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

States Amending Policies to Slow Congenital Syphilis Increases States Trying Policies that Increase Syphilis Testing Amelia Poulin State are exploring ways to slow the rapid increase of congenital syphilis cases by strengthening policies to require testing at key points during pregnancy. Syphilis among newborns, or congenital syphilis, is preventable. Yet the latest CDC data show that congenital syphilis cases have more than doubled (106%) from 2019-2023. In 2023 alone, there were nearly 4,000 cases of congenital syphilis resulting in 279 stillbirths and infant deaths. Timely testing and adequate treatment during pregnancy might have prevented up to 80% of these cases. Increases in congenital syphilis often mirror increases in syphilis among reproductive-aged women. From 2022 to 2023, the rate of syphilis (all stages) increased 6.8% among women aged 15–44 years; rates also increased in 39 states and Washington, D.C. CDC recommends testing pregnant women for syphilis at the first prenatal visit, as well as at 28 weeks gestation and delivery if they are at increased risk of infection. Syphilis testing recommendations extend to asymptomatic women who are at increased risk for infection as they may face additional barriers to health care. ASTHO’s policy-level interventions for states and territories suggest universal syphilis testing for pregnant women. Additionally, states have been taking action to increase access to syphilis testing for people, including those who are pregnant. The Syndemic Perspective A history of incarceration, sex work, drug use, and geography can all significantly increase risk for sexually transmitted infections (STIs), HIV, tuberculosis (TB), and more. Structural barriers, including housing instability, economic insecurity, stigma, and restricted health care access, create conditions that heighten vulnerability to multiple infections. These conditions do not occur in isolation but rather as part of a syndemic, where overlapping epidemics interact with and exacerbate one another. Health agencies may be positioned to address upstream and root cause issues recognizing and addressing the intersections of these disease areas and related structural and social issues (e.g., drug use and poverty). Health agencies carry a wealth of interdisciplinary expertise, with staff leading efforts around data collection and surveillance, policy, community mitigation, and more, all of which support capacity to identify root causes and design an evidence-based, multifaceted response. Policies that prioritize housing stability, harm reduction services, and access to comprehensive health care, including STI screening, can help mitigate these risks and improve health outcomes. Geography can also increase the chances of syphilis transmission. Some regions with limited health care infrastructure, provider shortages, and limited STI prevention program funding and capacity may have higher rates of infection. Rural areas and certain urban settings may lack accessible clinics or specialized services, creating significant barriers to timely testing and treatment. Rural areas and certain urban settings may lack accessible clinics or specialized services, creating significant barriers to timely testing and treatment. Social and economic differences across different geographic locations contribute to varying levels of disease burden. By adopting a syndemic framework, states can move beyond disease-specific interventions and implement comprehensive strategies that address upstream factors contributing to disease transmission. State Actions Several states have introduced or passed legislation to expand syphilis testing access, with a focus on increasing screening opportunities, mandating insurance coverage, and ensuring appropriate prenatal testing protocols. Syphilis Testing In 2024, Colorado enacted HB 24-1456, which gave the state’s Board of Health rulemaking authority over syphilis testing. This flexibility allows the state to adapt its public health response based on emerging epidemiological trends as new data on syphilis transmission and congenital infections become available. The 2025 legislative sessions have highlighted additional approaches to expanding access to syphilis testing. The New York legislature introduced S 2704, which would require health insurance coverage for certain approved STI home test kits. This policy would provide individuals who face barriers to in-person care a convenient and private way to get tested and stay healthy. Oregon is also addressing testing accessibility through HB 2943, which would require hospitals to test people for HIV and syphilis when they have blood tests done in the emergency department (ED). Since EDs often serve populations who do not routinely access preventive health care (e.g., people experiencing homelessness or struggling with substance use disorders), this legislation would strengthen the role of emergency settings in STI prevention and intervention. Perinatal Syphilis Testing Recognizing the importance of perinatal screening, several states have introduced legislation to add requirements for syphilis testing at key points in pregnancy. Tennessee recently enacted SB 1283, which requires that health care providers take a blood sample to screen for syphilis, hepatitis B, and hepatitis C at the first prenatal examination, ten days after the examination, and at delivery. This approach aligns with CDC recommendations and ensures infections are identified and treated in time to prevent congenital transmission. Similarly, Nebraska LB 41 would require testing for syphilis at the first examination, in the third trimester, and at birth (with the mother’s consent), reinforcing a multi-point screening strategy to detect and treat infections that may develop later in pregnancy. Missouri’s SB 178 would take a comprehensive approach to syphilis prevention during pregnancy by requiring an additional test at 28 weeks, a critical point for intervention. The legislation would also require treatment for mothers who test positive for an STI, reducing the risk of congenital infections. Additionally, it would expand Expedited Partner Therapy by allowing any health care professional authorized to prescribe medications to administer Expedited Partner Therapy as well as include other STIs in the treatment, enabling faster treatment for sexual partners who might otherwise go untreated and continue the cycle of transmission. Policy Considerations Expanding both syphilis and perinatal syphilis testing policies demonstrate a growing recognition of the need for proactive, evidence-based strategies to address the increasing rates of syphilis and congenital syphilis. However, the ability of policies to affect public health outcomes may depend on continued resource allocation, workforce training, and public awareness campaigns. State and territorial health agencies can consider additional measures, such as integrating syphilis screening into routine primary care visits and providing funding for community-based outreach. Conclusion These legislative actions represent various approaches states are taking to addressing syphilis. Implementing screening protocols aligned with current evidence may contribute to efforts to address syphilis and congenital syphilis. By leveraging legislative action and evidence-based interventions, states can improve health outcomes and reduce disparities in syphilis and other STIs. A comprehensive approach that includes additional testing, expanded health care access, and targeted interventions for populations at higher risk for infection or severe disease may ensure better health outcomes for parents and infants alike. ASTHO will continue to monitor and report on this important public health issue. article yes

