Journal of Public Health Management and Practice最新文献

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.

Background: Mental or emotional health (MEH) among public health employees is crucial for their well-being, organizational performance, workforce retention, and effective delivery of public health activities. This study examines the relationship between domains of workplace environment and self-rated MEH among governmental public health employees, drawing on data from the 2021 Public Health Workforce Interests and Needs Survey.

Methods: Perceptions of workplace environment domains were examined using exploratory factor analysis. The dependent variable, self-rated MEH, was assessed on a 5-point scale from poor to excellent. Logistic regression was used to examine the association of workplace environment domains-organizational support & satisfaction, supervisor relationships, and work values & commitment-on the likelihood of predicting fair or poor (suboptimal) MEH.

Results: More than 20% of public health employees rated their MEH as suboptimal. Employees who reported an intention to leave their positions in the next year were significantly more likely to report suboptimal MEH (OR: 2.17, P < .001). Individuals who were satisfied with organizational factors, such as training needs being met, and perceived impact through their work were significantly less likely to report suboptimal MEH. Employees in supervisory roles, especially managers (OR: 1.28) and executives (OR: 1.37), were significantly more likely to report suboptimal MEH.

Conclusion: Workplace dissatisfaction was significantly associated with suboptimal MEH and increased the probability of employees leaving public health roles. These findings underscore the need for strategies that strengthen organizational factors and workplace values, thereby promoting workforce stability within governmental public health agencies.

Context: Declarations of racism as a public health crisis and increased awareness of racial injustice in health disparities were prominent in 2020, and 72% of 2021 Public Health Workforce Interests and Needs Survey (PH WINS) respondents agreed that addressing racism should be part of their work.

Program: The Public Health Training Center Network and National Network of Public Health Institutes developed the Racial Justice Competency Model for Public Health Professionals (RJCM) and conducted a pilot test to assess its application at the organizational level across a range of public health settings.

Implementation: Sixteen public health organizations participated, with funding used to develop or update competency-based training, strategic plans, organizational policies, or for novel projects addressing racism.

Evaluation: Most pilot respondents (85%) reported increased confidence in applying racial justice principles, with the development of practical tools enhancing organizational capacity and partnerships. All pilot respondents affirmed changing practices to better promote racial justice as a result of implementing their funded projects.

Discussion: The RJCM has potential for continued use as a framework to continue advancing racial justice within public health organizations and to empower collective action in support of health equity.

Context: Precarious employment is a social determinant of health, impacting an increasing number of workers. Cross-sectoral, multilevel initiatives (eg organizational, community, and systems) that address upstream policy, systems, and environmental changes have demonstrated impact for improving worker health and wellness through addressing social determinants of health-like precarious employment. The Cook County Department of Public Health (CCDPH), such as other health departments, had not historically focused on prioritizing healthy work despite acknowledging it as an important social determinant of health.

Program: Through the Healthy Work Collaborative (HWC), a capacity building initiative launched by the University of Illinois Chicago (UIC) Center for Healthy Work in 2017, CCDPH partnered with Centro de Trabajadores Unidos (CTU) and Arise Chicago, and later with Chicago Workers Collaborative (CWC). These are worker centers who organize and advocate for policy changes to increase standards for all workers. The purpose of this evaluation is to describe the lessons learned about facilitating successful collaboration for policy, systems, and environmental change.

Implementation: These organizations worked together from the time of the HWC's first phase of in-person planning and training sessions through later phases of HWC funding and beyond.

Evaluation: Interview and focus group data were examined to identify lessons learned for the partnership, yielding the following: (1) Commitments to equity and justice provided the foundation for a common agenda and complementary roles; (2) Creativity and openness facilitated novel ways to engage and expand areas of work; (3) Strong relationships, supported by humility, provided a foundation for collaboration; (4) Having clearly defined goals, objectives, and a work plan facilitated focused progress and flexibility; and (5) Systems thinking and strategic planning supported implementation and sustainability.

Discussion: The CCDPH-CTU-Arise-CWC-UIC partnership can serve as a powerful illustration of how public health, together with partners, can position itself to address precarious employment through policy, systems, and environmental change.

Context: Rural populations face greater barriers to care and worse health outcomes than urban populations. Local health departments (LHDs) serving rural populations may play a key role in bridging the clinical care gap within their communities.

Objective: To assess and describe the differences in services provided by rural and urban LHDs, as well as the contextual factors contributing to those differences.

Methods: Data from the 2022 National Profile of Local Health Departments was used to estimate the provision of various clinical and population-based services and types of occupations employed, across urban and rural LHDs. Analyses were descriptive in nature but weighted by jurisdiction size to provide nationally representative estimates.

Results: Rural LHDs were more likely to provide many clinical services, offering care that is often more limited from other providers in the jurisdiction than urban LHDs. Conversely, fewer rural LHDs tend to provide population-based services or programs related to emergent public health issues, such as substance use. While 88% of rural LHDs reported that clinical substance use care was available through other community organizations, this is less than the proportion of urban LHDs (94%). Fewer rural LHDs also provide population-based primary prevention in this area than urban LHDs. Fewer rural LHDs employ occupations that support the provision of population-based services than urban LHDs.

Conclusions: Rural LHDs are a key clinical service provider in their communities. However, they may have challenges prioritizing population-based services and those addressing emergent public health issues. Implications include supporting rural LHDs through formula-based funding, workforce capacity, and partnerships to continue and bolster both clinical and population-based services available for their communities.