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Objectives. To examine sudden and unexpected or trauma-related deaths that occurred in the presence of law enforcement in Johnson County, Iowa, between 2011 and 2020. Methods. We identified deaths in the presence of law enforcement using definitions from the National Association of Medical Examiners. We obtained data, including demographics, cause and manner of death, toxicology results, and circumstances and location of event leading to death, from comprehensive medical examiner investigative reports. Results. There were 165 deaths that occurred in the presence of law enforcement: 114 were from a known disease, and 51 were either trauma related or the sudden, unexpected initial presentation of a previously unrecognized disease. Three deaths occurred in the context of physical restraint by law enforcement. Suicide was the leading manner of death among trauma-related deaths; the means of suicide was predictable based on in-custody (hanging) or precustody (firearm) circumstances. Conclusions. Our findings highlight the potential role of medical examiners and coroners in improving completeness of data on reporting death in the presence of law enforcement to public health agencies. (Am J Public Health. 2024;114(6):642–650. https://doi.org/10.2105/AJPH.2024.307616) [ABSTRACT FROM AUTHOR]

The author discusses a study by Pomeranz and colleagues, published in the issue which described the regulatory failure for food additives in the U.S. Topics include structural forces other than judicial scrutiny that have assailed the effectiveness of the U.S. Food and Drug Administration across its regulatory areas, how an obesity epidemic driven significantly by excess sugar consumption could be mitigated, and important lesson highlighted by the failed oversight system for food additives.

The landmark 1988 Institute of Medicine report The Future of Public Health served the public health community well by pointing to what needed to be done, fostering a sense of urgency, and offering concrete directions to be pursued. In this article, the impact of the 1988 report, and of the subsequent 2003 report on the Centers for Disease Control and Prevention (CDC), is considered by tracing the course of the ideas that influenced the consciousness of the public health community and subsequently catalyzed concrete action. Among these ideas was that "public health is in disarray." This assessment led to an awareness that something needed to be done. Further, by stating that the public health enterprise had 3 core functions (assessment, policy development, and assurance), the 1988 report set in motion policy development to address the "disarray." At a more fundamental level, both reports championed the need for governmental public health (particularly at the CDC) to take action to strengthen the capacity of local and state public health agencies to address a growing range of public health threats and emergencies. (Am J Public Health. 2024;114(5):489–494. https://doi.org/10.2105/AJPH.2024.307598) [ABSTRACT FROM AUTHOR]

Unaccompanied immigrant children continue to arrive at the US–Mexico border and are at high risk for ongoing abuse, neglect, and poor mental and physical health. We are medical and legal experts in the fields of immigrant and refugee health, child abuse, and the legal rights of international refugee and migrant children. We provide an overview of US federal agencies with custody of unaccompanied immigrant children, a summary of medical care provided while in custody, and recent findings from the independent Juvenile Care Monitor Report mandating new custodial conditions for immigrant children while in federal custody. We provide recommendations to improve the health and well-being of unaccompanied immigrant children while in custody and once released to US sponsors. (Am J Public Health. 2024;114(3):340–346. https://doi.org/10.2105/AJPH.2023.307570) [ABSTRACT FROM AUTHOR]

Racial/ethnic disparities in the administration of mpox vaccine in Fulton County, Georgia, threatened to undermine the effectiveness of the response. To counteract this inequity, the Fulton County Board of Health partnered with local agencies serving Black and Latino men who have sex with men to coordinate efforts and reserve blocks of time for clients of these agencies to receive a vaccine. The disparities were reversed and approached equity with case rates. (Am J Public Health. 2023;113(12):1263–1266. https://doi.org/10.2105/AJPH.2023.307416) [ABSTRACT FROM AUTHOR]

The article discusses two reports from the Institute of Medicine (IOM) which assessed the state of public health to determine the opportunity to accomplish public health mission and improve health at the population level. Cited are improvements in the public's health since the IOM reports, the gaps on how the reports address the issue of climate change which is the greatest threat to collective health, and the reports' failure to emphasize population growth as a contributor to climate change.

One of the most well-documented episodes of scientific manipulation and overt fraud was the scandal involving Industrial Bio-Test Laboratories (IBT) in the 1970s and the chronic toxicity tests it conducted on behalf of Monsanto that ultimately led to the indictment and conviction of employees of IBT and the Monsanto Corporation. IBT, at the time the nation's largest private laboratory, served a range of industries and government agencies. IBT conducted about 22 000 toxicology studies for scores of corporations, representing between 35% and 40% of all tests conducted in private labs in the country. IBT has been justly condemned for its fraudulent activities in the 1970s, but no one has looked at the relationship between the corporate funders of IBT's research and its fraudulent practices. We use previously secret corporate documents that detail the role of IBT's largest customer, Monsanto, which used fraudulent data to influence government. This material, revealed through legal discovery proceedings now under way regarding polychlorinated biphenyls (PCBs) and Roundup, show the long-lasting impact of Monsanto's behavior on efforts to regulate large corporations as well as on the long-term effects on human health. (Am J Public Health. 2023;113(6):661–666. https://doi.org/10.2105/AJPH.2023.307247) [ABSTRACT FROM AUTHOR]