This report identifies and breaks down seven core value areas that emerge from taking a health in all policies approach to policymaking and programming.

Support for programs and policies that encourage positive mental health in early childhood and provides support for parents and caregivers to have the best chance to improve mental health across the life course.

Every August, national, state, and local breastfeeding stakeholders celebrate National Breastfeeding Month by engaging each other and the public in conversations about changes needed to build a landscape of breastfeeding support. The 2021 theme for National Breastfeeding Month is “Every Step of the Way,” which envisions a world in which all families are supported at every step along the infant feeding journey. Given evidence showing the crucial role of family members in influencing breastfeeding decisions, efforts to support breastfeeding must engage family members in addition to birthing people.

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.

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

Public health agencies are working to reduce dementia risk and to optimize the health and well-being of people living with dementia and their caregivers.

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.

On the 32nd anniversary of the ADA, this blog post explores state legislation around the country that supports people living with disabilities.

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.

Recap the state legislative sessions in 2025 thus far, spanning maternal health, infectious disease, and other important public health issues.

2026 State Legislative Session Update 2026 State Legislative Session Update Learn about state legislation from FY26 focused on hot public health topics in this Health Policy Update. ASTHO’s 2026 Legislative Prospectus Series announced the top five public health state policy issues to watch this year. With at least 30 states scheduled to conclude their legislative sessions by the end of May, state legislatures focused on many of these public health topics. Expanding Access to Care As expected, a number of states considered legislation to expand access to care, including policies that promote community-based services and rural health care access. Doula birthing support services continue to be a topic for state legislatures with at least a dozen states considering legislation to expand coverage or access. Oregon enacted SB 1568, expanding coverage for birth and postpartum doulas and lactation counselors. Virginia enacted two bills that support access to doulas: HB 328 requires the Bureau of Insurance to select a new essential health benefits benchmark plan that includes doula care coverage starting in 2029, while HB 838 expands Medicaid coverage to include incentive payments for doulas to provide linkage to care visits in the postpartum period. For other licensed health care professionals, interstate compacts allow health care professionals licensed in one member state to practice in another without additional credentials. This year, legislatures have considered more than 100 health care professional compact bills so far, with at least six states enacting legislation: Arizona (HB 2190), North Dakota (HB 1622), and South Dakota (HB 1146) adopted the Physician Assistant Licensure Compact. New Mexico adopted the Interstate Medical Licensure Compact (SB 1) and the Social Work Licensure Compact (HB 50). Mississippi (SB 2543) adopted the Dentist and Dental Hygienist Compact. Washington (HB 2088) adopted the Dietitian Licensure Compact. Finally, at least two states enacted legislation to expand telehealth. Virginia HB 1284 specifies that its Medicaid provider-to-provider consultation provision includes services provided via telehealth, and Kentucky HB 424 eases the requirements for social worker telehealth practice. Behavioral Health Legislatures are also continuing to explore policies that address mental health and substance misuse. This includes legislation that supports people across the care continuum, explores the use of psychoactive substances in mental health treatment, and regulates emerging substances. At least seven states have enacted legislation to establish or enhance the continuity of care for people in a behavioral health crisis. This includes Maine LD 1216, which requires the Department of Health and Human Services to establish crisis intervention support services in all counties. Virginia enacted HB 453, which specifically allows amendments to the state’s Marcus Alert plan supporting the state’s comprehensive crisis system and requires state agencies and local partners to align their policies accordingly. States also continue to promote the availability of opioid reversal drugs through legislative action. Virginia SB 257/HB795 requires certain health insurance plans to include at least one opioid antagonist with limited cost-sharing on their drug formularies. Kansas HB 2534 requires schools to stock naloxone and establish polices to support its administration, and Utah SB 87 clarified its immunity provisions for administering opioid antagonists and will allow expired — but still effective — opioid antagonists to be dispensed and administered in certain situations. Another trend this legislative session is the legalization and regulation of use, medical study, and reclassification of certain psychedelic drugs for therapeutic purposes. Several states considered legislation to allow psilocybin for therapeutic purposes, including Oregon HB 4040, which already allows psilocybin service centers and expanded its licensing criteria for psilocybin service facilitators. At least 23 states considered, and five states (Mississippi SB 2056, South Dakota HB 1099, Utah