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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.

Connecticut Health Official Renée Coleman-Mitchell Testifies on Vaping Illnesses ARLINGTON, VA—Renée Coleman-Mitchell, MPH, commissioner of the Connecticut Department of Public Health, testified today on the threats of e-cigarette use before the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies. The hearing, “E-cigarettes: An Emerging Threat to Public Health,” featured two panels that conveyed the magnitude of the current vaping-related lung disease epidemic from e-cigarette use. “Vaping of nicotine and marijuana related products has continued to rise in Connecticut and nationally – especially among young people,” says Coleman-Mitchell. “Vaping is now super easy and convenient and doesn’t smell like cigarettes. This means it’s really easy to hide it from parents. And now, vaping is endangering the lives of our citizens.” “Providing states with the necessary resources for a structure to help us cope with both our lung injury reporting and our youth epidemic is key. We cannot afford to wait another 50 years to combat the vaping epidemic, we need to take action now.” The Association of State and Territorial Health Officials (ASTHO) is pleased that Congress continues to investigate the national outbreak and learn from state public health officials about the severity tobacco use has on our health. Coleman-Mitchell is the sixth ASTHO member to testify this year on the vaping-related lung disease epidemic. Visit the committee’s website for more information and to read Coleman-Mitchell’s testimony. ASTHO Press Release Boilerplate website yes

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.

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.

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.

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.

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.

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Juthani plans to focus presidency on the importance of public health and public health communications

Healthy People 2030 charts the course for public health over the next decade. In this episode, public health leaders share their perspectives about where state and territorial health agencies intersect with Healthy People 2030 and why it should be treated as a "North Star" in public health.

This blog from ASTHO’s PH-HERO team touches on the importance of trauma-responsive leadership in the public health workforce.

To address the youth tobacco epidemic, jurisdictions filed lawsuits against JUUL to end their marketing practices aimed at youth and to obtain compensation from the financial toll experienced by communities.

There are a number of court cases playing out across the country that could affect the options state and territorial health officials have to limit the spread of disease and promote health and well-being.

While communities transition from emergency response to long-term monitoring and recovery, the federal government and states are taking legislative action to improve emergency preparedness capabilities.

