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An introduction to articles in the issue is presented on topics including interventions designed to test workforce and other approaches to reducing maternal morbidity and mortality, a quality improvement study which showed an increase in COVID-19 vaccination rates among pregnant and postpartum people, and interventions designed to test workforce and other approaches to reducing maternal morbidity and mortality.

The author addresses ways to move forward to achieve optimal nutritional status during the first 1000 days, which is critical because children experience more growth and development in that time period. Topics discussed include main themes that emerged in a series of international articles that drew attention to the critical impact of maternal and child nutrition during the first 1000 days, and barriers and opportunities to be considered in advancing the quality of nutrition during that period.

The article discusses data sources and opportunities for monitoring intersectional stigma in public health practice, key gaps within intersectional stigma research, and implementation strategies for successful monitoring. Topics include how select data sources can better address intersectional stigma at multiple levels of public health practice and conceptual, methodological, policy-related, and procedural gaps challenging integration of intersectional stigma within monitoring efforts.

The article offers a perspective on the attainability or desirability of the aspirational goal of healthiest nation that requires a culture change in all aspects of society. It identifies implications of striving to become the healthiest nation including promotion of the concepts of otherness and inequity and self-defeat by creation of a false sense of achievement and complacency. Emphasis is given on the need to know the limitations of health and to strive for continuous health maintenance.

We explore and contextualize changes at the Environmental Protection Agency (EPA) over the first 6 months of the Trump administration, arguing that its pro-business direction is enabling a form of regulatory capture. We draw on news articles, public documents, and a rapid response, multisited interview study of current and retired EPA employees to (1) document changes associated with the new administration, (2) contextualize and compare the current pro-business makeover with previous ones, and (3) publicly convey findings in a timely manner. The lengthy, combined experience of interviewees with previous Republican and Democratic administrations made them valuable analysts for assessing recent shifts at the Scott Pruitt-led EPA and the extent to which these shifts steer the EPA away from its stated mission to "protect human and environmental health." Considering the extent of its probusiness leanings in the absence of mitigating power from the legislative branch, we conclude that its regulatory capture has become likely--more so than at similar moments in the agency's 47-year history. The public and environmental health consequences of regulatory capture of the EPA will probably be severe and far-reaching. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions. Methods: We conducted a single-blind, randomized clinical trial in Philadelphia, Pennsylvania (2013-2014). Participants (n = 302) were high-poverty neighborhood residents, uninsured or publicly insured, and diagnosed with 2 or more chronic diseases (diabetes, obesity, tobacco dependence, hypertension). All patients set a disease-management goal. Patients randomly assigned to CHWs also received 6 months of support tailored to their goals and preferences. Results: Support from CHWs (vs goal-setting alone) led to improvements in several chronic diseases (changes in glycosylated hemoglobin: -0.4 vs 0.0; body mass index: -0.3 vs -0.1; cigarettes per day: -5.5 vs -1.3; systolic blood pressure: -1.8 vs -11.2; overall P = .08), self-rated mental health (12-item Short Form survey; 2.3 vs -0.2; P = .008), and quality of care (Consumer Assessment of Healthcare Providers and Systems; 62.9% vs 38%; P < .001), while reducing hospitalization at 1 year by 28% (P = .11). There were no differences in patient activation or self-rated physical health. Conclusions: A standardized CHW intervention improved chronic disease control, mental health, quality of care, and hospitalizations and could be a useful population health management tool for health care systems. [ABSTRACT FROM AUTHOR]

Objectives. To determine the effectiveness of the COMmunity of Practice And Safety Support (COMPASS) Total Worker Health intervention for home care workers. Methods. We randomized 16 clusters of workers (n = 149) to intervention or usualpractice control conditions. The 12-month intervention was scripted and peer-led, and involved education on safety, health, and well-being; goal setting and self-monitoring; and structured social support. We collected measures at baseline, 6 months, and 12 months, which included workers' experienced community of practice (i.e., people engaged in a common activity who interact regularly for shared learning and improvement). Implementation occurred during 2013 and 2014 in Oregon. Results. In an intent-to-treat analysis, relative to control, the intervention produced significant and sustained improvements in workers' experienced community of practice. Additional significant improvements included the use of ergonomic tools or techniques for physical work, safety communication with consumer-employers, hazard correction in homes, fruit and vegetable consumption, lost work days because of injury, high-density lipoprotein cholesterol, and grip strength. Consumer-employers' reports of caregiver safety behaviors also significantly improved. Conclusions.COMPASSwas effective for improving home careworkers' social resources and simultaneously impactedboth safety and health factors. [ABSTRACT FROM AUTHOR]

