Displaying 1-20 of 83 results for

Supporting policies that reduce HIV stigma and promote health equity is an important public health issue.

In an effort to help meet demand, some states and territories have joined interjurisdictional licensing compacts that allow a mental health care provider licensed in one state to provide care in another state—without needing to gain licensure in multiple states. These agreements also offer guidance on patient privacy for services rendered remotely or from out-of-state.

Adopting a public health approach to substance use by implementing harm reduction policies across all levels of government can help communities address the overdose crisis. This post analyzes e

Geographic Information Systems and other data visualization tools have become integral parts of public health decision-making workflows and provide crucial support to topic areas such as environmental health, the COVID-19 pandemic response, and chronic disease investigation and prevention.

Learn how public health agencies are improving their financial management strategies and systems.

Xylazine: What Health Agencies Need to Know astho, association of state and territorial health officials, xylazine trend, xylazine, overdose epidemic, overdose deaths, harm reduction, drug overdose deaths, drug related harm, blood pressure, respiratory depression, medical examiners, mental health, reducing the harms, substance use disorder, harm reduction services, drug overdose, people who use drugs, drug overdose epidemic, skin ulcers, puerto rico, overdose prevention, early 2000s, harm reduction programs, synthetic opioids, overdose deaths involve, prescription opioids Stephanie Swanson, Richa Ranade ASTHO | How health agencies are handling the rise of xylazine in the illicit drug supply. Communities across the United States are facing an evolving and complex overdose epidemic, which claimed more than 100,000 lives in 2022. Recent increases in overdose deaths have largely been attributed to illicit fentanyl, which has increasingly been combined with both opioid and stimulant drugs and used to lace counterfeit pills.     Federal agencies have been warning that xylazine, a non-opioid tranquilizer used in veterinary medicine, is infiltrating the drug supply and being mixed with other illicit substances—most commonly heroin and fentanyl. Xylazine threatens to worsen outcomes for people who use drugs and complicate the overdose prevention landscape across the country.  Xylazine is approved for veterinary use in the United States but is not approved by FDA for human medicine. The drug, which is not currently controlled under the Controlled Substances Act, first appeared in the Philadelphia drug supply in the mid-to-late 2010s, but has since spread throughout the northeast and westward. The Philadelphia Department of Public Health reported that more than 90% of opioid samples tested in the city in 2021 tested positive for xylazine. Heroin or fentanyl cut with xylazine is often referred to as "tranq" or "tranq dope." Substances containing xylazine can be ingested orally, snorted, sniffed, or—mostly commonly—injected intravenously. Leading Concerns  People may not know whether they are exposed to xylazine when using other substances, which may place people who encounter it at greater risk for harm. Xylazine is a central nervous system depressant, causing drowsiness, slowed breathing, reduced heart rate, and hypotension, which may increase the risk of a fatal overdose.   The symptoms of xylazine use and opioid use are similar, making it difficult to differentiate whether an individual has used both substances. Xylazine use is associated with skin ulcers, lesions, and abscesses. Individuals who develop a physical dependency on xylazine may develop severe withdrawal symptoms. What Steps are Health Agencies Taking? State and territorial health agencies can take several steps to prevent harm related to xylazine. Agencies can partner with harm reduction organizations, hospitals, substance use treatment providers, High Intensity Drug Trafficking Areas, and medicolegal death investigators to understand whether xylazine is present in the local drug supply.  Connecticut conducted a pilot project with hospitals to collect urine samples from patients who experienced nonfatal overdoses. The Connecticut State Public Health Lab tested the samples between 2021 and 2022, and found that 13% contained a combination of fentanyl and xylazine.  During a presentation about xylazine to medicolegal death investigators in January, 2023, Shobha Thangada, a specialist at the Connecticut Department of Public Health, said, "In cases of fatal overdose, we cannot communicate with those people. However, when patients with a non-fatal overdose come to the hospital setting, we can inform them to watch their drugs and know what is in what they are using." In areas where xylazine is detected, raising community awareness of risks associated with xylazine is critical. Philadelphia, New York City, Connecticut, Massachusetts, and Rhode Island have developed campaigns and awareness materials to alert people about the risks of xylazine and to inform them of ways to prevent xylazine-related overdose. Philadelphia also plans to utilize opioid settlement funding to implement wound care sites for those affected by xylazine.  Those responding to a suspected xylazine overdose are advised to administer naloxone. Though xylazine is not an opioid and does not respond to naloxone, xylazine is commonly mixed with opioids. If an overdose is not responsive to naloxone, providers are encouraged to provide supportive measures.   article yes

Health providers have widely used telehealth to mitigate the spread of COVID-19 infection and to improve access to healthcare services thanks in large part to policy changes and regulations. This brief explores how state and territorial health agencies (S/THAs) are responding to COVID-19 through telehealth policy and operational changes, as well as how telehealth has quickly emerged as a tool to improve health equity.

