Search

In the United States, the public health response to control COVID-19 required rapid expansion of the contact tracing workforce from approximately 2200 personnel prepandemic to more than 100 000 during the pandemic. We describe the development and implementation of a free nationwide training course for COVID-19 contact tracers that launched April 28, 2020, and summarize participant characteristics and evaluation findings through December 31, 2020. Uptake of the online asynchronous training was substantial: 90 643 registrants completed the course during the first 8 months. In an analysis of a subset of course participants (n = 13 697), 7724 (56.4%) reported having no prepandemic public health experience and 7178 (52.4%) reported currently serving as case investigators, contact tracers, or both. Most participants who completed a course evaluation reported satisfaction with course utility (94.8%; 59 497 of 62 753) and improved understanding of contact tracing practice (93.0%; 66 107 of 71 048). These findings suggest that the course successfully reached the intended audience of new public health practitioners. Lessons learned from this implementation indicate that an introductory course level is appropriate for a national knowledge-based training that aims to complement jurisdiction-specific training. In addition, offering a range of implementation options can promote course uptake among public health agency staff. This course supported the emerging needs of the public health practice community by training a workforce to fill an important gap during the COVID-19 pandemic and could serve as a feasible model for enhancing workforce knowledge for future and ongoing public health threats.

US states and big cities acted to protect the residents of their jurisdictions from the threat of SARS-CoV-2 infection and reduce COVID-19 transmission. As there were no known pharmacologic interventions to prevent COVID-19 at the outset of the pandemic, public health and elected leaders implemented a host of nonpharmaceutical interventions (NPIs) to slow the spread of the virus. This article discusses variation among states and cities in their implementation of 3 NPIs: stay-at-home/shelter-in-place orders, gathering restrictions, and mask mandates. We illustrate how frequently each was used by states and big cities, discuss state and local authorities to implement such interventions, and consider how these NPIs and accompanying public adherence to public health orders may vary considerably in different regions of the country and by local and state laws specific to state preemption of public health authority.

The nation’s first broad-based, mandatory investment in public health and prevention, the Prevention and Public Health Fund (the Fund), has had a brief and controversial history. Advocates for the Fund have had to defend it from both Democratic and Republican threats, including being used as an offset for administration priorities, and from congressional efforts to repeal and replace the Patient Protection and Affordable Care Act. Lessons learned from efforts to sustain the Fund are instructive in addressing current and future challenges faced by advocates for public health programs and prevention policies.

Context Creativity and innovation in the governmental public health workforce will be required to generate new ideas to solve complex problems that extend beyond traditional public health functions such as disease surveillance and monitoring. Creativity and innovation can promote and advance necessary organizational transformation as well as improve organizational culture and workplace environment by motivating employees intrinsically. However, there is little empirical evidence on how rewarding creativity and innovation in governmental public health departments is associated with organizational culture and workplace environments. Objective This study describes (1) the degree to which creativity and innovation are rewarded in governmental public health agencies and (2) associations between rewarding creativity and innovation and worker satisfaction, intent to leave, and workplace characteristics. Design The cross-sectional Public Health Workforce Interests and Needs Survey (PH WINS) was administered using a Web-based platform in fall 2017. Settings and participants Data used for these analyses were drawn from the 2017 PH WINS of governmental health department employees. This included state health agency and local health department staff. PH WINS included responses from 47 604 staff members, which reflected a 48% overall response rate. PH WINS excludes local health departments with fewer than 25 staff or serving fewer than 25 000 people. Results Fewer than half of all workers, regardless of demographic group and work setting, reported that creativity and innovation were rewarded in their workplace. Most measures of worker satisfaction and workplace environment were significantly more positive for those who reported that creativity and innovation were rewarded in their workplace. Conclusion This research suggests that promoting creativity and innovation in governmental public health agencies not only could help lead the transformation of governmental public health agencies but could also improve worker satisfaction and the workplace environment in governmental public health agencies.

Context Case investigation and contact tracing are fundamental public health strategies for controlling and preventing the spread of infectious diseases. Although the principles behind these strategies are not new, the capacity and operational requirements needed to support disease investigation during the SARS-CoV-2 (COVID-19) pandemic are unprecedented. This article analyzes the implementation of case investigation and contact tracing in controlling COVID-19 transmission during the early stages of the US pandemic response (January 20 through August 31, 2020). Program implementation Governmental public health agencies mobilized to expand case investigation and contact tracing programs in the early months of the pandemic. In doing so, they encountered a range of challenges that included rapidly scaling up the workforce; developing and subsequently revising guidance and protocols specific to COVID-19 as more was learned about the virus over time; defining job functions; encouraging public acceptance of and participation in case investigation and contact tracing; and assessing the utility of these activities during both the containment and mitigation phases of outbreak response. COVID-19 case investigation and contact tracing programs presented an array of opportunities for health departments to innovate, especially around technology to support public health efforts, as well as opportunities to address health equity and advance community resilience. Conclusion Lessons learned from disease intervention specialists, guidance and resources from federal agencies and national partners, and peer-to-peer exchange of promising practices can support jurisdictions encountering early implementation challenges. Further research is needed to assess COVID-19 case investigation and contact tracing program models and innovations, as well as strategies for implementing these activities during containment and mitigation phases.

