in East Harlem, a diverse, low-income neighborhood in New York City with a large immigrant population.

Participants: A total of 163 residents of East Harlem, New York City participated in the program.

Intervention: The paper-based food vouchers were distributed to study participants biweekly for 8 weeks, for a total of 4 distributions. Each voucher was valued at $10 and participants received either $100 or $150 in grocery store vouchers, bi-weekly, depending on household size. Participants completed evaluation surveys during each distribution period.

Main outcome measure: Household food insecurity was assessed using the US Department of Agriculture (USDA) 6-item short form Household Food Security Survey Module and the associated 6-item Food Security Scale developed by researchers at the National Center for Health Statistics.

Results: The average food security score among participants significantly improved from 4.4 at the start of the program to 2.6 by the end of the program (P < .001), with a lower score indicating higher food security. Food security status also changed significantly, with a change from 97% participants considered low or very low food security at the start of the study, to 66% by the end of the study (P < .001).

Conclusions: Grocery store vouchers may be effective at improving household food security among foreign-born residents who do not participate in SNAP.

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.

Context: Between 2020 and 2022, the US saw sharp increases in syphilis cases, particularly among American Indian and Alaska Native (AI/AN) people. In July of 2023, the Indian Health Service (IHS), the federal agency charged with providing health care services to AI/AN people, recommended annual syphilis screening for all people aged 13 to 64 years to address the nationwide syphilis outbreak.

Objectives: To assess annual syphilis screening policy recommendation changes at an outpatient clinical facility in 1 IHS clinical service unit and associated case finding outcomes between May 2022 and May 2025.

Design: A retrospective analysis of medical and public health records related to syphilis screening and positivity as a public health practice activity.

Setting: An outpatient clinical facility in 1 IHS clinical service unit in South Dakota.

Participants: Any 13- to 64-year-old person who had at least 1 visit to primary care services at the facility. Individuals were eligible for inclusion once for each year analyzed. A total of 27 282 unique visits were analyzed.

Intervention: Implementation of an annual syphilis screening policy for those aged 13 to 64 years.

Main outcome measure: Percentage change in syphilis screening coverage.

Results: Syphilis screening coverage increased by 57% overall after policy implementation, including increased coverage among females, males, all age groups, and pregnant people. A total of 354 cases of syphilis were newly diagnosed.

Conclusions: After implementation of a facility-based annual syphilis screening policy for those aged 13 to 64 years, screening coverage for syphilis increased nearly 60% and over 350 cases of syphilis were identified during a syphilis outbreak in the community. In this outbreak setting, increased screening facilitated case finding and represents an important component of overall outbreak response efforts.

Context: Medicaid-funded obstetric care coordination services improve birth outcomes. Whether these benefits vary by race/ethnicity or urbanicity is uncertain.

Objective: We examined whether the associations between Wisconsin Medicaid's Prenatal Care Coordination (PNCC) program and birth outcomes varied by race/ethnicity and urbanicity.

Design: Data came from a statewide cohort of birth records and linked Medicaid claims. The treatment was PNCC receipt during pregnancy for the birthing parent (none; assessment/care plan; service receipt). Covariate-adjusted conventional and sibling fixed effects linear probability models computed associations between PNCC treatment and birth outcome risks. We stratified models on birthing parent race/ethnicity (American Indian/Alaska Native non-Hispanic [NH]; Asian/Pacific Islander NH; Black NH; Hispanic; White NH; multiple NH; other NH) or on residence county urbanicity (large central metro; large fringe metro; medium metro; small metro; micropolitan; noncore).

Setting: Wisconsin, US.

Participants: A total of 249 502 Medicaid-paid births (2010-2019).

Main outcome measures: Preterm birth (PTB; gestational age <37 weeks). Low birth weight (LBW; <2500 g).

Results: Bias-limiting sibling fixed effects estimates indicated that PNCC's benefit is greatest among Black NH births and large central metro births. For Black NH births, PNCC service receipt was associated with a 3.3 percentage point (pp) reduction (95% CI: -4.5, -2.1pp) and a -2.9pp reduction (95% CI: -4.0, -1.7pp) in the risks of PTB and LBW, respectively. For large central metro births, PNCC service receipt was associated with a 2.7pp reduction (95% CI: -3.7, -1.7pp) and a -2.4pp reduction (95% CI: -3.4, -1.5pp) in the risks of PTB and LBW, respectively.

Conclusions: Estimates suggest that PNCC services were most effective in Black NH and urban populations. This motivates policy to improve PNCC outreach and impact in populations that stand to benefit from care coordination during pregnancy.

Context: Denominator inflation (DI) can burden long-standing immunization information systems (IIS), evident through a system having more client records than population estimates. DI underestimates IIS vaccination coverages compared to National Immunization Surveys (NIS) data. To mitigate DI, the Wisconsin Immunization Registry (WIR) implemented a dormant indicator in June 2020. Clients are presumed to have left the jurisdiction and are placed in the dormant state if they meet the following criteria: client age is at least 11 years old, no updates to the client record in at least 10 years, and the record has not been queried in the last five years. The querying component is a novel approach when compared to American Immunization Registry Association recommendations for the Patient Active/Inactive Status.

Objective: The study purpose was to quantify how incorporating the dormant state in an adolescent population assessment impacts Wisconsin's vaccination coverage rates compared to the NIS-Teen estimates. This study also addressed the population characteristics of adolescent dormant state and non-dormant state client records.

Design: The study population included all Wisconsin adolescents, aged 13-18 years, and assessed vaccine uptake for Meningococcal ACWY , Tdap, HPV initiation, and HPV Complete. Vaccination coverage was assessed, with and without the dormant clients, and then compared to the NIS-Teen estimates. Descriptive statistics were assessed among dormant and non-dormant clients, including a regional variation assessment.

Results: Initial results showed an increase in adolescent vaccination rates for all vaccines and series when excluding dormant clients and suggest a more accurate assessment in line with NIS-Teen estimates. Dormant clients had a higher proportion of unknown and missing data fields for race, sex, and ethnicity.

Conclusion: At this time, removing dormant client records is an effective strategy for reducing DI in WIR, with opportunities for further refinement.