Journal of Public Health Management and Practice最新文献

Context: About half of adolescents aged 13 to 17 in United States are not fully vaccinated against human papillomavirus (HPV). As they age into young adulthood, colleges may be an excellent target population nexus for implementing interventions to improve HPV vaccination uptake.

Objectives: Our study goal was to generate knowledge about HPV vaccine offerings and awareness programs at colleges to ascertain the extent of campus-facilitated access to HPV immunization and education in 1 state.

Design: An electronic survey was designed and emailed to 32 of 47 Maryland colleges for which relevant campus contacts could be identified.

Settings: The study took place at Johns Hopkins Bloomberg School of Public Health in consultation with the Maryland Cancer Collaborative and the Maryland Department of Health.

Participants: Maryland colleges and universities.

Main outcome measures: HPV vaccine and awareness program offerings on college and university campuses.

Results: Twenty Maryland colleges responded. Two colleges offer awareness programs only. Ten colleges offer HPV vaccine, covering about 39% of Maryland college students. Of these, 4 colleges schedule "periodic" campus health clinics or provide an immunization prescription, which is filled at nearby pharmacies. In all colleges, which offer HPV vaccine, immunization is offered to everyone (both men and women) at no out-of-pocket cost.

Conclusions: In cooperation with the Maryland Cancer Collaborative, the implementation arm for the Maryland Cancer Control Plan, we showed that college campuses are an excellent target site for implementation of interventions to improve access of college age students to HPV vaccine and awareness programs. We lay the groundwork for recommendations, programs and policies that can improve HPV vaccine offerings among college students thus raising the HPV vaccination rate in young adults. Simple inexpensive alternatives to offering vaccine at college health centers may be periodic campus health clinics and arrangements with nearby pharmacies.

Potential changes in health care quality resulting from variation in pandemic severity since 2020 have received less attention. This study aims to assess the relationship between the pandemic and health care quality in Medicare Shared Savings Program (MSSP) accountable care organizations and identify possible heterogeneity in the relationship. The year-by-year difference-in-difference event study of MSSPs between 2016 and 2022 (N = 3390) indicated that 1 standard deviation increase in standardized cumulative COVID-19 incidence in 2020 was associated with a decrease in total quality score of 0.83 percentage points (95% CI: -0.21 to 1.44) after controlling for confounders. The reduction in quality score was mostly driven by ACOs with the highest COVID-19 incidence and in the Midwest. We found no evidence for a persisting decline in quality scores in 2021 to 2022. Public health efforts may need to carefully monitor quality performance and mitigate negative effects during future health crises. Continued investment in strengthening health care resilience remains crucial.

Objective: This article focuses on supports and challenges to health equity that small local health departments (LHDs) experienced while working toward national reaccreditation or Pathways Recognition with the Public Health Accreditation Board's Standards & Measures Version 2022 (PHAB S&M v2022).

Design: The study team conducted 22 qualitative interview sessions with members of health department leadership teams.

Setting: In the spring of 2024, participants from 4 small LHDs in the western and midwestern regions of the United States participated in individual remote interview sessions.

Participants: Participants were members of leadership teams in LHDs with population jurisdictions less than 50 000.

Main outcome measures: Common challenges relating to the health equity measures in the PHAB S&M v2022 included external influences on equity language; lack of small population data; and racially and ethnically homogeneous populations and staff. The main support was the national equity standards provided justification for pursuing equity work.

Results: Strategies to overcome challenges associated with the equity measures included staff training, seeking alternative equity language, and examining socioeconomic inequities in addition to race and ethnicity. Internal workforce understanding of health equity was improved through department-wide training initiatives. When working under restrictive language requirements for state agencies, grants, and other funding sources, staff suggested using alternative phrases and keywords such as level playing field and equal access. When addressing racially and ethnically homogenous populations, staff pursued equity in terms of income and focused on those living with pre-existing conditions (ie, diabetes).

Conclusions: Ensuring that LHDs can work toward health equity is crucial for reducing health inequities. While the equity focus of PHAB S&M v2022 proved challenging, for this selection of LHDs, participants affirmed that PHAB accreditation allowed them to solidify their equity work to better serve their communities.

Context: Digital exposure notification (EN) systems were widely used to supplement public health case investigations and contact tracing during the 2019 coronavirus disease (COVID-19) pandemic. In Washington State, the state Department of Health (DOH) implemented one such system, WA Notify, which generated ENs based on smartphone Bluetooth proximity detection. However, the privacy preserving measures of this technology prevented collection of information on how users responded after seeing an EN on their device.

Objective: To understand the influence of ENs on intended and implemented protective behaviors among WA Notify users.

Design: Two self-report surveys were administered by the WA DOH: a baseline survey regarding planned protective behaviors, available immediately after seeing an EN, and a follow-up survey distributed 2 weeks later regarding actual protective behaviors implemented. Self-reported planned and implemented protective behaviors were compared across 3 time periods relevant to the COVID-19 pandemic. Poisson regression was used to compare the probability of engaging in various protective behaviors across demographic characteristics and other contextual factors.

Setting: Washington State.

Participants: A total of 4280 individuals who chose to respond to both surveys and who completed the initial survey between September 1, 2021, and March 1, 2022.