SB 83, Virginia SB 379, and West Virginia SB 906) enacted legislation that would automatically reschedule psilocybin or certain formulations, pending federal approval and/or rescheduling. Finally, at least 10 states considered bills to support access or research into ibogaine, which is being studied in relation to PTSD and substance use disorder. States include Washington (SB 5204), Oregon (HB 4110), Tennessee (SB 2149/HB 2075), Louisiana (SB 43), Oklahoma (HB 3834), and Georgia (HB 1296), with Mississippi enacting HB 314 to allow the state health department to participate in a consortium supporting clinical trials for ibogaine drug development. A number of states are also taking action to address kratom, a plant-based substance with the potential for serious side effects, including substance use disorder and withdrawal symptoms. As of January 2026, 31 jurisdictions regulate kratom, with at least five states enacting legislation this year. New York (A 9472/S 8814), Virginia (HB 360), and West Virginia (SB 985) established or enhanced prohibitions on selling kratom to people under 21, while Nebraska (LB 901) enacted an excise tax on kratom products. Utah enacted two bills (HB 385 and SB 45) that regulate processors and retailers and New York mandated warning labels on certain kratom products (A 9443/S 8780). Healthy Food and Chronic Disease States continue to prioritize chronic disease by advancing policies recognizing the importance of prevention and how food impacts health. In 2026, a number of states considered legislation to address food insecurity, improve school nutrition, and promote chronic disease screening and prevention. At least 10 states considered legislation to limit ultra-processed foods or promote access to healthy foods, with Nebraska LB 940 prohibiting public schools from offering foods that contain certain color additives and Tennessee SB 2423/HB 1853 taking a similar approach but for any artificial food dye. States are also exploring ways to accommodate student dietary preferences. Minnesota (SF 2970), New Jersey (S 1676), New York (A 1834), and Washington (S 5878) introduced legislation that would mandate plant-based options in school cafeterias. Illinois enacted HB 1607, creating a health department task force to review state efforts to eliminate food deserts and requiring a report with recommendations by January 2028. Finally, state legislatures are taking action to support access to early detection and chronic disease management through insurance regulation. Mississippi enacted HB 565 to require Medicaid and other health plans to cover biomarker testing for the diagnosis, treatment, management, or monitoring of patients when supported by medical evidence. Additionally, Oregon enacted SB 1527, which limits out of pocket costs for medically necessary cervical cancer screenings and follow-up examinations. Finally, Alabama (SB 19) will prohibit certain insurance plans from imposing cost-sharing for prostate cancer screening of all men over 50 and younger men at high risk. Infectious Disease Prevention With recent changes to the membership and recommendations of the Advisory Committee on Immunization Practices (ACIP), a number of state legislatures have considered changes to vaccine policy in 2026. Several states enacted legislation to modify the role of ACIP, including Colorado (SB 26-032), Connecticut (HB 5044), Maine (LD 2146), Maryland (HB 637), New Mexico (HB 156), Oregon (SB 1598), Vermont (H 545), and Washington (HB 2242). Many of these bills address other components of vaccine policy, including: Vaccine Schedule Recommendations: Colorado, Connecticut, Maryland, New Mexico, Vermont, and Washington substitute or add state health agencies and/or organizations like the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and American College of Physicians as sources for vaccine recommendations. Insurance Coverage: Connecticut, Maryland, New Mexico, Oregon, Vermont, and Washington require health insurance plans to cover vaccines recommended by health agencies or other organizations, rather than ACIP alone. Pharmacist Scope of Practice: Maryland and Vermont substitute or remove ACIP recommendations as an authority for pharmacists to administer vaccines, and Colorado allows pharmacists to prescribe vaccines independently. Funding: Colorado, Maine, and Vermont expand vaccine purchasing programs to include vaccines recommended by bodies other than ACIP. Liability Protections: Colorado, Maine, and Vermont include liability protections for certain providers administering vaccines according to state or medical organization recommendations. Public Health Funding Legislatures in thirty-one states, the District of Columbia, and three U.S. territories will enact budgets for the 2027 fiscal year, while legislatures in three more states will enact biennial budgets for the 2027 and 2028 fiscal years. With reductions in federal funding, states continue to find ways to leverage state funds to invest in public health and public health infrastructure while adhering to balanced budget requirements. Eleven states have enacted FY 2027 budgets and three states enacted biennial budgets for FY 2027-FY 2028, with several states increasing public health funding, including Kansas (HB 2513), New Mexico (HB 2), and Wyoming (SF 0001). Additionally, three states passed FY 2027 supplemental budgets featuring public health provisions: Maine LD 2212 appropriates funding to support access to affordable prescription drugs in rural and underserved areas, Washington SB 6003 increases funding for the state’s Drinking Water State Revolving Fund, and Nebraska LB 1071 shifts funds to children’s health insurance, community-based aging services, and mental health operations. States have also

