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Learn about how five jurisdictions approached self-measured blood pressure monitoring programs to reduce hypertension and uncover systemic barriers to care.

Disease Forecasting and Modeling Data for Public Health Action Disease Forecasting Benefits Public Health Planning Disease forecasting and modeling help prepare public health departments for future infectious disease outbreaks and epidemics. Disease forecasting and modeling data can be powerful tools for state and local health agencies (S/THAs) that respond to outbreaks, develop appropriate policies, and ensure interventions have maximum impact. Actions for which decision-makers can leverage such data include: Surveillance. Forecasts and modeling help public health agencies anticipate the spread of disease or outbreaks. This advance warning allows public health officials to inform public health recommendations, preparation, and response. Communication. Disease forecasts help relate the risk of disease outbreaks to various audiences accurately and quickly, which, in turn, can inform messages on important preventive measures and encourages compliance with recommended interventions. Resource allocation. Modeling data can help decision-makers better allocate resources by predicting where and when disease outbreaks are likely to intensify and create the greatest need. Evaluation. Forecasts and modeling can help make evaluating the effectiveness of public health policies and interventions more efficient by comparing predicted outcomes with observed data and adjusting as needed. Considerations Informed by S/THA Forecasting Jurisdictions with forecasting experience identified key indicators to monitor as part of outbreak forecasting, which fall into three main categories: Epidemic spread indicators (e.g., symptom monitoring, morbidity and mortality data, percent positivity, regional pictures of transmission). Health care system capacity (e.g., essential and/or surge personnel, available beds, ventilator usage, and supply of personal protective equipment. Public health capacity for testing capacity and contact tracing. Further considerations for S/THAs: Know your strengths. Identify the unique skillsets among partners in public health, academia, and the private sector and consider how they foster reciprocal relationships. Recognize capacity/expertise gaps. Consider leveraging partnerships for specific types of analytics expertise while exploring internal capacity building opportunities (e.g., job shadowing and resource-sharing programs on workflows and methodologies). Engage legal and compliance teams. Ensure policy and practice are aligned among partners. Explore data access/sharing pipelines. Connect public, private, academic partners, and their audiences. Start small. Identify discrete forecasting and modeling projects to demonstrate success. Identify decision-makers’ needs. Provide quick access to analyses, metrics, dashboards. Michigan Used Models and Forecasting for Hep C Cases In response to Hepatitis C virus (HCV) in young adults from 2010-2018, the Michigan Department of Health and Human Services (MDHHS) simulated how HCV treatment could significantly reduce HCV prevalence among young people who inject drugs, especially for those both previously or currently injecting drugs. MDHHS used several novel predictors to paint a local picture of probable HCV diagnoses among residents up to age 40. These predictors included measures related to a variety of population characteristics (e.g., access to transportation, college education, presence of non-family households) and public health indicators (e.g., heroin treatment admissions, newborns with neonatal abstinence syndrome, and sexually-transmitted infections). MDHHS also leveraged county-level assessments of HCV vulnerability to identify locations for new syringe services programs in the state. MDHHS has recognized several modeling and analytics use cases that benefitted their work during responses to HCV and COVID-19: Short-term forecasts (i.e., weeks) helped predict likely transmission patterns and potential ranges of projections. Longer-term forecasts (i.e., months) explored scenarios based on new recommendations and policy changes. Retrospective counterfactuals evaluated the impact of policies or other changes by examining “what-if” situations. MDHHS is considering using forecasts and models for COVID-19, influenza epidemics, tuberculosis vulnerability, and C. auris spread. Resource constraints require decision-makers and public health practitioners to consider how they are using available resources for the highest return on investment. Models generated momentum to respond to threats and evaluate whether interventions were successful. CDC-RFA-OT18-1802 2018-2024 article yes