Despite broad agreement that prioritizing health equity is critical to minimizing the health impacts of climate change, there is a lack of clarity about what advancing health equity means in practice. More than reducing health disparities; it also implies engaging and empowering marginalized communities. We propose a typology of health equity processes, focused on building community agency and power, and then apply it to a nonrepresentative, purposive sample of 48 community-based climate actions (CBCAs) selected from lists of projects funded by foundations and state climate programs and from other sources. All CBCAs were in the United States, community-based, active since 2015 or more recently, engaged in climate mitigation or adaptation, and stated health equity aims. Two team members reviewed project reports to assess the engagement of vulnerable and marginalized populations, agency-building, and transformation of community power relationships. Although 33 CBCAs reported efforts to build community agency, only 19 reported efforts to increase community power. City-led CBCAs showed less emphasis on agency-building and power transformation. This typology can support efforts to advance health equity by providing concrete indicators to diagnose gaps and track progress. (Am J Public Health. 2023;113(2):185–193. https://doi.org/10.2105/AJPH.2022.307143) [ABSTRACT FROM AUTHOR]

The disproportionate impact of COVID-19 on low-income Latinos with limited access to health care services prompted the expansion of community-based COVID-19 services. From June 25, 2020, to May 20, 2021, we established a coalition of faith leaders, community organizations, and governmental organizations to implement a Spanish-language hotline and social media campaign that linked people to a COVID-19 testing site at a local church in a high-density Latino neighborhood in Baltimore, Maryland. This retrospective analysis compared the characteristics of Latinos accessing testing in community versus health care facility–based settings. (Am J Public Health. 2022;112(S9):S913–S917. https://doi.org/10.2105/AJPH.2022.307074) [ABSTRACT FROM AUTHOR]

We initiated a collaboration between local government, academia, and citizen scientists to investigate high frequencies of elevated Escherichia coli bacteria levels in the coastal Short Beach neighborhood of Branford, Connecticut. Citizen scientist involvement enabled collection of short-duration postprecipitation outfall flow water samples (mean E. coli level = 4930 most probable number per 100 mL) and yielded insights into scientific collaboration with local residents. A records review and sanitary questionnaire identified aging properties with septic systems (3.3%) and holding tanks (0.6%) as potential sources of the E. coli contamination. (Am J Public Health. 2022;112(9):1261–1264. https://doi.org/10.2105/AJPH.2022.306943) [ABSTRACT FROM AUTHOR]

The article comments on a study which examined the effectiveness of using low-cost sensors for revealing spatial and temporal variations in air quality and for reducing disparities in neighborhood-level exposures to air pollution. Topics discussed are importance of selection of dates, times and locations to conducting air quality measurement campaigns and the significance of having equitable sensor networks to understanding disparities in air pollution health outcomes.

In the late 20th century, fetal protection policies barred women from hundreds of thousands of industrial jobs on the pretext that if women became pregnant, their fetuses might be harmed by workplace exposure to toxic chemicals. Beginning in the 1970s, these policies set off a decades-long contest between the chemical industry, government agencies, and the judicial system over how to balance the uncertain reproductive health risks against sex discrimination. This article revives the subject of reproductive health and workplace protections through a historical case study of fetal protection policies at Firestone Plastics, a leader in the postwar vinyl chloride industry. I use formerly secret industry documents to argue that Firestone used scientific uncertainty and gender essentialism to skirt new regulatory pressures and minimize corporate liability. Ultimately, fetal protection policies stymied innovative regulatory efforts to protect all workers—not just women—from reproductive hazards in the workplace. (Am J Public Health. 2022;112(2):271–276. https://doi.org/10.2105/AJPH.2021.306539) [ABSTRACT FROM AUTHOR]

An editorial is presented in which the authors discuss their thoughts about how organizations and government entities might address public health education gaps in order to further environmental justice. The article discusses environmental health (EH) content and curricula, accreditation standards of the Council on Education for Public Health (CEPH), and the credentials of EH professionals.

