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Learn how states approach Community Health Worker certification, training, and standards, with policy insights that support workforce development and public health.

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.

Learn about state and federal efforts to bolster the behavioral health workforce in response to the growing demand for behavioral health services.

States Are Innovating to Improve Indoor Air Quality Abe Kulungara Indoor air quality can significantly impact health and well-being—learn how states are using policy to address this issue. Whether at home, in the workplace, or in schools, the air we breathe inside is affected by improper ventilation, exposure to toxic chemical cleaning agents, buildup of moisture, and the presence of pests—all of which contribute to poor indoor air quality (IAQ). In addition, increases in extreme weather conditions (e.g., heat, hurricanes, flooding) can deteriorate buildings, reducing the physical barriers between outdoor and indoor spaces. And inadequate weatherization of schools and buildings can lead to indoor fungi and mold growth. Indoor air pollutants can have both short-term and long-term impacts on public health and well-being. Some examples of health outcomes (and their associated hazards) include: acute injury (carbon monoxide and other asphyxiants from combustion and safety hazards from improper design), cancer (asbestos and radon), infectious disease (COVID-19), as well as allergic disorders and asthma (mold and other products of damp indoor environments. Furthermore, poor IAQ in school can potentially affect comfort, concentration, and student performance. While the United States has made significant progress in improving outdoor environmental quality, improvements in indoor environments have been much slower, despite Americans spending approximately 90% of their lives indoors. In many cases, the responsibility for improving IAQ falls to individual states, resulting in a patchwork of regulations and varied approaches across the country. Indoor Air Quality at the Federal Level The federal government’s authority over indoor air quality is limited to federal buildings but there is no current comprehensive national regulation specifically focused on indoor air quality. Notwithstanding, federal laws and regulations addressing outdoor air quality can indirectly impact indoor air quality. For example, the Clean Air Act gives EPA the authority to establish and enforce National Ambient Air Quality Standards (NAAQS) for pollutants in outdoor air, such as ground-level ozone, particulate matter, and carbon monoxide. Improvements to ambient air quality will have an impact on indoor air quality as well. Even though the federal government’s role in IAQ is less direct, agencies including EPA have issued voluntary guidelines and best practices. This gap in federal regulations offers state and local governments the opportunity to set standards for their jurisdictions. The Model Clean Indoor Air Quality Act The Model Clean Indoor Air Quality Act (MCIAA) provides a framework for states to adopt and implement measures that are most relevant to their local needs and circumstances, much like the Model Food Code is used by states for food safety regulations. The Act consists of six main articles, each containing key sections designed to support a comprehensive mission of safeguarding and enhancing IAQ in public buildings through collaboration among public and private entities. The Act also presents extensive statutory language on IAQ and offers states the flexibility to choose the components that best suit their specific needs, priorities, and local conditions. By adopting the Model Act or portions of it, states can establish standards for ventilation, moisture control, hazardous materials use, and public education efforts. State Actions on Indoor Air Quality A growing number of states are proactively improving indoor air quality. Massachusetts recently introduced SD 2588, which incorporates language from MCIAA, while others are addressing IAQ issues more broadly, enacting legislation that prohibits smoking in indoor public spaces or responding to specific local challenges (e.g., mold, radon, volatile organic compounds ). At least five states are considering various bills relating to air quality in public schools. Massachusetts (SD 173 and SD 630) and New Jersey (S 1033) are establishing task forces or commissions to study indoor air quality. Connecticut (HB 5873), New York (A 2649) Virginia (HB 2618 and SB 1413) are establishing or amending indoor air quality standards for public schools. Massachusetts (HD 2890) is also prohibiting cleaning agents that could have an adverse effect on health. As states consider streamlining indoor air quality standards using the MCIAA, there are a large number of current statutes that improve IAQ. For example, Florida requires their Department of Health to have an IAQ testing and monitoring program to assess health risks from exposure to chemical, physical, and biological agents in the indoor environment. In Hawaii, the Department of Health is authorized to correct indoor air pollution problems in all buildings. The agency must establish and coordinate an IAQ assessment network involving state agencies and managers of publicly owned buildings to identify, evaluate, and resolve indoor air pollution problems. The statute also grants the agency the authority to implement a program for approving plans to construct, inspect, and monitor ventilation systems, as well as to provide IAQ information to managers, owners, and occupants of both public and private buildings. Other states, such as Washington and Oregon, have implemented programs that focus on IAQ in schools, acknowledging children’s unique vulnerabilities to poor air quality. ASTHO will continue to monitor and provide updates. article yes

ASTHO staff identified a range of evidence-supported policies considered by state legislatures that could prevent ACEs. This report synthesizes these research and policy proposals and is intended for public health practitioners and policymakers who are considering adopting similar policies.

This report contains lessons learned and examples of messaging strategies that were successful during cyanobacterial bloom responses, they were collected from 17 state health agency staff members across 12 states.

A pressing public health issue before the COVID-19 pandemic hit, the need for public health interventions to reduce tobacco use is heightened with a strong association between tobacco use, in all forms, with severe COVID-19 outcomes. Additionally, tobacco use remains the leading cause of preventable death in the U.S., claiming approximately 480,000 deaths each year. Evidence-based policies to reduce tobacco use like raising the age of sale to 21, increasing tobacco pricing, and prohibiting the sale of flavored tobacco products are common public health strategies enacted through state legislation. As anticipated in ASTHO’s 2021 Legislative Prospectus on E-Cigarettes, states are considering many of these evidenced-based tobacco reduction strategies during the 2021 legislative sessions.