Engaging Communities Is a Critical Tobacco Control Strategy Community Engagement Tobacco Control, Menthol Cigarette Disparities, Tobacco Control Learning Collaborative, Culturally Tailored Tobacco Interventions, Flavored Tobacco Product Legislation, United States, Flavored Tobacco Product, Health Equity, Youth and Young Adults, Tobacco Free, Cigarettes Smoked, Community Partners, Young People, Community Health, Youth Tobacco Survey, Flavored E-Cigarettes, Smoking Cessation, Tobacco Industry, Smoking Behavior, Study Showed, African American, Smoking Rates, Tobacco Marketing, Minority Populations, Hispanic Black, ASTHO, Association of State and Territorial Health Officials Charla Sutton, Matta Sannoh, Josh Berry, Kenny Ray, Ashley Hebert, Iman Byfield For decades, the tobacco industry has disproportionately targeted communities of color increasing rates of menthol cigarette use and tobacco-related health disparities. By prioritizing community efforts, health agencies can confront these disparities by fostering trust, inclusivity, and cultural responsiveness. Funded by CDC’s Office of Smoking and Health (OSH) and in partnership with The Center for Black Health & Equity (The Center), ASTHO initiated the Increasing State Menthol Capacity Learning Collaborative consisting of eight state tobacco use prevention teams each paired with a local community-based organization. The program fosters strong linkages between state commercial tobacco control programs and community-based partners to reduce menthol and flavored product use. The Role of Community Engagement Community-based initiatives are pivotal in tobacco control efforts, as they enable stakeholders to: Understand history, context, culture, and geography. Underserved communities possess a keen awareness of the origins of their problems and how decision-making processes affect them. Embrace community voices. “No one asked us” is the most common feeling communities most impacted by a problem share when decision-makers act without including them. Build organizational capacity that sustains change, creates credibility with decision-makers, and empowers communities to meet challenges head-on and garner support for their initiatives. Barriers to effective community engagement include insufficient training, funding, communication, and planning, plus disorganization, under-acknowledged communities, over-committed leaders, and inability to change course. Learning Collaborative at a Glance Eight state health teams (IN, MN, NY, PA, RI, MI, WA, WI)—each paired with a community-facing organization—kicked off the Increasing State Menthol Capacity Learning Collaborative in January 2023 with a shared vision and plan to reduce menthol and flavored product use. The Collaborative worked to: (1) improve capacity to identify and implement strategies to prevent menthol and other flavored tobacco product use, (2) strengthen collaboration between state commercial tobacco control programs and community-based partners, (3) tailor interventions to those most affected, and (4) understand the role of policy interventions and/or systems change and culturally-appropriate cessation strategies. ASTHO, OSH, and The Center provided peer-to-peer learning, technical assistance, and networking opportunities to help project teams draw from the group’s various resources, expertise, and experiences. For example, each state team participated in five virtual, expert-led learning sessions, which provided training on SMARTIE goals, equity-centered community engagement strategies, and effective communication messages for policies that restrict or eliminate the sale of flavored tobacco products. In addition, technical assistance provided the project teams guidance on their established workplan objectives and helped them navigate community-specific challenges. Menthol Capacity Building Strategies Each team worked to address health inequities of their chosen target population with culturally-tailored actions in one of three strategies: (1) Policy, Systems, and Environmental Change, (2) Menthol Cessation, or (3) Counter Marketing/Public Education. Teams focused on African Americans (nearly two-thirds of whom start by using tobacco with menthol), youth, Latinx, immigrant populations, and the LGBTQ+ community. Each team curated state-specific infographics, factsheets, webpages, and media campaigns to examine the role of policy in reducing menthol and flavored tobacco product use. Others engaged legislators or held educational events. Key Takeaways and Next Steps Community Engagement and the Menthol Landscape: Despite challenges, preemption should not stop community engagement work. While state or federal laws and regulations may change, the communities most impacted—and their voices, experiences, and advocacy efforts—remain and are essential in driving meaningful change. Ongoing awareness of the disproportionate impact of menthol and other flavored tobacco products on marginalized communities underscore a continuous need for community engagement and policies that prioritize health equity. Partnering for Influence and Advocacy: Community engagement fosters awareness of the unique challenges that marginalized populations face, ensuring that initiatives are tailored accordingly. In the face of preemption and other regulatory challenges, community voices are critical for national change. Mobilizing Support through Collaboration: Partnerships between state agencies and local organizations allow capacity building and resource sharing. Such partnerships help mobilize broader support with both constituents and legislators, share best practices/lessons learned, and collectively address challenges. Funding Local Initiatives: Effective community engagement often requires financial resources. Examples include facilitating quality meetings as needed, developing educational tools for community dissemination, using paid and social media, and obtaining individuals to implement key activities (e.g., employees or subject matter experts). The collaborative’s participants further encourage: Sustaining and strengthening partnerships with community-based organizations, state health agencies, and national partners to leverage stakeholder expertise and insights. Investing in ongoing capacity building efforts to equip communities with the knowledge, skills, and resources to address tobacco-related challenges effectively (e.g., training, resource sharing, offering technical assistance, and funding community-led initiatives). Engaging with policymakers, community leaders, and others to raise awareness about the negative impact of menthol and other tobacco products. Advocate for evidence-based policies (e.g., e-cigarette flavor restriction) at the local and state level to inform national discussion. Sharing lessons learned—both successes and challenges—with others. website yes

This brief examines the ways states can support certification for community health workers.

In addition to PFAS exposure assessments, state and territorial health agencies may also consider the role of social stressors during the risk assessment process.

Breastfeeding is a shared priority across the nation, and should accommodate mothers who are incarcerated.

This infographic highlights 10 high-level strategies to advance work in school behavioral health.