Containing coronavirus disease 2019 (COVID-19) through case investigation and contact tracing is a crucial strategy for governmental public health agencies to control the spread of COVID-19 infection in the United States. Because of the recency of the pandemic, few examples of COVID-19 contact-tracing models have been shared among local, state, and federal public health officials to date. This case study of the Anne Arundel County Department of Health (Maryland) illustrates one model of contact-tracing activity developed early in the outbreak. We describe the contact-tracing effort’s place within the broader county health agency Incident Command System, as well as the capabilities needed, team composition, special considerations, and major lessons learned by county health officials. Other local, state, tribal, territorial, and federal health officials and policy makers can use this case study to innovate, iterate, and further refine contact-tracing efforts to prevent the spread of COVID-19 infection and support community members in isolation or quarantine.

Prescription drug monitoring programs (PDMPs) have become a widely embraced policy to address the US opioid crisis. Despite mixed scientific evidence on their effectiveness at improving health and reducing overdose deaths, 49 states and Washington, DC have adopted PDMPs, and they have received strong bipartisan legislative support. This article explores the history of PDMPs, tracking their evolution from paper-based administrative databases in the early 1900s to modern-day electronic systems that intervene at the point of care. We focus on two questions: how did PDMPs become so widely adopted in the United States, and how did they gain popularity as an intervention in the contemporary opioid crisis? Through this historical approach, we evaluate what PDMPs reflect about national drug policy and broader cultural understandings of substance use disorder in the United States today. (

Just a few weeks before the first confirmed case of novel coronavirus (COVID-19) was reported in the United States, the US Centers for Disease Control and Prevention (CDC) issued a bold promise to the nation: the agency will use its scientific expertise to bring a new level of preparedness in the United States and global health security against current and growing threats, finally eliminate certain diseases, and bring an end to the devastation of epidemics (1) The current outbreak of COVID-19 reminds us how urgent this promise is and just how critical it is to continue to sustain and strengthen our nation's public health infrastructure The unprecedented pace of the public health response to COVID-19 has only been possible because of prior investments in public health preparedness To accelerate our pace and meet the challenges of current and future health threats, we must advance our world-class data and analytics capabilities;maintain and expand our state-of-the-art public health laboratory capacity;continue building a workforce of trusted, expert, public health professionals;sustain our capacity to rapidly respond to outbreaks at their source;and assure a strong global and domestic preparedness capacity (Am J Public Health Published online ahead of print February 13, 2020: e1-e2 doi:10 2105/AJPH 2020 305618)

A public health guide to ending the opioid crisis is needed to help frame efforts to go “upstream” and address the root causes of substance use disorder and addiction. In this introduction, the editors provide an overview of the book’s three parts (Fundamentals and Frameworks; Connecting Clinical Perspectives and Public Health Practice; Moving Upstream—Prevention, Partnership, and Public Health). While a great deal of prior work has focused on the clinical aspects of the opioid epidemic, more is needed to address the community-level aspects, including addressing the root causes of addiction, and where public health professionals can intervene at the primary, secondary, and tertiary levels of prevention. The case is made for increasing effort in the areas of primary prevention and policy change to support effective opioid stewardship at the local, state, and federal levels. The editors conclude by stating that communities will not “arrest” or “treat” their way out of this crisis. Instead, we have to redouble efforts to prevent addiction and address the clinical and community aspects of what drives an individual to become addicted in the first place.

This chapter presents the role that public health agencies play as leaders and/or conveners of partnerships and collaborations in responding to the opioid epidemic at the state and local levels. “Partnership” is defined as a continuum of relationships between two or more entities ranging from informal engagement around topics of interest to formal, structured memoranda of understanding or contracts that govern resource exchange, the various roles and responsibilities of the partners, and performance metrics or other accountability metrics. The work of partnerships around opioid use and addiction requires intentional engagement of a variety of groups, many of whom have not traditionally worked with public health agencies before. Examples of various partners and their roles in ending the crisis are presented. The chapter includes a discussion of what makes for successful partnerships and key considerations when engaging collaborators in developing shared goals and objectives.