The goal of this project was to enhance the capacity of local health departments to translate and implement evidence-based programs in emergency preparedness by using the Getting To Outcomes approach. Our evaluation determined that local health department staff reported improved capacities. A “Getting To Outcomes Guide for Community Emergency Preparedness” guidebook was produced and is available online. [ABSTRACT FROM AUTHOR]

Public health, like politics, is the art of the possible.To maximize effectiveness, public health officers in any jurisdiction should (1) get good data and ensure timely and effective dissemination; (2) prioritize and tackle more difficult initiatives first; (3) find, fight, and win winnable battles in areas where progress is possible but not ensured without focused, strategic effort; (4) support andhire greatpeople and protect themso they can do their jobs; (5) address communicable diseases and environmental health effectively; (6) do not cede the clinical realm-- public health programs depend on clinical care and on effective coordination between health care and public health; (7) learn and manage the budget cycle; (8)manage the context; (9) never surprise their boss; and (10) follow core principles. [ABSTRACT FROM AUTHOR]

The article discusses the possibility that bipartisan health care reform can be achieved in America as of 2017, and it mentions efforts to repeal and replace the U.S. Patient Protection and Affordable Care Act, as well as information about the health policy-related priorities of Democrat and Republican state legislators. U.S. surveys are examined, along with goals regarding medical care cost reductions and limits on government involvement in health care.

We conducted a literature review in 2011 to determine if accepted governance functions continue to reflect the role of public health governing entities. Reviewing literature and other source documents, as well as consulting with practitioners, resulted in an iterative process that identified 6 functions of public health governance and established definitions for each of these: policy development; resource stewardship; continuous improvement; partner engagement; legal authority; and oversight of a health department. These functions provided context for the role of governing entities in public health practice and aligned well with existing public health accreditation standards. Public health systems research can build from this work in future explorations of the contributions of governance to health department performance. [ABSTRACT FROM AUTHOR]

In this article, we compared the characteristics of public and private accredited public health training programs. We analyzed the distinct opportunities and challenges that publicly funded schools of public health face in preparing the nation’s public health workforce. Using our experience in creating a new, collaborative public school of public health in the nation’s largest urban public university system, we described efforts to use our public status and mission to develop new approaches to educating a workforce that meets the health needs of our region and contributes to the goal of reducing health inequalities. Finally, we considered policies that could protect and strengthen the distinct contributions that public schools of public health make to improving population health and reducing health inequalities. [ABSTRACT FROM AUTHOR]

Objectives. We combined a metabolic and an epidemiological model of obesity to estimate changes in calorie intake and physical activity necessary to achieve the Healthy People 2020 objective of reducing adult obesity prevalence from 33.9% to 30.5%. Methods. We used the National Health and Nutrition Examination Survey (1999– 2010) to construct and validate a microsimulation model of the US population aged 10 years and older, for 2010 to 2020. Results. Obesity prevalence is expected to shift toward older adults, and disparities are expected to widen between White, higher-income groups and minority, lower-income groups if recent calorie consumption and expenditure trends continue into the future. Although a less than 10% reduction in daily calorie intake or increase in physical activity would in theory achieve the Healthy People 2020 objective, no single population-level intervention is likely to achieve the target alone, and individual weight-loss attempts are even more unlikely to achieve the target. Conclusions. Changes in calorie intake and physical activity portend rising inequalities in obesity prevalence. These changes require multiple simultaneous population interventions. [ABSTRACT FROM AUTHOR]

We compared projections from a dynamic model of US adult smoking prevalence with official estimates of prevalence from the National Health Interview Survey. Ten years after they were made, the model projections closely fit the National Health Interview Survey estimates for 2005 and 2010. We conclude that a verified model of adult smoking prevalence can assist governmental authorities in establishing aspirational but feasible targets for tobacco control. By extension, carefully crafted models can help in goal setting in multiple areas of public health. [ABSTRACT FROM AUTHOR]