Establishing an Office of Health Equity or Minority Health Learn how to establish, structure, and fund a health equity or minority health office. A dedicated office of health equity or minority health can provide a focus on cross-cutting efforts and strategies that help to improve services, outreach, and engagement with marginalized communities. This report delves into the typical scope for setting up a health equity or minority health office, including how to establish, structure, and fund it—providing a blueprint to island areas working to build one or considering establishing one in the future. In addition, it explores lessons learned from state offices of health equity or minority health, including California, Michigan, Nebraska, Nevada, New Jersey, New York, Ohio, Vermont, and Washington. Get the Report (PDF) website yes

Opportunities for Public Health Agencies to Advance Sustainable Financing of Community Health Worker Programs Advancing Sustainable Financing of Community Health Workers Explore how health officials can play key roles as funders, administrators, and policy designers to advance sustainable financing of community health workers. Many states face upcoming funding gaps for community health worker (CHW) positions, with COVID-19 related grant funding streams expiring. Concurrently, many states are rapidly beginning to cover CHW services under Medicaid. In addition, Medicare launched a new reimbursement opportunity for CHWs in January 2024. These factors create an opportunity for state and territorial health agencies to develop or contribute to equitable reimbursement and robust implementation. This report details how health officials can play key roles as funders, administrators, and policy design champions to ultimately advance sustainable financing of CHW services. Get the Report (PDF) website yes

Supporting Resilience in Rural Areas Through Cross-Sector Partnerships ASTHO, Association of State and Territorial Health Officials, rural health, public health, public health partnerships, health in all policies, government agencies, community organizations, academic institutions, rural populations, infrastructure improvement, healthcare systems, environmental determinants, climate change, sustainable practices, environmental challenges, extreme weather, environmental health risks, protective factors, engaging rural partners, building trust, idaho department of health and welfare, michigan department of health, health equity, austin climate equity plan, healthy start oregon, kansas department of commerce, wisconsin broadband access, chesapeake housing mission Ali Aslam The key to making rural communities more resilient is for public health to partner with community organizations, governmental agencies, and other critical partners. Working across sectors of government agencies, community organizations, businesses, and academic institutions is critical to address public health challenges in rural communities. Using a Health in All Policies (HiAP) approach helps public health agencies better address the interconnected social, economic, and environmental determinants of health impacting rural communities and improve community well-being. HiAP brings together a multitude of perspectives to develop holistic strategies that can support infrastructure improvements, sustainable land use practices, diversified economic opportunities, safer and healthier home environments, and robust health care systems in rural communities. Through community leadership and collaboration, this cross-sector approach can enhance the capacity of rural communities to build resilience, adapt to climate change, and foster long-term sustainability to improve public health outcomes. Learn how states are implementing HiAP strategies to improve health in their rural communities in this report. Get the Report (PDF) website yes

This report examines how four states (Colorado, Michigan, North Dakota, and Rhode Island) made use of their Preventive Health and Health Services Block Grant funding.

This toolkit is designed to support public health leaders in leveraging the policy development process to achieve health equity in their jurisdiction.

State and local jurisdictions are developing Ending the HOV Epidemic plans. The EHE initiative has largely focused on four key strategies: Diagnose, Treat, Prevent, and Respond to potential outbreaks. The EHE initiative set a goal to increase the estimated percentage of individuals with indications for PrEP who have been prescribed PrEP to 50 percent by 2025, as the national average as of 2018 is 18.2 percent. Several states have proposed and/or passed legislation to ensure insurance coverage of PrEP and/or to allow pharmacists to prescribe and dispense it. In addition to efforts addressing cost-related challenges, states can also employ innovative approaches—such as telehealth—to expand access to PrEP services to those in need.

As COVID-19 emerged and spread in the U.S., people working and residing in long-term care facilities have experienced a significant burden of COVID-19 cases and deaths. As of Oct. 8, deaths associated with these facilities account for 40% of total COVID-19 deaths in the U.S. Health officials have taken measures to improve their funding and capacity.

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.

The COVID-19 pandemic has exasperated challenges around access to nutritious and affordable foods. In response, the federal government has taken action to increase funding and access to programs to strengthen food security.