An effective public health response to the opioid crisis includes understanding the many different contributors to the crisis and the need for a comprehensive versus piecemeal approach to addressing it. In this chapter, the authors add to prior work that describes the essential elements of a comprehensive response to the opioid crisis. Building on their commentary published in 2018, the authors state that there is a need to propel the governmental public health agency response well beyond its traditional role as data broker and convener of primarily health care partners toward a more contemporary and much-needed focus on the primary prevention of opioid misuse and addiction that forges new ground with social service agencies, employment and housing programs, law enforcement and corrections, addiction treatment providers and substance abuse prevention agencies, and many other sectors equally engaged in ending the opioid crisis.

The goal of opioid stewardship is to provide public health practitioners and health care professionals with the education and tools they need to appropriately prescribe opioid medications to patients for whom an opioid is indicated and to reduce the overall supply of unused opioid medications that might be diverted and used by individuals other than the intended patient. In this chapter, the Pennsylvania Department of Health’s experience with developing a comprehensive opioid stewardship approach illustrates that creating a statewide culture of opioid stewardship is a process requiring active involvement of health care professionals, provider and patient groups, law enforcement agencies, academic institutions and large health systems, state policymakers and politicians, and the general public. By analyzing Pennsylvania’s experience of building a culture of opioid stewardship, other states can learn how to foster opioid stewardship to ensure its effective spread across the nation.

This chapter outlines the powerful role of state health officials in the policy process, illustrated by the collaborative approach to the complex opioids epidemic. The opioid misuse and addiction epidemic has left no segment of the American population untouched. It is important to note that multiple factors have led to the explosive scale and spread of addiction to prescription and illicit opioids. The combination of tertiary, secondary, and primary prevention programs and the policies that support them are critical. No single policy will comprehensively address the complex issues involved in the current crisis, the chapter argues, but more work in the area of primary prevention is greatly needed. A comprehensive approach that utilizes evidence-based approaches to primary, secondary, and tertiary prevention are critical. The chapter concludes that the complexity of the opioid crisis requires strong clinical and community partnerships to scale and spread successful policy interventions. State and territorial public health officials are committed and well-positioned to lead such efforts in their jurisdictions.

The Centers for Disease Control and Prevention's report of overdose deaths from prescription and illicit opioids underscores the need for urgent action to prevent overdose deaths, promote evidence-...

Background. The initiation of universal genotyping revealed 3 clusters of 19 patients with tuberculosis (TB) in Wisconsin, with no apparent epidemiologic links among most of them. An epidemiologic investigation was conducted to determine whether genotype clustering resulted from recent transmission. Methods. We conducted additional interviews with patients and reviewed medical records. Places frequented by the patients while they were infectious were visited to identify contacts. Results. Our investigation revealed several previously unrecognized possible sites of TB transmission: a singleroom occupancy hotel, 2 homeless shelters, 1 bar, and 2 crack houses. Seven patients with previously diagnosed TB were added to the clusters. Of 26 patients, we identified epidemiologic links for all but 1. Common risk factors among patients included alcohol abuse, crack cocaine use, homelessness, and unemployment. Additionally, 98 contacts missed during routine contact investigation were identified. Conclusions. Transmission of TB, particularly among high-risk groups, may go undetected for years. Our investigation demonstrated the value of universal genotyping in revealing unsuspected recent TB transmission and previously unrecognized sites of transmission, which can be targeted for specific TB interventions.

Using a sociolinguistic analysis of correspondence, this essay examines letters sent to Dr. Martin Luther King, Jr. by supporters and participants in the Civil Rights movement. In the letters, writers employ discourse strategies to construct their experiences of the movement and formulate themselves as supporters and participants. They also formulate their solidarity and framings of the movement. Correspondents' race, gender, and circumstances influence the ways they create solidarity with, and frame the movement. These findings indicate that Civil Rights movement supporters and participants held both private and shared conceptions of the movement. The implications of these findings for movement theory are discussed.

This paper presents an analysis of comments written on signature square panels of the NAMES Project AIDS Memorial Quilt. In our paper we explore how collective memory regarding AIDS deaths emerges from conflict among members of vernacular, mainstream and official culture. The cultural contest waged over how individuals who have died from AIDS-related illnesses will be remembered in society fits within the realm of the sociology of collective memory. Visitor responses to the Quilt illustrate that as a form of commemoration the Quilt is interpreted as a therapeutic device and a political tool. Like other memorials, especially those for which there is social disdain or conflict (e.g., the Vietnam Veteran's Memorial), signature square comments provide an alternative conception of public memory. The fact that the Quilt is used to symbolically commemorate the dead, providing an outlet for collective grieving and inspiring social action, is what makes it an important sociological phenomenon. In our paper we put forward a conception of the politics of collective memory that extends previous work in this area. In doing so this paper contributes to an emerging understanding of public commemoration and to the debate over how different segments of society are to be remembered.