ASTHO’s 2024 Legislative Session Update: Part One legislative session, state policy, data collection, domestic violence, health information exchange, data privacy, substance misuse, overdose prevention, sexually transmitted infections, reproductive health, contraceptive care, climate change, public health, protect data, user data, personal data, centers for disease control, disease control and prevention, social media, data management, primary care, health organizations, higher risk, family planning, data sources, astho, association of state and territorial health officials Lillian Colasurdo, Maggie Davis, Lana McKinney, JoAnne McClure This past December, ASTHO announced the top 10 public health state policy issues to watch for during the 2024 state and territorial legislative sessions. With at least 30 states concluding their regularly scheduled 2024 sessions, here is a brief update on five of the topics to watch. Data Collection and Exchange As expected, there was an increase in proposed legislation that specifically advances electronic health data access, encourages interoperability, and safeguards identifiable patient health records; this was particularly true for vital records. Hundreds of bills have been introduced this session addressing state vital records systems. The state of Illinois alone has already passed several bills, including HB 2856, which requires veteran status to be designated on death certificates, and HB 2841, which prohibits the assessment of fees to victims of domestic violence who are seeking a certified vital record (birth or death certificate) from the state. Other states such as Arizona (SB 1252) considered legislation that would require the Department of Health to provide vital records information on deceased individuals to the qualifying health information exchange (HIE). Arizona is one of eight jurisdictions (AZ, FL, IA, IL, NH, NJ, OK, and WV) that have proposed legislation addressing HIEs this session. Most of these bills increase requirements to connect to HIEs, but New Hampshire HB 1663 and Oklahoma HB 3556 would allow patients and health care providers to opt out of HIEs. As many states look to address health data privacy concerns, New Hampshire recently passed a constitutional amendment granting the explicit right to privacy and has introduced HB 1663, which would update many of the state’s privacy laws regarding medical records to conform with the constitutional requirements. Just next door, Maine considered legislation (LD 1902) that would strengthen privacy requirements for reproductive and gender-affirming patient health information. Finally, the launch of the new federal Trusted Exchange Framework and Common Agreement (TEFCA) led to the Florida legislature proposing SB 668, which, had it passed, would have required hospitals to make patient records available through a nationally recognized trusted exchange framework. It would also have required the Agency for Health Care Administration to adopt relevant rules. Substance Misuse and Overdose Prevention Measures to prevent substance misuse and reduce overdoses, namely increasing access to opioid antagonists, such as naloxone and regulating substances with the potential for misuse, are priorities this legislative season. ASTHO anticipated that states would consider legislation to reduce fatal overdoses including decriminalizing drug checking equipment, expanding naloxone access and distribution, establishing overdose prevention centers, and establishing state regulatory frameworks for commercial substances with the potential for misuse, including kratom and Delta-8. Current legislative priorities to expand access to naloxone include public spaces, such as libraries, schools, workplaces. Island jurisdictions along with at least four states—Colorado (HB 24-1003), Tennessee (SB 2141), Virginia (HB 732), and Wisconsin (AB 223)—passed legislation to provide greater access to and/or proper storage of naloxone in school settings. Additionally, Virginia passed HB 342 that requires naloxone access in state agency buildings. These legislative actions, along with the approval last year by the FDA of two non-prescription naloxone spray products for over-the-counter use, are collectively powerful policy shifts to expand access to naloxone. In an attempt to regulate substances with the potential for abuse or misuse, specifically kratom, eight states have considered legislation that would restrict the sale to people under the age of 18. Similarly, twelve states have considered legislation that would restrict the sale of kratom to those under the age of 21. At least 22 states have considered legislation that would compel specific labeling requirements for kratom. Of those, California (AB 2365) and New Jersey (A 1188) would require kratom products to be registered with the state health department annually and require lab testing of the product to meet certain qualifications. Preventing Sexually Transmitted Infections ASTHO has