States Pursue Policy Options to Support Access to Over-the-Counter Contraception State Policy to Support Over-the-Counter Contraception Access Christina Severin Learn about state policy options that can help to support over-the-counter contraception access including levers within Medicaid programs. Effective contraceptive care improves maternal health outcomes by helping individuals plan if and when they become pregnant. Additionally, some contraceptive methods may reduce the risk of certain cancers and protect against sexually transmitted infections. While the most effective methods generally require a visit to a health care provider, over-the-counter (OTC) options may address certain barriers to accessing contraception (e.g., taking time off work for a medical appointment and lack of health insurance or access to health care providers/settings). The New Age of Nonprescription Oral Contraceptives A significant change in the marketplace of OTC options occurred in 2023 when FDA approved the first daily non-prescription oral contraceptive. This progestin-only pill —known as Opill — is considered both safe and highly effective at preventing pregnancy when taken correctly. Opill reached stores in early 2024 and has a suggested retail price of about $20 per month or $50 for a three-month supply. While OTC oral contraceptives like Opill may improve access among individuals not currently using contraception or those using a less effective method, high out-of-pocket costs can be a barrier. One way to limit out-of-pocket costs is to require private health insurance coverage of contraception without cost-sharing. ACA requires most private health insurance plans to do this, but it does not extend to all health insurances or contraceptives. For OTC contraceptives, the landscape is even more complex: While plans are encouraged to cover OTC emergency contraception at no cost and without a prescription, it is not required. HHS and the Departments of Labor and Treasury issued a proposed rule in 2023 that would have required broader coverage of OTC contraception without a prescription or cost-sharing, but the rule was later withdrawn. Without a federal mandate, states can pursue coverage requirements through the health insurance products they regulate. Jurisdictions can also support OTC contraception access in their Medicaid programs. While Medicaid requires coverage of family planning supplies without cost-sharing, jurisdictions have some flexibility in how they design this benefit, and the scope of coverage depends on jurisdiction and state plan-specific factors. Jurisdictions also have flexibility in determining how they provide prescription drug coverage for contraceptive medications and what OTC products are covered. State Legislative Action Legislation is one way for states to promote access to OTC contraceptives, including hormonal contraceptives, through state-regulated plans and provider scope of practice considerations. Since 2024, several states have enacted laws requiring coverage of OTC hormonal contraception, including Delaware (SB 232), which directs insurance carriers to cover FDA-approved OTC contraception with or without a prescription, and Maine (LD 163), which requires coverage of nonprescription oral hormonal contraception. At least two states have clarified the role of pharmacists in supporting access to OTC contraceptives. Massachusetts (HB 4800) allows pharmacist dispensing of OTC oral contraception per a standing order and provides liability protections, while California (AB 50) allows pharmacists to furnish self-administered OTC hormonal contraception without complying with the state’s protocols for prescription-only oral contraceptives. States have also enacted laws to explore or support broader access to OTC contraception, including at least three bills enacted in Maryland since 2024: HB 367/SB 527 requires community colleges to develop an OTC contraception access plan and allows the health department to serve as a resource, including for consultation on vending machine access. HB 1171/SB 944 allows local health department registered nurses to dispense OTC contraception. SB 674/HB 939 creates a collaborative tasked with studying and making recommendations on OTC contraceptive access, with a final report due to the governor and legislature by Jan. 1, 2027. Other Policy Levers Legislation isn’t the only policy lever available to jurisdictions looking to support OTC contraception access. A number of states have taken executive actions to improve access, including (but not exclusively) through Medicaid. While jurisdictions already have the flexibility to support OTC contraceptive access in their Medicaid programs, Medicaid rules require a prescription even for OTC products, which may present a barrier for some individuals. One potential solution is to use standing orders, which allow individuals direct access to OTC products at a pharmacy, without having to visit a separate provider for a prescription first. To ease access to OTC hormonal contraception specifically, several states have recently utilized standing orders that facilitate Medicaid coverage, including Wisconsin, Massachusetts, and New Mexico. Additionally, in 2024, North Carolina announced that it was removing barriers to OTC oral contraception, and would cover condoms and spermicide as OTC products. Outside of Medicaid, several other states have taken action to support access to OTC hormonal contraception: In 2024, the Governor of Arizona issued an executive order directing the Department of Administration to designate Opill and OTC hormonal contraception as a no-cost essential health benefit for state employees, among other actions to expand coverage and access. Also in 2024, Pennsylvania issued guidance to health insurers encouraging coverage of OTC hormonal contraception and highlighting two insurers intending to comply with the guidance. Finally, Michigan’s health agency, in partnership with the Governor’s office, implemented a Take Control of Your Birth Control campaign. This initiative distributed OTC contraception at hundreds of community sites across the state, with a stated goal of connecting individuals to insurance coverage, including Medicaid. While the campaign recently ended, the state distributed more than 400,000 OTC contraceptive resources (e.g., condoms, emergency contraception, and oral contraceptives) and saw an increased number of Medicaid applications. Jurisdictions can play a significant role in connecting public health and health care industry leadership, providers, and other experts — promoting awareness, increasing utilization, and encouraging connection to existing resources. Related Content - Blog - State Policy to Support OTC Contraception Access article yes

State and federal actions to expand the doula workforce and improve maternal health.

Learn how states have increased and/or allocated funding to continue supporting core public health services.

In Michigan, CDC's Comprehensive Suicide Prevention (CSP) program, Preventing Suicide in Michigan Men (PRiSMM), focuses on a population that is disproportionately affected by suicide, men over the age of 25.