More than a year after the first domestic COVID-19 cases, the United States does not have national standards for COVID-19 surveillance data analysis and public reporting. This has led to dramatic variations in surveillance practices among public health agencies, which analyze and present newly confirmed cases by a wide variety of dates. The choice of which date to use should be guided by a balance between interpretability and epidemiological relevance. Report date is easily interpretable, generally representative of outbreak trends, and available in surveillance data sets. These features make it a preferred date for public reporting and visualization of surveillance data, although it is not appropriate for epidemiological analyses of outbreak dynamics. Symptom onset date is better suited for such analyses because of its clinical and epidemiological relevance. However, using symptom onset for public reporting of new confirmed cases can cause confusion because reporting lags result in an artificial decline in recent cases. We hope this discussion is a starting point toward a more standardized approach to date-based surveillance. Such standardization could improve public comprehension, policymaking, and outbreak response. (Am J Public Health. 2021;111(12):2127–2132. https://doi.org/10.2105/AJPH.2021.306520) [ABSTRACT FROM AUTHOR]

The authors comment on the struggle of U.S. state and territorial health agencies (STHA) in meeting the challenges brought by climate change. Topics covered include the growing preparedness gaps in the public health system, the findings of a 2021 online survey aimed to characterize the level of adaptation activity of STHA and to determine whether they have developed climate and health programs (CHP) and inventory the climate-related activities they were implementing.

Objectives. To determine if and how state and local public health departments present information about climate change on their Web sites, their most public-facing platform. Methods. We collected data from every functioning state (n = 50), county (n = 2090), and city (n = 585) public health department Web site in the United States in 2019 and 2020. We analyzed data for presence and type of climate-related content and to determine whether there existed clear ways to find climate change information. We analyzed Web sites providing original content about climate change for explanatory or attributional language. Results. Fewer than half (40%) of state health department Web sites, and only 1.6% of county and 3.9% of city Web sites, provided clear ways to find climate change information, whether through provision of original content or links to external agencies' Web sites. Among Web sites providing original content, 48% provided no explanation of climate change causes. Conclusions. National and global public health associations have identified climate change as a public health emergency, but most state and local public health departments are not delivering that message. These departments must be better supported to facilitate dissemination of reliable, scientific information about climate change and its effects on health. [ABSTRACT FROM AUTHOR]

Objectives. To quantify the impact of a citywide bicycle share program on rates of motor vehicle collisions involving a bicycle. Methods. We conducted an interrupted time series analysis, using crash records from the Pennsylvania Department of Transportation for Philadelphia County from 2010 through 2018. We also calculated summary statistics to illustrate annual and monthly trends in rates of motor vehicle crashes involving a bicycle. Results. The baseline rate of bike events was 106% greater (95% confidence interval [CI] = 1.25, 3.38) at the time bicycle share was implemented compared with January 2010. Before bicycle share implementation, the rate of bicycle events decreased 1% (95% CI = 0.95, 1.03) annually. After the bicycle share program started, the rate of bicycle events decreased 13% (95% CI = 0.82, 0.94) annually. Conclusions. In the long term, programs that increase the number of bicycles on the road, such as bike share, may reduce rates of motor vehicle crashes involving a bicycle. [ABSTRACT FROM AUTHOR]

Structural racism is a root cause of poor health in the United States and underlies COVID-19–related disparities for Black and Latinx populations. We describe how one community-based organization responded to structural racism and COVID-19 in Florida. Informed by the literature on how public health practice changed from emphasizing prevention (Public Health 1.0) to collaboration between governmental and public health agencies (Public Health 2.0) and examining social determinants of health (Public Health 3.0), we call for a politically engaged Public Health 4.0. (Am J Public Health. 2021;111(S3):S201–S203. https://doi.org/10.2105/AJPH.2021.306408) [ABSTRACT FROM AUTHOR]

Rates of neonatal abstinence syndrome (NAS) have increased fivefold in the past decade. To address this expanding and complex issue, state public health agencies have addressed the opioid crisis affecting newborns in diverse ways, leading to a variety of methods to quantify the burden of NAS. In an effort to understand this variability, we summarized clinical case and surveillance definitions used across jurisdictions in the United States. We confirmed that the rapid progression of the nation's opioid crisis resulted in heterogeneous processes for identifying NAS. Current clinical case definitions use different combinations of clinician-observed signs of withdrawal and evidence of perinatal substance exposure. Similarly, there is discordance in diagnosis codes used in surveillance definitions. This variability makes it difficult to produce comparable estimates across jurisdictions, which are needed to effectively guide public health strategies and interventions. Although standardization is complicated, consistent NAS definitions would increase comparability of NAS estimates across the nation and would better guide prevention and treatment efforts for women and their infants. [ABSTRACT FROM AUTHOR]

After Hurricane Harvey, researchers, media, and public health agencies collected data in Houston, Texas, to assess potential health effects and inform the public. To limit redundancy and ensure sampling coverage of impacted areas, research and practice partners used disaster research response (DR2) resources and relied on partnerships formed during a 2015 DR2 workshop in Houston. Improved coordination after the disaster can improve the effectiveness and efficiency of DR2 and enable the use of data to improve recovery and preparedness for future disasters. [ABSTRACT FROM AUTHOR]