spotlighted the growing concerns of rising rates of sexually transmitted infections and state actions reducing congenital syphilis rates and expanding access to HIV prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Rates of both syphilis and congenital syphilis continue to rise at an alarming rate, with more than 10 times as many babies being born with syphilis in 2022 than in 2012. Routine screening and timely and adequate treatment of pregnant people for syphilis, ideally more than 30 days before delivery, can effectively prevent this condition in newborns. Due to increasing cases, the American College of Obstetricians and Gynecologists recently updated their guidance for obstetrician–gynecologists and other obstetric care professionals advising serological screening for all pregnant individuals at the first prenatal visit and universal screening at the third trimester and at birth. During the 2024 legislative session at least two states—Missouri (SB 1260) and Maryland (HB 119)—are considering legislation that would require testing during pregnancy care at the third trimester for syphilis. Maryland’s legislature passed HB 119, which would require screening at the third trimester and at birth, as well as requiring the hospital to determine the syphilis status of the birthing parent before discharging the newborn. In 2023, New York enacted legislation (A 3007) that requires syphilis screening in the third trimester, and in the current legislative session they are considering S 2472, which would allow the state health department to provide education about congenital syphilis and screenings. At least six states have considered and passed legislation during the 2024 legislative session regarding expanded access for HIV prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Of those considered, Georgia enacted HB 1028 to allow PEP to be issued by a standing order; Florida’s legislature passed HB 159 that would allow pharmacists to screen for HIV exposure, order, and dispense prevention drugs PEP and PrEP and sent it to the governor. Similarly, in Delaware the Senate chamber passed SB 194 that would permit pharmacists to provide PrEP and PEP pursuant to an approved protocol. Family and Reproductive Health Policymakers across all levels of government continued taking steps to make it easier for people to access contraceptives. In 2023, at least 14 states enacted laws in 2023 to facilitate expanding access to contraceptive care by either expanding the ability for pharmacists to dispense birth control without an individualized prescription and/or allowing pharmacists to dispense up to 12 months of contraceptives at once. So far in 2024, at least 13 jurisdictions considered legislation allowing pharmacists to dispense contraceptives without a prescription and at least 18 states considered legislation supporting access to 12 month supply of contraceptives. Following FDA’s July 2023 approval of Opill—the first over-the-counter (OTC) birth control pill—the drug is currently available in stores with several major pharmacies and health plans announcing that they will provide the medication at zero cost for many health plan sponsors. To further support access to Opill, at least two states (New Mexico and Wisconsin) issued standing orders for Opill to facilitate Medicaid coverage of the medication. Additionally, Maryland’s legislature passed SB 527 in March 2024, which requires community colleges to develop and implement a plan to provide students access to OTC contraception. In February 2024, New York enacted S 8096 allowing the commissioner of health to issue a standing order allowing a pharmacist to dispense self-administered hormonal contraceptives, effective retroactively to January 1, 2024. Under the new law, New York’s Commissioner of Health issued a standing order to allow pharmacists to dispense up to 12 months of self-administered hormonal contraceptives like birth control pills, vaginal rings, and contraceptive patches. Optimal Health for All ASTHO anticipates policymakers will take steps to improve collection of health disparities data, address inequities rural communities face in accessing care, and to support climate change adaptation planning efforts. So far in the 2024 legislative session, several states are considering bills to improve health care access and outcomes in rural areas. California is considering legislation (SB 945) that would build an integrated data dashboard to provide the public with information on the health impacts caused by wildfires and the effectiveness of forest health and wildfire mitigation on health outcomes. Additionally, California (AB 2342) is looking to ensure critical access hospitals on remote islands receive adequate funding through a dedicated annual supplement. New York is considering at least two bills that would promote rural health care access. First, New York S 8582 would create a pilot program to identify rural health zones and convene a rural health zone board