An issue brief by ASTHO and the Duke University Margolis Center for Health Policy that highlights considerations for state health officials as they look to maximize the benefits of COVID-19 therapeutics.

National HIV Testing Day is observed each year on June 27, the goal is to encourage people to get tested and know their HIV status. Recent legislation on this topic speaks to its prioritization and importance; themes include: consent for HIV testing, site-specific processes for routine screening, increased access to testing.

During the 2022 state legislative sessions, at least 20 states considered bills that would require a religious exemption to a vaccine requirement. As state legislatures continue considering vaccine protocols for COVID-19, HPV, and other diseases—along with what types of exemptions should be given—courts are reconsidering what type of vaccine requirements are constitutional.

The ASTHO State Health Policy team provides brief updates on 5 of the ten state health policy issues to watch in 2022: mental and behavioral health, rural health, e-cigarettes and flavored tobacco products, HIV and PFAS.

Continuing ASTHO’s Legislative Prospectus series—which highlights the top 10 public health policy issues for 2022—we are focusing this week on mental and behavioral health as well as supporting the public health workforce.

Flavored tobacco policy has changed rapidly over the past few months. In April, FDA announced their intention to implement rules prohibiting the sale of menthol e-cigarettes and flavored cigars, though it may take years until they implement a final rule. And in 2021, 15 states and Washington, D.C. considered legislation prohibiting the sale of some or all flavored tobacco products. However the tobacco industry has seen success recently in obstructing the legislative efforts of states in this area.

Although suicide was a critical public health issue in the U.S. long before the COVID-19 pandemic began, Americans are now reporting increased mental health challenges like depression, anxiety, and suicidal behaviors. In addition, millions have experienced financial hardships, social isolation and loneliness, and increased stress—all of which are shared risk factors for mental health conditions, suicidal behaviors, and substance misuse. State public health officials have taken bold action over the past 12 months to mitigate the physical impacts of COVID-19, and the same swift action should be applied to mitigate the acute and potential long-term mental health, suicide, and substance use impacts. The National Response’s "An Action Plan for Strengthening Mental Health and Prevention of Suicide in the Aftermath of COVID-19" provides a roadmap for addressing the mental health, suicide prevention, and substance misuse prevention needs spurred by COVID-19.

During the early months of the COVID-19 pandemic, the federal government enacted the Coronavirus Aid, Relief, and Economic Security (CARES) Act, temporarily expanding the use of telehealth technologies by removing various requirements and waiving certain restrictions. Many states also expanded telehealth access through changes to state Medicaid laws. These temporary policy changes created an uptick of telehealth use that improved access to care for millions of Americans—but questions remain about which policy changes will stick around beyond the pandemic. Currently, states are making decisions about what temporary policies to permanently implement and which policies to end without disrupting the delivery of care and further exacerbating health disparities.

An increasing body of research finds racism can have a significant impact across one’s lifespan. Research shows that persistent exposure to racial discrimination may result in premature aging, poor health outcomes, and increased prevalence of certain chronic diseases. At every level of government, policymakers are seeking to acknowledge the systemic oppression of people of color that persists and to elevate racism as an urgent public health crisis comparable to other public health emergencies.

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

Conditioning school attendance on student vaccinations is an evidence-based way of maintaining and increasing vaccine coverage. State law establishes school vaccination requirements which apply not only to public schools but often to private schools and childcare facilities as well. All states allow an exemption for those where a vaccine poses a medical risk. Several states also allow non-medical exemptions, often based on an asserted religious, philosophical, or personal belief of the parents or child opposing vaccinations. However, a few states have recently abolished all non-medical exemptions.

Several states and territories, as well as many local governments, are going beyond recommendations and requiring individuals to wear face coverings when they are in public settings and spaces (i.e. grocery stores, retail stores, restaurants, public and private transportation services, parks, etc.). Ongoing research and evidence suggests the relationship between mandatory face coverings and declines in daily COVID-19 growth rates is statistically significant.