Two major public health evaluations of e-cigarettes—one from the National Academies of Science, Engineering, and Medicine (NASEM), the other from Public Health England (PHE)—were issued back to back in the winter of 2018. While some have read these analyses as broadly consistent, providing support for the view that e-cigarettes could play a role in smoking harm reduction, in every major respect, they come to very different conclusions about what the evidence suggests in terms of public health policy. How is that possible? The explanation rests in what the 2 reports see as the central challenge posed by e-cigarettes, which helped to determine what counted as evidence. For NASEM, the core question was how to protect nonsmokers from the potential risks of exposure to nicotine and other contaminants or from the risk of smoking combustible cigarettes through renormalization. A precautionary standard was imperative, making evidence that could speak most conclusively to the question of causality paramount. For PHE, the priority was how to reduce the burdens now borne by current smokers, burdens reflected in measurable patterns of morbidity and mortality. With a focus on immediate harms, PHE turned to evidence that was "relevant and meaningful." Thus, competing priorities determined what counted as evidence when it came to the impact of e-cigarettes on current smokers, nonsmoking bystanders, and children and adolescents. A new clinical trial demonstrating the efficacy of e-cigarettes as a cessation tool makes understanding how values and framing shape core questions and conclusive evidence imperative. [ABSTRACT FROM AUTHOR]

Objectives. To investigate whether a newborn home visiting program for primiparous adolescent mothers (aged 16–20 years at childbirth) reduced recurrence of child maltreatment in child protective services (CPS) reports. Methods. We conducted a randomized controlled trial of Healthy Families Massachusetts, a statewide home visiting program for young parents. A total of 704 first-time young mothers were randomly assigned to a home visiting group, or to a control group who we referred to other services and who received child development and parenting information. The outcome variable was CPS reports (2008–2016) available for 688 families—specifically, rereports following an initial report (up to mean child age of 7 years). Results. Of the 52% of families who experienced initial CPS reports, 53% experienced additional CPS reports. Children of mothers in the home visiting group were less likely to receive a second report and had a longer period of time between initial and second reports. Conclusions. The home visiting program reduced the recurrence of CPS maltreatment report by 32% and increased the length of time between initial and additional CPS reports. Home visiting parenting support and prevention programs may reduce the likelihood of recurrent maltreatment following completion of program services. [ABSTRACT FROM AUTHOR]

Amid an opioid epidemic and increasing HIV and hepatitis C virus (HCV) concerns, the Louisville Metro Department of Public Health and Wellness developed syringe exchange programming (SEP) to reduce HIV and HCV transmission, increase linkage to health care, and provide health education to clients in Louisville, Kentucky. We describe organizational, community, and policy factors contributing to SEP development. Approximately 8000 clients received SEP services from June 2015 to December 2016. Coalition building, timely advocacy, and media engagement are integral to successful SEP development and uptake. [ABSTRACT FROM AUTHOR]

In this article, we examine the role of nongovernmental entities (NGEs; nonprofits, religious groups, and businesses) in disaster response and recovery. Although media reports and the existing scholarly literature focus heavily on the role of governments, NGEs provide critical services related to public safety and public health after disasters. NGEs are crucial because of their ability to quickly provide services, their flexibility, and their unique capacity to reach marginalized populations. To examine the role of NGEs, we surveyed 115 NGEs engaged in disaster response. We also conducted extensive field work, completing 44 hours of semistructured interviews with staff from NGEs and government agencies in postdisaster areas in Texas, Florida, Puerto Rico, Northern California, and Southern California. Finally, we compiled quantitative data on the distribution of nonprofit organizations. We found that, in addition to high levels of variation in NGE resources across counties, NGEs face serious coordination and service delivery problems. Federal funding for expanding the capacity of local Voluntary Organizations Active in Disaster groups, we suggest, would help NGEs and government to coordinate response efforts and ensure that recoveries better address underlying social and economic vulnerabilities. [ABSTRACT FROM AUTHOR]

The author argues that the U.S. response to the COVID-19 pandemic was a failure due to an underfunded public health system, political conflicts, and inadequate responses by science and public health officials, all of which necessitate the establishment of well-funded and strong public health agencies.

The article examines the facilitation of collaboration and partnership between corporations and public health efforts in the U.S. It discusses the profit-driven motivations and fiduciary responsibilities of corporations, blockers against and benefits to public health and business cooperation, and partnerships between government agencies and corporations.