Effective maternal and child health (MCH) practice requires skillfully combining a number of theoretical models and frameworks to support systems addressing the health needs of women, children, and families. This paper describes three perspectives relevant to current MCH practice: the federal Maternal & Child Health Bureau’s Pyramid of MCH Health Services [1], Frieden’s Health Impact Pyramid [Frieden in Am J Public Health 100(4):590–595, (2010)], and life course theory [Halfon in Milbank Quart, 80:433–79, (2002); Kotelchuck in Matern Child Health J, 7:5–11, (2003); Pies (2009)], an emerging conceptual framework that addresses a number of pressing maternal and child health issues including health disparities and the social determinants of health. While developed independently, a synthesis of these three frameworks provides an important analytical perspective to assess the adequacy and comprehensiveness of current public health programs and systems supporting maternal and child health improvement. Synthesizing these frameworks from the specific vantage point of MCH practice provides public health practitioners with important and dynamic opportunities to promote improvements in health, especially for state and local governmental health agencies with the statutory authority and public accountability for improving the health of women, children, and families in their jurisdictions. A crucial finding of this synthesis is that significant improvements in MCH outcomes at the state and local levels are the result of collaborative, integrated, and synergistic implementation of many different interventions, programs and policies that are carried out by a number of stakeholders, and administered in many different settings. MCH programs have a long history of coordinating disparate sectors of the health care and public health enterprise to create systems of services that improve maternal and child health. Future improvements in MCH build on this legacy but will come from a “paradigm shift” in MCH practice that blends (1) evidence-based interventions and best practices that improve the health of individuals, communities, and populations, and crosscuts health service settings with (2) public policies that promote and improve maternal and child health needs at the local, state, and national levels, and (3) supports MCH leadership to implement such changes in MCH systems nationwide. As such, the challenge presented by this synthesis is not merely technical, i.e. having the scientific and organizational capacity to address identified MCH needs. Instead, a more pressing challenge is providing effective leadership in the coordination and integration of these frameworks and using them in practice to develop a vision that guides programs and policies to improve maternal and child health nationwide.

Research addressing “environmental equity” and “environmental racism” claims that facilities for treatment, storage, and disposal of hazardous wastes (TSDFs) are located disproportionately in minority areas. In the first comprehensive study of TSDFs to use census tract-level data, we find no nationally consistent and statistically significant differences between the racial or ethnic composition of tracts which contain commercial TSDFs and those which do not. TSDFs are more likely to be found in tracts with Hispanic groups, primarily in regions with the greatest percentage of Hispanics. Different geographic units of analysis elaborate on, but are consistent with, these results.

Pseudopseudohypoparathyroidism (PPH) is a rare genetic disorder characterized by multiple musculoskeletal anomalies and normal serum calcium, phosphate, and parathyroid hormone levels. Although the musculoskeletal manifestations of PPH are well known, little has been reported on the management of orthopedic problems. We report a case of total knee arthroplasty (TKA) performed in a patient with PPH. To our knowledge, this case is not only unique to the arthroplasty literature but is the first report of its kind. This report illustrates the unique pathoanatomy of PPH, the medical and surgical management required, and a previously unreported musculoskeletal abnormality associated with PPH: synovial osteochondromatosis of the knee. Common musculoskeletal anomalies associated with PPH include shortening/bowing of long bones; shortening of metacarpals, metatarsals, and/or phalanges; exostoses; calcification/ossification of subcutaneous and/or periarticular soft tissues; a thickened calvarium; microcephaly; bony coalitions of the hand; vertebral column abnormalities; cubitus valgus; radius/ulna curvus; coxa vara; coxa valga; and genu valgum. This case is the first to report an association of synovial osteochondromatosis with PPH. Because synovial osteochondromatosis and PPH share a common disorder of soft tissue calcification/ossification, as well as abnormal bone formation, this clinical finding does not seem merely coincidental.

Effective partnerships between local and state public health agencies and schools of public health have tremendous potential to improve the health of communities nationwide. This article highlights successful collaboration between local public health agencies (LPHA), state health departments, and Academic Centers for Public Health Preparedness (ACPHP) in schools of public health developed through participation in Project Public Health Ready, a program to recognize LPHA emergency preparedness. The project's pilot phase illustrated that LPHAs, state health departments, and ACPHP can effectively work together to improve individual public health worker competency and organizational response capacity in local public health agencies nationwide.