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

Utah, Colorado, Tennessee, and Missouri Win ASTHO Vision Awards for Innovative Projects SALT LAKE CITY—Today the Association of State and Territorial Health Officials (ASTHO) presented its 2015 Vision Awards to the Utah Department of Health, Tennessee Department of Health, Colorado Department of Public Health and Environment, and Missouri Department of Health & Senior Services. The ASTHO Vision Awards are presented annually to recognize outstanding state and territorial health department programs or initiatives that demonstrate creative and innovative approaches to address public health needs or challenges. The Vision Awards promote awareness and provide peer recognition to successful state and territorial health programs. ASTHO presents Vision Awards in two categories: programs with budgets greater than $250,000 and programs with budgets less than $250,000. Applications are judged by experts and leaders in state public health based on innovation, program effectiveness, and potential for replication. This year, Utah’s Electronic Message Staging Area (EMSA) Program won first place in the Vision Award category for programs with budgets greater than $250,000. EMSA is an extensive rules engine that automatically processes incoming reportable disease laboratory data and manages how the data is processed and inserted into Utah’s disease surveillance system. Since its implementation, the volume of lab results that public health receives has increased by 400 percent. Colorado’s Retailing Marijuana Health Monitoring and Prevention Program won second place for programs with budgets greater than $250,000. As the first state to allow sales of retail marijuana, Colorado developed the first systematic literature review on the potential public health impacts of marijuana, guidance for public health surveillance, and an education and prevention campaign to focus on public health impacts, such as preventing or delaying youth initiation, preventing use among pregnant and breastfeeding women, and reducing secondhand marijuana smoke exposure. The first place Vision Award winner for programs with budgets less than $250,000 is Tennessee’s Innovate to Accelerate: Achieving Excellence in Public Health program, a continuous quality improvement (QI) program designed to align all of the Tennessee Department of Health’s work processes with the agency mission. It addressed core public health functions through the lens of the six-process criteria of the Baldrige Framework: training staff in rapid cycle improvement tools, supporting staff to achieve QI utilizing the Baldrige Framework, and building a network for training utilizing experienced examiners. Missouri’s Disease Electronic Surveillance with Trigonometric Models (DESTEM) won second place in the category for programs with budgets less than $250,000. DESTEM is an interactive visual analytical system that allows for accurate and timely detection of the communicable disease outbreaks. The system produces the typical epidemiological graphs and reports, but also allows an epidemiologist to tailor disease surveillance parameters to see data from different angles. Unlike a static report, its interactive approach to surveillance analysis gives epidemiologists the ability to perform more in-depth analysis, enabling them to make better-informed decisions. ASTHO Press Release Boilerplate website 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.