Objectives. To assess the value of hospital records in augmenting information on homelessness counts at a state level. Methods. We used data from the Illinois Hospital Discharge Database (2011–2018) to identify outpatients and inpatients identified as affected by homelessness. We used probabilistic linkage methodology to estimate unique individuals rather than visits and compared them with US Department of Housing and Urban Development annual estimates of homelessness based on point-in-time counts. Results. Department of Housing and Urban Development point-in-time estimates indicate a substantial decline of approximately 24% in homelessness in Illinois; however, estimates of unique individuals visiting the hospital with a code for homelessness more than doubled in this same period. Conclusions. Other data sources, such as hospital records, are increasingly able to identify and report information related to homelessness. Using these additional data sources may help to augment the Department of Housing and Urban Development point-in-time estimates to provide more accurate estimates of homelessness that are used to direct resources and assess policy and support services for those affected by homelessness. [ABSTRACT FROM AUTHOR]

The Health Resources and Services Administration's Ryan White HIV/AIDS Program (RWHAP) supports direct health care treatment and support services to more than 50% of all people living with diagnosed HIV in the United States. A critical goal of the RWHAP is to reduce HIV-related health disparities to help end the HIV epidemic. From 2010 through 2016, the RWHAP made significant progress reducing viral suppression disparities among client populations, particularly among women, transgender persons, youths, Blacks or African Americans, and unstably housed clients. To assist with the reduction of the remaining disparities in HIV-related health outcomes among clients, the RWHAP continues to support planning and resource allocation for RWHAP Parts A through D and AIDS Drug Assistance Program, as well as through implementing policy and program initiatives, Special Projects of National Significance, evaluation studies, and collaborations to disseminate effective interventions. [ABSTRACT FROM AUTHOR]

The Centers for Disease Control and Prevention's Strategic National Stockpile is a national repository of potentially lifesaving medical countermeasures including pharmaceuticals and medical supplies for use in a public health emergency severe enough to cause local, regional, and state supplies to run out. Several planning considerations can assist state, local, tribal, and territorial jurisdictions in preparing to receive, distribute, dispense, and administer medical countermeasures from the Strategic National Stockpile. These considerations include, but are not limited to, issues surrounding regulatory requirements, controlled substances, cold chain management, and ancillary supply needs. Multiple aspects to consider for each of these functions are discussed here to assist partners in their planning efforts. [ABSTRACT FROM AUTHOR]

In the United States, groups advocating for and against abortion rights often deploy public health arguments to advance their positions. Recently, these arguments have evolved into state laws that use the government health department infrastructure to increase law enforcement and regulatory activities around abortion. Many major medical and public health associations oppose these new laws because they are not evidence-based and do not protectwomen’s health.Yet state health departments have been defending these laws in court. We propose a 21st-century public health approach to abortion based in an accepted public health framework. Specifically,we apply the Centers for Disease Control and Prevention’s 10 Essential Public Health Services framework to abortion to describe how health departments should engage with abortion. With this public health framework as our guide, we argue that health departments should be facilitating women’s ability to obtain anabortion in the stateandcounty where they reside, researching barriers to abortion care in their states and counties, and promoting the use of a scientific evidence base in abortion-related laws, policies, regulations, and implementation of essential services. [ABSTRACT FROM AUTHOR]

Objectives. To examine the influence of undocumented immigration in the United States on 4 different metrics of drug and alcohol problems: drug arrests, drug overdose fatalities, driving under the influence (DUI) arrests, and DUI deaths. Methods. We combined newly developed state-level estimates of the undocumented population between 1990 and 2014 from the Center for Migration Studies with arrest data from the Federal Bureau of Investigation Uniform Crime Reports and fatality information from the Fatality Analysis Reporting System and the Centers for Disease Control and Prevention Underlying Cause of Death database. We used fixed-effects regression models to examine the longitudinal association between increased undocumented immigration and drug problems and drunk driving. Results. Increased undocumented immigration was significantly associated with reductions in drug arrests, drug overdose deaths, and DUI arrests, net of other factors. There was no significant relationship between increased undocumented immigration and DUI deaths. Conclusions. This study provides evidence that undocumented immigration has not increased the prevalence of drug or alcohol problems, but may be associated with reductions in these public health concerns. [ABSTRACT FROM AUTHOR]

Objectives. To identify occupations with high-priority workforce development needs at public health departments in the United States. Methods. We surveyed 46 state health agencies (SHAs) and 112 local health departments (LHDs). We asked respondents to prioritize workforce needs for 29 occupations and identify whether more positions, more qualified candidates, more competitive salaries for recruitment or retention, or new or different staff skills were needed. Results. Forty-one SHAs (89%) and 36 LHDs (32%) participated. The SHAs reported having high-priority workforce needs for epidemiologists and laboratory workers; LHDs for disease intervention specialists, nurses, and administrative support, management, and leadership positions. Overall, the most frequently reported SHA workforce needs were more qualified candidates and more competitive salaries. The LHDs most frequently reported a need for more positions across occupations and more competitive salaries. Workforce priorities for respondents included strengthening epidemiology workforce capacity, adding administrative positions, and improving compensation to recruit and retain qualified employees. Conclusions. Strategies for addressing workforce development concerns of health agencies includeprovidingadditional trainingandworkforcedevelopmentresources, andidentifyingbest practices for recruitment and retention of qualified candidates. [ABSTRACT FROM AUTHOR]