Main outcome measures: Self-reported plans for and engagement in protective behaviors (quarantining, testing, and symptom watching).

Results: The proportion of individuals who reported implementing quarantining and symptom watching after seeing an EN was higher than the proportion that reported planning to engage in each respective behavior. Respondents who reported experiencing symptoms when seeing an EN were more likely to quarantine and test for COVID-19 compared to those with no symptoms.

Conclusion: Plans to engage in protective behaviors after initially seeing an EN can change and may be influenced by evolving personal and contextual factors. Future digital EN systems can be improved through messaging tailored to encourage protective behaviors relevant to disease prevention.

Lead poisoning remains a significant public health concern with preventable exposure from different sources, including certain traditional consumer products. To address the concern of product-related lead exposures, the New York City Department of Health and Mental Hygiene has developed the Non-Paint Sample Database (NPSD). NPSD systematically tracks information about hazardous consumer products collected during New York City case investigations and store surveys. NPSD has enabled identification of new products-related lead sources and populations at risk of lead exposure and has guided risk communication, regulatory activities, and policy initiatives. Since 2007, approximately 8000 consumer products have been tracked by NPSD. NPSD demonstrates the potential for consumer product surveillance to enable source identification, monitor lead exposure trends, and facilitate effective educational and enforcement activities, which advances lead exposure prevention strategies.

Context: The Healthy People 2030 Leading Health Indicators (LHIs) offer a select set of measurable objectives to help community-based organizations focus their efforts to improve health equity and reduce health disparities across the lifespan within the populations they serve. Disparities are observed across LHIs, including infant mortality, maternal mortality, and food insecurity, and reducing these disparities is a key strategy for improving health and well-being for all.

Objective: This study was designed to answer the following research questions: (1) What programs and initiatives are organizations implementing to address the LHIs of focus - infant mortality, maternal mortality, and food insecurity? (2) How do organizations determine which programs and initiatives they will implement?

Design: NORC conducted 9 qualitative interviews with Healthy People 2030 Champions, organizations dedicated to furthering Healthy People goals and objectives, who are working to address disparities within infant mortality, maternal mortality, and food insecurity through a variety of strategies, interventions, and programs.

Results: Wraparound services, doula programs, and education and advocacy emerged as common strategies for addressing disparities in maternal and infant mortality. Organizations that are working to reduce household food insecurity and hunger implemented food pharmacies and support participant enrollment in federal food assistance programs. Interviewees shared strategies for determining programs to implement and continued program improvement including assessing community needs, leveraging partnerships, and measuring program success.

Conclusions: Healthy People Champion organizations are using several multidimensional strategies to address infant mortality, maternal mortality, and food insecurity in their communities. These strategies, and the community-based organizations that implement them, are critical for addressing disparities in priority health outcomes among the people who have the greatest need. These findings offer insights into how local communities are tackling national priorities and underscore opportunities for more rigorous evaluation to demonstrate progress toward addressing disparities in the LHIs.

Objective: Prioritization is an essential task of local health departments (LHDs). We examined the alignment of priorities reported in Community Health Needs Assessments (CHNA) priorities align with priorities in the Community Health Improvement Plans (CHIP). We report factors that influence the choice of priorities and the alignment of the priorities.

Design: A mixed method study design.

Setting: California.

Participants: CHNA and CHIP documents were sought for all 58 counties. Interviews were conducted with 19 state and local public health officials.

Outcome measures: The priorities in the CHNA and the CHIP were coded as i) only in the CHNA, ii) only in the CHIP, or iii) in both the CHNA and the CHIP. The interviewees were asked to share their experiences related to issue prioritization and decision-making in public health agencies. The interviews were coded and thematically analyzed to identify barriers and facilitators of the prioritization process.

Results: The alignment between the needs prioritized in CHNA and the priorities targeted in CHIP was 35%. The interviews identify reasons for the misalignment, including a need to include priorities in the CHNA even though LHDs are not able to address them, political factors that influence the selection of priorities, and a lack of discretionary funding or capacity/expertise within the agency or its community partners to respond to the needs identified. The lack of discretionary funding was particularly acute for smaller (rural) LHDs (CMSP) and resulted in their often having to focus on priorities where there was state or federal funding.

Conclusions: LHDs face numerous challenges in aligning the priorities reported in the CHNA and the priorities they focus upon in the CHIP. LHDs should consider using a formal, transparent, and evidence-based approach to setting aligning. Future research should focus on developing a formal decision-making process that is appropriate for local public health decision-making.

There are multiple surveillance systems working to address the issue of maternal mortality in Missouri. These surveillance systems have key methodological differences in their definitions, terminology, inclusion criteria, and purpose. This study aims to provide an understanding of the practical effects of these programmatic differences regarding what cases are included and how this can impact the interpretations of the data and influence policy decisions. To accomplish this, death certificates identified by the Missouri Vital Statistics program, the Pregnancy Mortality Surveillance System, and the Pregnancy-Associated Mortality Review (PAMR) program were compared. Commonalities and differences were noted, demonstrating the real-world effects of the methodological differences between programs. In particular, the PAMR program includes injury deaths in the count of pregnancy-related deaths, which are not included by other surveillance systems. These differences highlight the importance of understanding the methodology and limitations of a dataset.