Reprioritizing Black Maternal Health How We Can Prioritize Black Maternal Health Lawrence Young Black women face significant rates of maternal morbidity and mortality — learn how public health can better support them in this blog post. I do not have to look far to understand the urgency of the Black maternal health crisis. I have watched friends, colleagues, and loved ones from every walk of life struggle through pregnancies that should have been safe and celebrated. Some are highly educated professionals. Others are young mothers still finding their way. Many had access to quality insurance and still faced complications, long hospital stays, and minimal follow-up care. Many have shared unfortunate experiences that run the gamut from feeling unheard or perhaps unnecessarily undergoing a procedure — the care in health care was not there for them. These are not isolated incidents. They are part of a larger, structural failure that demands our attention and our action. As public health professionals, we must ask ourselves: How can we better care for and about Black mothers? And what would it look like to center them in the systems that were created to protect women in one of the most vulnerable times of their lives? Understanding the Root of the Crisis Black women in the United States are three to four times more likely to die from pregnancy-related causes than their White counterparts. In many states, including Connecticut, this difference persists even when controlling for education and income. These outcomes are not the result of individual choices or biological differences — they are the result of systems designed with historical blind spots. Education and income, often seen as protective factors, do not shield Black women from these outcomes. Research shows that pregnancy-related mortality rates are higher among Black women with a college degree than among White women with the same level of education or with less than a high school diploma. The same is true for women with respect to the risk of dying within the first year postpartum. These disparities grow with age and extend beyond mortality to include severe maternal morbidity, such as preeclampsia — a pregnancy complication related to high blood pressure — which can have lasting health impacts if untreated including death. Additionally, American Indian, Alaska Native, Black, Native Hawaiian, Pacific Islander, Asian, and Hispanic women all experience higher rates of ICU admission during delivery compared to White women. ICU admission is considered a key marker for maternal complications and system-level failure. Public Health as Partner in Progress Public health has a responsibility to do more than document issues and concerns. We must be in the business of addressing them. In Connecticut, we are working across agencies and community organizations to move from acknowledgment to action. One of the most important leaders in this work is #Day43, an initiative launched by Waterbury Bridge to Success Community Partnership. The name refers to the period between 43 days and one year postpartum, during which approximately 20% of pregnancy-related deaths occur. #Day43 exists to raise awareness of Black maternal health and transform systems to support mothers. Their work spans research, advocacy, policy, technical assistance, and storytelling grounded in lived experience. Waterbury’s maternal health data reflects this crisis. According to the #Day43 Black Maternal Health Report, 18.6% of pregnant women in Waterbury received late or no prenatal care. Those in the city face higher rates of C-sections, limited access to postpartum care, and insufficient support for mental health and breastfeeding. The community described a significant lack of maternity care resources, particularly in the North End, where many Black and Hispanic families reside. Through initiatives like this, residents are not just seen as stakeholders. They are recognized as storytellers, system builders, and agents of change. Their leadership is shaping how we define, measure, and deliver maternal care in Connecticut. This vision aligns with broader maternal health equity efforts across the state. For example, The Connecticut Health Foundation is developing a Maternal Health Equity Blueprint in partnership with community leaders, researchers, and families. Waterbury voices are essential contributors to this process. Listening as a Path of Healing The experiences of Black mothers reflect a broader truth. Too often, our systems are not built to hear them. That lack of trust is both historical and current. It shows up in rushed appointments, dismissed symptoms, and inaccessible services. Community-based providers, such as doulas and midwives of color, are critical to bridging this gap. They do more than provide care — they restore dignity. Yet these providers are often underfunded and undervalued in mainstream health care systems. Public health must champion integrating these providers into existing systems and promoting long-term sustainability. To maximize maternal health outcomes, the next phase of this work must intentionally include structured cross-sector collaboration. It must focus on building systems that educate both providers and families on urgent maternal warning signs, provide consistent discharge education, and strengthen local surveillance and outreach infrastructure. These strategies are essential, scalable, and lifesaving. We cannot improve outcomes without acknowledging the deep cultural, emotional, and psychological work required to rebuild trust. We cannot heal what we do not hear. Re-Examining the “Public” in Public Health Re-examining the public in public health means placing the needs of our most vulnerable communities at the center. It means investing in care that is integrative and supportive with community co-designed solutions. It also means wholistically addressing other intersecting systems that influence maternal outcomes. We can start by: Expanding funding for community-based perinatal health workers, including doulas and midwives. Embedding relevant metrics into maternal health program design and evaluation. Creating statewide listening sessions and family advisory councils to ensure policies reflect lived realities. Partnering across sectors to improve access to safe housing, transportation, and mental health supports for new mothers. Supporting local initiatives like #Day43 that lead from within communities and reflect community-defined solutions. Educating families on health information and individual health rights through accessible, trusted channels. To truly care for and about Black mothers, we must act beyond awareness months and social media campaigns. We must improve current processes and design opportunities that will support them and keep them alive. Public health was created to serve the public. The most powerful way to honor that mission is to focus on the public, ensuring they are a priority and not an afterthought. article yes