Objectives. To assess the feasibility of chronic disease surveillance using distributed analysis of electronic health records and to compare results with Behavioral Risk Factor Surveillance System (BRFSS) state and small-area estimates. Methods. We queried the electronic health records of 3 independent Massachusettsbased practice groups using a distributed analysis tool called MDPHnet to measure the prevalence of diabetes, asthma, smoking, hypertension, and obesity in adults for the state and 13 cities. We adjusted observed rates for age, gender, and race/ethnicity relative to census data and compared them with BRFSS state and small-area estimates. Results. The MDPHnet population under surveillance included 1 073 545 adults (21.8% of the state adult population). MDPHnet and BRFSS state-level estimates were similar: 9.4% versus 9.7% for diabetes, 10.0% versus 12.0% for asthma, 13.5% versus 14.7% for smoking, 26.3% versus 29.6% for hypertension, and 22.8% versus 23.8% for obesity. Correlation coefficients for MDPHnet versus BRFSS small-area estimates ranged from 0.890 for diabetes to 0.646 for obesity. Conclusions. Chronic disease surveillance using electronic health record data is feasible and generates estimates comparable with BRFSS state and small-area estimates. [ABSTRACT FROM AUTHOR]

An academic health department (AHD) is a formal partnership between an academic institution and a governmental public health agency. Case studies have described the value of individual AHDs in the areas of student engagement, practice-based research, workforce development, and service. With growing interest in AHDs and the increasing importance of academic-practice linkages in both academic programs' and public health agencies' accreditation processes, articulating a research agenda focused on the AHDmodel can be useful for stimulating the research and practicefields to further develop the evidence base for AHDs. We provide a researchagenda, developed through an iterative process involving academicians, practitioners, and others interested in academic-practice linkages. [ABSTRACT FROM AUTHOR]

On November 30, 2016, the US Department of Housing and Urban Development (HUD) published a final rule mandating that public housing authorities it supports prohibit all smoking on their residential premises, including within residents' apartments. The primary rationale for this action was to protect nonsmoking residents from the harms of tobacco smoke exposure. Although the harms of secondhand smoke are clear and the potential for reducing nonsmoking residents' exposure is real, it will be no simple matter to successfully implement the policy requirements set down by HUD. Some challenges to policy implementation will apply to all public housing authorities, and others will be unique to specific settings. By being aware of the benefits of smoke-free public housing as well as the challenges inherent in complying with HUD's rule, public housing authorities stand the best chance of fulfilling the potential of this major policy initiative to significantly improve public health in a vulnerable population. [ABSTRACT FROM AUTHOR]

Objectives. To develop a local board of health (LBoH) classification scheme and empirical definitions to provide a coherent framework for describing variation in the LBoHs. Methods. This study is based on data from the 2015 Local Board of Health Survey, conducted among a nationally representative sample of local health department administrators, with 394 responses. The classification development consisted of the following steps: (1) theoretically guided initial domain development, (2) mapping of the survey variables to the proposed domains, (3) data reduction using principal component analysis and group consensus, and (4) scale development and testing for internal consistency. Results.The final classification scheme included 60 items across 6 governance function domains and an additional domain—LBoH characteristics and strengths, such as meeting frequency, composition, and diversity of information sources. Application of this classification strongly supports the premise that LBoHs differ in their performance of governance functions and in other characteristics. Conclusions. The LBoH taxonomy provides an empirically tested standardized tool for classifying LBoHs from the viewpoint of local health department administrators. Future studies can use this taxonomy to better characterize the impact of LBoHs. [ABSTRACT FROM AUTHOR]

Objectives. To assess the improvements of the Chinese Centers for Disease Control and Prevention (CDCs) systembetween2002and 2012, andproblems the system hasencountered. Methods. We obtained data from 2 national cross-sectional surveys in 2006 and 2013, including 32 provincial, 139 municipal, and 489 county-level CDCs throughout China. We performed a pre-post comparative analysis to determine trends in resource allocation and service delivery. Results. The overall completeness of public health services significantly increased from 47.4% to 76.6%. Furthermore, the proportion of CDC staff with bachelor's or higher degrees increased from 14.6% to 32.6%, and governmental funding per CDC increased 5.3-fold (1.283-8.098 million yuan). The working area per CDC staff increased from 37.9 square meters to 63.3 square meters, and configuration rate of type A devices increased from 28.1% to 65.0%. Remaining problems included an 11.9% reduction in staff and the fact that financial investments covered only 71.1% of actual expenditures. Conclusions. China's CDC system has progressed remarkably, enabling quicker responses to emergent epidemics. Future challenges include establishing a sustainable financing mechanism and retaining a well-educated, adequately sized public health workforce. [ABSTRACT FROM AUTHOR]

