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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

PrEP is a powerful tool to reduce new HIV infections; expanding access to PrEP is a priority within the federal Ending the HIV Epidemic in the U.S. initiative. One way to increase access to PrEP is by allowing pharmacists to prescribe and dispense it.

People who use electricity-dependent durable medical equipment (DME) at home—such as ventilators and oxygen concentrators—can face life-threatening consequences during a power outage. HHS reports that 2.7 million Medicare beneficiaries rely on electricity-dependent DME to live independently. This ASTHOBrief details the significant challenges that individuals who rely on electricity-dependent DME face during power outages and discuss recent efforts to increase support for this population.

This brief focuses on how telehealth expansion during the COVID-19 pandemic has increased access to care for pregnant and postpartum women, and made maternal and child health care services like doulas and midwives more accessible.

Learn how territorial and freely associated state health agencies can support community health workers and their vital work in this brief.

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

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.

Social determinants of healthcare are the conditions in which people are born, live, work, play, worship, and age. Read how these issues affect population health.

State Strategies for Advancing Viral Hepatitis Elimination astho, association of state and territorial health officials, public health officials, state health officials, territorial health officials, state health department, population health, health care systems, distribution of such outcomes, triple aim, defined group, individuals including the distribution, health system, outcomes within the group, save lives, group of individuals including, health outcomes, health improvement, community health, health and health, institute of medicine Cases of viral hepatitis are on the rise across the United States. There are many barriers on the road to progress. See what's being done about it. Cases of viral hepatitis are on the rise across the United States. Current barriers to progress include recent increases in rates of injection drug use, lack of awareness, limitations on testing and diagnostic capacity, access to treatment, and availability of data. ASTHO strives to support states and territories as they work to solidify comprehensive approaches to viral hepatitis elimination. This report synthesizes key actions and proven strategies for public health leaders to consider as they approach elimination planning within their own jurisdictions. Get the Report (PDF) website

Initial estimates from 2020 suggest that annual drug overdose deaths in the United States reached a record high of 93,000. Fortunately EMS strategies are being put in place to combat this nation-wide issue.

Get insight into the successes and challenges of integrating race/ethnicity data in public health and future directions in this field.

Braiding and layering funding allows state health departments to leverage diverse fundings sources and amplify their impact. Learn more about this strategy and its importance.

ASTHO Legislative Prospectus | Previewing 2025 state legislative actions on data modernization and privacy.