The US National Strategy for Suicide Prevention (National Strategy)described 11 goals across multiple areas, including suicide surveillance. Consistent with these goals, the Department of Defense (DoD) has engaged aggressively in the area of suicide surveillance. The DoD's population-based surveillance system, the DoD Suicide Event Report (DoDSER) collects information on suicides and suicide attempts for all branches of the military. Data collected includes suicide event details, treatment history, military and psychosocial history, and psychosocial stressors at the time of the event. Lessons learned from the DoDSER program are shared to assist other public health professionals working to address the National Strategy objectives. [ABSTRACT FROM AUTHOR]

I criticize the concern over the politicization of public health policy as a justification for preferring a narrow to a broad model of public health. My critique proceeds along 2 lines. First, the fact that administrative structures and actors are primary sources of public health policy demonstrates its inescapably political and politicized nature. Second, historical evidence shows that public health in Great Britain and the United States has from its very inception been political and politicized. I conclude by noting legitimate ethical concerns regarding the political nature of public health policy and argue that open deliberation in a democratic social order is best served by acknowledging the constraints of the inescapably politicized process of public health policymaking. [ABSTRACT FROM AUTHOR]

Thirty years ago, the Centers for Disease Control and Prevention reported the first cases of AIDS in the United States. Since then, more than half a million Americans have died of AIDS, and 1.1 million people are currently living with HIV in the United States. In an attempt to reinvigorate the domestic response to the HIV epidemic, the Obama administration developed and released the National HIV/AIDS Strategy for the United States (NHAS). The NHAS has 3 focus areas: reducing new infections, improving access to care and health outcomes, and reducing HIV-related disparities. With ambitious five-year targets set for each goal, the NHAS requires significant fiscal investment to achieve its desired impact on the domestic HIV epidemic. [ABSTRACT FROM AUTHOR]

Prescription monitoring programs (PMPs), state-level databases that collect patient-specific prescription information at the time medications are dispensed, have been suggested as tools to address the overdose epidemic. We reviewed all laws in the United States (n = 25) that articulated the purposes PMPs are intended to serve. Attributes related to reducing abuse, misuse, and diversion of prescription medications appeared most commonly. Only 5 purpose statements mentioned the promotion of public health as goals of the PMP, and only 3 listed improving health care. None listed overdose prevention as a goal of the PMP. [ABSTRACT FROM AUTHOR]

Objectives. This study examined correlates of tobacco use among Cherkee women. Methods. Prevalence rates were analyzed for 614 randomly selected Eastern Band Cherokee women. Results. The prevalence rates for current smokeless tobacco use and smoking were 8% and 30%, respectively. Smokeless tobacco use correlates included lower education and having consulted an Indian healer. Smoking correlates included younger age, alcohol use, no yearly physical exam, separated or divorced marital status, and lack of friends or church participation. Conclusions. Smoking razes among these women were slightly above national rates. The association of smokeless tobacco use with having consulted an Indian healer may help in understanding Cherokee women's smokeless tobacco use. [ABSTRACT FROM AUTHOR]

An editorial is presented which addresses the authors' views about the goals of translational science in public health intervention research in America, and it mentions the U.S. National Institutes of Health's research investments and efforts to inform prevention and treatment practices. A multiphase optimization strategy (MOST) and randomized controlled trials (RCTs) are examined, along with the elements of a classical translational science approach.

The article announces several job openings involving positions such as Editor at America's National Sleep Foundation and Managing Editor at the American Public Health Association which are posted in the journal, and it mentions the careers.apha.org/jobseekers/resources/ website.

The author reflects on the rationale and implications of setting objectives for tobacco control in the U.S. The author specifically focused on the target-setting process in the Healthy People 2010 objectives. The goal of reaching the 13 percent prevalence by 2010 depends partly on improved effectiveness for each attempt to quit, partly on increased numbers of smokers who attempt to quit and partly on increased frequency of smokers' attempts to quit.

The author argues that the U.S. public health community should develop comprehensive climate change adaptation strategies in 2016 that will embed population health as a main issue in the domestic and global response to climate change. The Paris Agreement international pact to limit global climate warming and greenhouse gas emissions is examined, along with the 1997 Kyoto Protocol environmental protection accord. A right to health, the U.S. government, and global responsibilities are assessed.

The article comments on the role of the local health department in the delivery of personal health services in the U.S. According to the author, the central long-term issue is to what extent local health departments will be integral operatives in the formulation and implementation of national health policy. The author states several imperatives operating to strengthen the national-local link, such as the social and the technologic imperatives. He also mentions the role of local health departments in objective setting and tracking.