Objectives. To document ethnic disparities in childhood abuse and neglect among New Zealand children. Methods. We followed the 1998 New Zealand birth cohort of 56 904 children through 2016. We determined the cumulative childhood prevalence of reports to child protective services (CPS), substantiated maltreatment (by subtype), and out-of-home placements, from birth to age 18 years, by ethnic group. We also developed estimates stratified by maternal age and community deprivation levels. Results. We identified substantial ethnic differences in child maltreatment and child protection involvement. Both Māori and Pacific Islander children had a far greater likelihood of being reported to CPS, being substantiated as victims, and experiencing an out-of-home placement than other children. Across all levels of CPS interactions, rates of Māori involvement were more than twice those of Pacific Islander children and more than 3 times those of European children. Conclusions. Despite long-standing child support policies and reparation for breaches of Indigenous people's rights, significant child maltreatment disparities persist. More work is needed to understand how New Zealand's public benefit services can be more responsive to the needs of Indigenous families and their children. [ABSTRACT FROM AUTHOR]

Objectives. To compare blood lead levels (BLLs) among US children aged 1 to 5 years according to receipt of federal housing assistance. Methods. In our analyses, we used 2005 to 2012 data for National Health and Nutrition Examination Survey (NHANES) respondents thatwere linked to 1999 to 2014 administrative records from the US Department of Housing and Urban Development (HUD). After we restricted the analysis to children with family income-to-poverty ratios below 200%, we compared geometricmean BLLs and the prevalence of BLLs of 3micrograms per deciliter or higheramongchildrenwhowerelivingin assisted housing at the time of theirNHANESblood draw (n = 151) with data for children who did not receive housing assistance (n = 1099). Results. After adjustment, children living in assisted housing had a significantly lower geometric mean BLL (1.44 mg/dL; 95% confidence interval [CI] = 1.31, 1.57) than comparable children who did not receive housing assistance (1.79 mg/dL; 95% CI = 1.59, 2.01; P < .01). The prevalence ratio for BLLs of 3 micrograms per deciliter or higher was 0.51 (95% CI = 0.33, 0.81; P < .01). Conclusions. Children aged 1 to 5 years during 2005 to 2012 who were living in HUD-assisted housing had lower BLLs than expected given their demographic, socioeconomic, and family characteristics. [ABSTRACT FROM AUTHOR]

Surveying governmental public health practitioners is a critical means of collecting data about public health organizations, their staff, and their partners. A greater focus on evidence-based practices, practice-based systems research, and evaluation has resulted in practitioners consistently receiving requests to participate in myriad surveys. This can result in a substantial survey burden for practitioners and declining response rates for researchers. This is potentially damaging to practitioners and researchers as well as the field of public health more broadly. We have examined recent developments in survey research, especially issues highly relevant for public health practice. We have also proposed a process by which researchers can engage with practitioners and practitioner groups on research questions of mutual interest. [ABSTRACT FROM AUTHOR]

The authors discuss the findings of the U.S. Department of Health and Human Services (HHS) Office of Adolescent Health (OAH) Teen Pregnancy Prevention (TPP) Program from 2010 to 2015, and it mentions how the OAH TPP is designed to reduce the risky behavior that is associated with adolescent pregnancy. American government funding for organizations to replicate evidence-based TPP programs and additional teenage pregnancy prevention plans is examined, along with organizational goals.

Objectives. To assess the US packaged food industry's progress from 2009 to 2014, when the National Salt Reduction Initiative had voluntary, category-specific sodium targets with the goal of reducing sodium in packaged and restaurant foods by 25% over 5 years. Methods. Using the National Salt Reduction Initiative Packaged Food Database, we assessed target achievement and change in sales-weighted mean sodium density in top-selling products in 61 food categories in 2009 (n = 6336), 2012 (n = 6898), and 2014 (n = 7396). Results. In 2009, when the targets were established, no categories met National Salt Reduction Initiative 2012 or 2014 targets. By 2014, 26% of categories met 2012 targets and 3% met 2014 targets. From 2009 to 2014, the sales-weighted mean sodium density declined significantly in almost half of all food categories (43%; 26/61 categories). Overall, sales-weighted mean sodium density declined significantly (by 6.8%; P < .001). Conclusions. National target setting with monitoring through a partnership of local, state, and national health organizations proved feasible, but industry progress was modest. Public Health Implications. The US Food and Drug Administration's proposed voluntary targets will be an important step in achieving more substantial sodium reductions. [ABSTRACT FROM AUTHOR]

The authors argue that a waterpipe smoking-related regulatory policy should be established in the U.S. in order to curb smoking by young people, and it mentions misperceptions about the health aspects of smoking using hookah, shisha, and narghile pipes. The U.S. Family Smoking Prevention and Tobacco Control Act is addressed, along with the American Food and Drug Administration's authority to regulate waterpipe products. Smoking-related diseases such as cancer are assessed.