Policy Trends Shaping Behavioral Health in 2026 Policy Trends Shaping Behavioral Health in 2026 Learn about the policy trends shaping behavioral health in 2026, including improving access to naloxone, mobile crisis units, and more. Public health efforts remain focused on reducing mental health-related harms and preventing substance use disorder and overdose. In 2024, an estimated 23.4% of U.S. adults — about 61.5 million people or more than one in five — experienced a mental illness, underscoring the widespread and urgent nature of mental health challenges nationwide. After years of rising fatalities, the United States saw its first notable decline in overdose deaths in 2023, followed by a nearly 24% decrease in 2024, with approximately 87,000 deaths reported over a 12-month period. While this progress is promising, overdose is still a leading cause of death in the United States, underscoring the need for sustained prevention, treatment, and recovery efforts. To continue strengthening behavioral health systems and advancing overdose prevention, state and territorial legislatures are considering measures that promote mobile crisis units, support access to overdose prevention tools and treatment, and address the increased use of unregulated substances. Mobile Crisis Response Over the past decade, federal and state policy has emphasized community-based behavioral health crisis response. Building on early local models, the 2021 American Rescue Plan Act created a new Medicaid option for states to fund mobile crisis intervention services with a time-limited enhanced federal matching rate. States also integrated mobile crisis teams into broader crisis response systems aligned with the 988 Suicide and Crisis Lifeline. As implementation expands, state legislatures are considering measures to strengthen service coordination, sustain funding beyond the enhanced federal match period, and address workforce and capacity needs. During the 2025 legislative session, at least 13 states considered and six enacted measures related to behavioral health mobile crisis services. Rhode Island (HB 6118) will require insurance coverage for mobile response and stabilization services for children and adolescents under 18. In Washington, HB 1813 directs additional planning and coordination among service providers to promote access to crisis stabilization services for Medicaid enrollees. Leg Prospectus-2026 - SBH - SAMHSA CMS Naloxone Availability Naloxone is a life-saving medication that quickly reverses opioid overdoses. Approved for over-the-counter sale by FDA in 2023, its expanded availability has increased opportunities for timely intervention. To support access for people at risk for overdose, many states are advancing policies to make naloxone available in public settings — such as schools, libraries, and community centers — to empower bystanders to respond to and prevent overdose deaths. At least eight states have considered legislation to increase naloxone availability with a focus on youth. Colorado enacted SB 25-164 to advance youth overdose prevention, clarifying access to naloxone in school communal areas, like buses, and giving the state board of health authority to establish what entities can receive naloxone for distribution. Michigan is considering SB 404, which would require schools receiving naloxone from the health department to adopt policies regarding administration and explicitly limit liability of school employees administering naloxone. Montana enacted SB 503, which extends liability protections for those who administer expired opioid antagonists — like naloxone — including in schools. Leg Prospectus-2026 - SBH - MOUD Therapeutic Substances for Mental Health Diagnoses Psilocybin and ibogaine are naturally occurring psychoactive substances being studied for their potential to treat mental health and/or substance use disorders. As interest in their therapeutic applications grows, several states are considering legislation to expand access for clinical research and regulated therapeutic use. In 2025, more than two dozen states considered and seven states passed measures related to psilocybin. Arizona (SB 1555), Colorado (HB 25-1063), and Nebraska (LB 72) enacted laws that would allow psilocybin prescribing pending FDA approval, though this approval has not occurred. Iowa (HF 383) and Virginia (SB 1135) passed similar provisions but both governors vetoed the bills, citing the need to wait for FDA approval and DEA rescheduling before taking state-level action. At least 10 states considered legislation to study ibogaine or fund clinical trials exploring its potential to treat PTSD, depression, opioid use disorder, and related conditions. Washington considered SB 5204, which would support the study of ibogaine-assisted therapy for adults with opioid use disorder. And several states — including Nevada (AB 378), New York (S 4664), and Oregon (HB 3817) — considered legislation focused on supporting research and trials that improve the health of veterans and first responders. Finally, Texas enacted SB 2308 to establish a consortium focused on ibogaine research and trials to support FDA approval of the drug for treatment of various mental health and substance use disorders. Kratom Regulation Public health leaders are examining ways to reduce the potential misuse of unregulated substances, including kratom, a product derived from the leaves of a tropical tree that can act as both a stimulant and sedative, and that carries the risk of addiction and abuse. Kratom is not a scheduled drug under federal law, but the FDA has reiterated that there are no legally marketed drugs containing kratom and that it is not an appropriate dietary supplement or approved food additive. While FDA explores a scheduling action for 7-OH, a concentrated byproduct of kratom, a number of state legislatures are considering measures to regulate kratom products. At least 34 states considered and 11 states passed legislation regarding kratom in 2025, including Louisiana (SB 154) which criminalizes the possession and distribution of kratom. Another six states — Colorado (SB 25-072), Mississippi (HB 1077), Nebraska (LB 230), Rhode Island (SB 792), South Carolina (S 221), and South Dakota (HB 1056) — passed legislation restricting the sale of kratom to people under the age of 21 and establishing product labeling standards. Looking Ahead ASTHO anticipates states and territories to continue considering and adopting laws to prevent substance misuse and overdose and reduce mental health-related harms, including those that: Enhance support and capacity for behavioral health mobile crisis units and improve care coordination and entry across the behavioral health care continuum. Expand coverage for peer support specialists and establish baseline standards for peer support specialists in treatment and social support recovery services. Develop measures to study and decriminalize some psychoactive substances for potential mental health and substance use treatment. Develop innovative policies to link recently incarcerated persons to substance use disorder treatment. Improve access to medications for opioid use disorder by expanding telehealth availability, prohibiting prior authorization requirements, and ensuring comprehensive insurance coverage. Explore state regulatory frameworks for commercially available substances with the potential for misuse, including kratom and hemp-derived cannabinoids like Delta-8. OE22-2203 PHIG article yes

ASTHO Legislative Prospectus | Prevention 2025 state legislative action on infectious disease control and prevention.

Good news and bad news on tobacco use: smoking rates are down but e-cigarette use continuing rapid rise among youth. Read how states are combating the problem.

Cases of sepsis and septic shock can be prevented with strong health policies as shown in New York. Several states have taken action to enact mandatory early detection and treatment protocols.

Following disruptions to daily life caused by the COVID-19 pandemic, emergency departments saw an increase of mental health-related visits. A June 2021 study showed a significant increase of mental health-related visits among 12–17-year-olds compared to the previous year. States and territories that implement a comprehensive public health approach to suicide prevention across all domains of life—an approach known as the socio-ecological model—can reduce contributing risk factors.

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.

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.