State and Federal Actions to Reduce Per- and Polyfluoroalkyl Substances’ Impact on Public Health safe drinking water act, per and polyfluoroalkyl substances, water supplies, contaminated groundwater, chemical companies, pfas contamination, forever chemicals, synthetic chemicals, maximum contaminant levels, industrial pretreatment program, polyfluoroalkyl substances pfas, chemical sales, chemical industry, bottled water, safe drinking water act sdwa, unregulated contaminants, companies in the world, united states, consumer products, 1996 amendments, national primary drinking water, surface water, water system, largest chemical companies, pfas strategic roadmap, primary drinking water regulations, pfas chemicals, pfoa and pfos, drinking water, testing for pfas, astho, association of state and territorial health officials Maggie Davis, Beth Giambrone State and Federal Actions to Reduce PFAS Impact on Public Health Since 2018, when the city of Stuart, Florida filed its lawsuit, communities across the United States have filed lawsuits against manufacturers that produce Per- and polyfluoroalkyl substances (PFAS), alleging that they contaminated groundwater and exposed residents to these harmful chemicals. In June 2023, manufacturer 3M agreed to pay at least $10.3 billion to settle the Stuart lawsuit and others across the country with public drinking water systems. Similarly, chemical companies DuPont, Chemours, and Corteva reached $1.18 billion settlement with local communities that have detected PFAS in their water supplies. PFAS are synthetic chemicals used in products like nonstick cookware and firefighting foam, which can migrate to soil, water, and air during production and use. Most of these chemicals remain in the environment without breaking down—hence the nickname “forever chemicals”—and can cause harmful health effects (e.g., higher risks of kidney or testicular cancer, and pre-eclampsia or high blood pressure among pregnant people) and are prevalent across the nation. Evidence shows the widespread nature of exposure to the chemicals and the economic costs of exposure. For example, a 2023 USGS study estimated that at least 45% of tap water nationwide could have one or more PFAS, while recent research estimates the annual cost of the disease burden attributable to long-chain (i.e., six or more carbon) PFAS exposure to be at least $5 billion. As communities seek restitution for PFAS contamination, federal and state policymakers are working to eliminate PFAS from ground water and drinking water and to mitigate exposure to these forever chemicals. Eliminating PFAS in Drinking Water Under the Safe Drinking Water Act, EPA has the authority to regulate the public drinking water supply in the United States. These regulations establish legally enforceable Maximum Contaminant Levels (MCLs) or Treatment Techniques and non-enforceable Maximum Contaminant Level Goals (MCLGs) for public water systems. EPA’s recently proposed PFAS National Primary Drinking Water Regulation could potentially add six different PFAS compounds to the list of regulated contaminants. Within the PFAS chemical family, PFOA and PFOS are proposed to each have MCLs of 4.0 parts per trillion (ppt), while PFNA, PFHxS, PFBS, and GenX would be regulated collectively as a mixture using EPA's Hazard Index approach. The proposed rule also could require public water systems to monitor and notify the public of PFAS levels and reduce the levels in drinking water if they exceed proposed standards. According to a survey conducted by the Environmental Council of the States, state guidelines vary; at least eleven states have established statewide MCLs for PFAS in drinking water. Some states prohibit their agencies from setting standards more stringent than federal ones and, in the absence of a federal standard, state agencies may hesitate to establish one that could easily be invalidated. In other cases, a lack of resources inhibits the agency’s capacity to set and enforce a PFAS standard. When a federal standard is established by EPA’s final rule, expected by the end of 2023, state primacy agencies will need to enforce the federal standard and adopt standards aligned with the federal standard or stronger within two years. Additional State Efforts to Reduce PFAS Exposure Even without MCLs, states are finding ways to mitigate the public’s exposure to PFAS. In 2023, states enacted legislation on banning PFAS in consumer products, increased requirements for testing and reporting of PFAS, and PFAS mitigation. Banning PFAS in Products Indiana enacted HB 1341 prohibiting fire departments from purchasing gear unless it contains a permanent label indicating whether it does or does not contain PFAS as of June 30, 2024. Minnesota’s HF 2310 prohibits selling or distributing products containing intentionally added PFAS beginning January 1, 2026. An exception may be made if the manufacturer submits information to the commissioner of the Pollution Control Agency such as the product, the amount of PFAS used, and the amount of PFAS in the product. The Oregon legislature enacted SB 543, which prohibits the selling or using polystyrene foam containers for prepared food, food containers containing intentionally added PFAS, and polystyrene packaging peanuts. Washington enacted HB 1047, which prohibits manufacturing, distributing, and selling cosmetic products with PFAS and other chemicals or chemical classes as of January 1, 2025. Testing/Reporting Indiana enacted HB 1219, establishing a pilot program that collects blood samples of previous or current firefighters, analyzes the samples for serum PFAS levels, and determines whether there are corresponding health implications associated with elevated serum PFAS levels. Maine’s LD 1248 requires bottlers who extract water from the state to sell as bottled water to test, regularly monitor, and report the presence of PFAS to the Department of Health and Human Services and post the results on a public-facing website. Sales of bottled water are prohibited if PFAS levels in the water source exceed the state or federal community water system standards, whichever is lower. Currently, Maine has an interim MCL standard of 20 ppt. Virginia’s HB 2189 directs the State Water Control Board to adopt regulations requiring industrial users of publicly owned treatment works to test waste streams for PFAS before and after cleaning, repairing, refurbishing, or processing items the user knows or reasonably should know uses PFAS chemicals. West Virginia’s HB 3189 requires its Department of Environmental Protection to identify and address sources of PFAS in raw sources of public drinking water systems. It also requires facilities to report the use of PFAS if they discharge to surface waters under a National Pollutant Discharge Elimination System (NPDES) permit or to a Publicly Owned Treatment Works under an industrial pretreatment program. Mitigation Connecticut enacted SB 100 establishing a PFAS testing account, which provides municipalities with grants or reimbursements for testing and remediating PFAS in drinking water. Maine enacted LD 289, which requires the state to purchase the real estate of a commercial farm found to be contaminated by PFAS before January 1, 2023 at the assessed fair market value but at no less than $20,000 per acre, and provides that the fair market value assessment cannot take PFAS contamination into consideration. Two enacted bills in Rhode Island (SB 724 and HB 5861) amend current law to add that if PFAS in drinking water exceed the state’s interim standard of 20 ppt, the state and the public water supply will enter into an agreement that requires dates for submittal of water treatment plans that will reduce the PFAS levels to or below the interim level. As more information emerges about the health effects of PFAS, states will be sure to continue their work to combat, mitigate, and report on their presence in the environment. ASTHO will continue to monitor and report on all legislative and regulatory activity around this issue. Special Thanks-Blog - State and Federal Actions to Reduce PFAS Impact on Public Health website yes

In the current legislative cycle, there are several policy strategies that support the development and integration of community health workers into the public health workforce, including dedicated federal funding and state laws supporting workforce development programs, certification standards, and Medicaid coverage.

A mid-session legislative update on five of ASTHO's top 10 public health state policy issues to watch in 2023: data privacy and modernization, reproductive health, health equity, strengthening public health agencies, and immunization.

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

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