An editorial is presented which addresses the authors' views about expanding methodologies to identify high-priority emergency management products for implementation in American public health agencies, and it mentions programs, trainings, and tools to build the U.S. public health emergency preparedness and response (PHPR) system's workforce capacity. The U.S. Centers for Disease Control and Prevention’s Preparedness and Emergency Response Research Center (PERRC) is assessed.

The author discusses employment trends of recent public health doctoral graduates.

Objectives. We explored whether various key stakeholders considered cost sharing with state telephone-based tobacco cessation quitlines, because including tobacco cessation services as part of the required essential health benefits is a new requirement of the Patient Protection and Affordable Care Act (ACA). Methods. We analyzed qualitative data collected from interviews conducted in April and May of 2014 with representatives of state health departments, quitline service providers, health plans, and insurance brokers in 4 US states. Results. State health departments varied in the strategies they considered the role their state quitline would play in meeting the ACA requirements. Health plans and insurance brokers referred to state quitlines because they were perceived as effective and free, but in 3 of the 4 states, the private stakeholder groups did not consider cost sharing. Conclusions. If state health departments are going to initiate cost-sharing agreements with private insurance providers, then they will need to engage a broad array of stakeholders and will need to overcome the perception that state quitline services are free. [ABSTRACT FROM AUTHOR]

Objectives. We investigated Black-White differences in the association between average alcohol drinking patterns and all-cause mortality. Methods. We pooled nationally representative samples of 152 180 adults in the National Health Interview Survey from 1997 to 2002 with mortality follow-up through 2006. Usual drinking days per week and level of alcohol consumed per day were based on self-report. We used race- and gender-specific Cox proportional hazards regression analyses to adjust for physical activity, smoking status, and other potential confounders. Results. Over 9 years, 13366 deaths occurred from all causes. For men, the lowest multivariable-adjusted hazard ratio (HR) for total mortality among drinkers was 0.81 among White men who consumed 1 to 2 drinks 3 to 7 days per week (compared with abstainers) and Black men who abstained. Forwomen,the lowest mortality risk was among White women (HR = 0.71) consuming 1 drink per day 3 to 7 days per week and Black women (HR = 0.72) consuming 1 drink on 2 or fewer days per week. Conclusions. Risks and benefits of alcohol consumption in relation to mortality risk were dependent on race- and gender-specific drinking patterns. [ABSTRACT FROM AUTHOR]

Objectives. We identified correlates of racial/ethnic disparities in colorectal cancer screening and changes in disparities under state-mandated insurance coverage. Methods. Using Behavioral Risk Factor Surveillance System data, we estimated a Fairlie decomposition in the insured population aged 50 to 64 years and a regression-adjusted difference-in-difference-in-difference model of changes in screening attributable to mandates. Results. Under mandated coverage, blood stool test (BST) rates increased among Black, Asian, and Native American men, but rates among Whites also increased, so disparities did not change. Endoscopic screening rates increased by 10 percentage points for Hispanic men and 3 percentage points for non-Hispanic men. BST rates fell among Hispanic relative to non-Hispanic men. We found no changes for women. However, endoscopic screening rates improved among lower income individuals across all races and ethnicities. Conclusions. Mandates were associated with a reduction in endoscopic screening disparities only for Hispanic men but may indirectly reduce racial/ ethnic disparities by increasing rates among lower income individuals. Findings imply that systematic differences in insurance coverage, or health plan fragmentation, likely existed without mandates. These findings underscore the need to research disparities within insured populations. [ABSTRACT FROM AUTHOR]

Objectives. We used objective oral health screening and survey data to explore individual-, psychosocial-, and community-level predictors of oral health status in a statewide population of adults. Methods. We examined oral health status in a sample of 1453 adult Wisconsin residents who participated in the Survey of the Health of Wisconsin Oral Health Screening project, conducted with the Wisconsin Department of Health Services during 2010. Results. We found significant disparities in oral health status across all individual-, psychosocial-, and community-level predictors. More than 15% of participants had untreated cavities, and 20% did not receive needed oral health care. Individuals who self-reported unmet need for dental care were 4 times as likely to have untreated cavities as were those who did not report such a need, after controlling for sociodemographic and behavioral factors. Conclusions. Our results suggested that costs were a primary predictor of access to care and poor oral health status. The results underscored the role that primary care, in conjunction with dental health care providers, could play in promoting oral health care, particularly in reducing barriers (e.g., the costs associated with unmet dental care) and promoting preventive health behaviors (e.g., teeth brushing). [ABSTRACT FROM AUTHOR]