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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

Investing in Indiana’s Public Health Infrastructure Through Community-Driven Policy Change public health infrastructure, community driven policy, indiana state health commissioner, public health system, indiana department of health, outpatient facilities, technical assistance, data and information integration, emergency preparedness, child and adolescent health, legislative action, state and local elected officials, health problems, health care, health system, health departments, federal agencies, essential public health services, centers for disease control, state and local levels, health outcomes, health organization, covid-19 pandemic, health infrastructure, promoting health, public health organizations, states public health, federal funding, astho, association of state and territorial health officials Maggie Davis, Keith Coleman Indiana enacts historic public health funding through community engagement and legislative support. In April 2023, Indiana passed bill SB 4, which was a historic investment in the state's public health funding and restructuring its public health system. This case study shares how the Governor's Public Health Commission and the Indiana Department of Health approached community listening sessions, formulated recommendations, and successfully built legislative support to reform the public health system in the state. Get the Report (PDF) website yes

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.

Looking to the future, states are improving access to care, providing subsidies for tuition costs, expanding hours of licensed facilities, increasing access, and meeting the needs of both parents and children.

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.

Vaccines are one of the greatest public health achievements of the last century, as well as some of the most powerful and cost-effective tools to prevent disease, disparities, disability, and death among children and adults. The COVID-19 pandemic and the unprecedented development and distribution of the vaccines against the novel coronavirus have generated much focus on state laws related to vaccinations. As state and territorial legislatures prepare to convene in the coming weeks, we can already identify several topics within vaccine law that policymakers across the country will consider.

The COVID-19 pandemic has impacted both the physical and mental health well-being of youth. Disruptions in both their home and school life have put youth at risk for poor mental health outcomes that include increased anxiety, depression, and risk of suicide. This Mental Health Month we examine state and territorial legislation that addresses youth mental health.

May is Mental Health Awareness Month and the importance of continued mental health promotion and suicide prevention efforts during the COVID-19 pandemic. As we address the physical effects of COVID-19 through social distancing, mask wearing, and vaccination, we still need to prioritize mental health and well-being during and after the pandemic. A recent Morbidity and Mortality Weekly Report found increases in adults reporting symptoms of anxiety or depression (36.4% to 41.5%) and unmet mental health care need (9.2% to 11.7%) between Aug. 2020 to Feb. 2021.

The ASTHO State Health Policy team provides brief updates on 5 of the ten state health policy issues to watch in 2022: mental and behavioral health, rural health, e-cigarettes and flavored tobacco products, HIV and PFAS.

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.

Many states have introduced bills to strengthen and increase access to these prenatal, delivery, and postpartum services, building a solid foundation of care for women who must navigate the healthcare system and make difficult decisions during public health emergencies.

Polysubstance Use During Pregnancy and the Benefits of Universal Verbal Screening polysubstance use, universal verbal screening, health equity, polysubstance use during pregnancy, public health, substance use disorder, health problems, health care, health outcomes, prescription medications, increase the risk, risk of overdose, pregnant women, treatment programs, health service, illicit drugs, birth defects, increased risk, neonatal abstinence syndrome nas, fetal alcohol spectrum disorder, prescription drugs, multiple substances, risk factors, prescription opioids Shannon Vance Polysubstance Use During Pregnancy and the Benefits of Universal Verbal Screening Polysubstance use, the use of two or more substances, during pregnancy is common and can result in negative outcomes for both mothers and infants. This report explores the occurrence of polysubstance use in pregnancy, details the advantages of universal verbal screening in pregnancy, and emphasizes the importance of health equity in providing this care to patients. Get the Report (PDF) website yes

As the nation grapples with the ongoing COVID-19 pandemic, community health workers are being recognized for the role they play in improving health outcomes of our most vulnerable communities. In fact, the recently enacted American Rescue Plan Act of 2021 allocates funding for the recruitment, hiring, and training community health workers by public health departments.

COVID-19 has generated awareness of the importance of building community resiliency and brought about an influx of federal funding, which offers an opportunity to advance equity in prevention, social determinants of health, and healthcare.

February is Heart Month, a time to not only celebrate our love for others but also the organ that pumps us full of life - yet heart disease continues to be the leading cause of death in the U.S. This post is an overview of state legislation that would increase access to nutritious food, wellness opportunities, and incentives to improve heart health.

Health Officials Combat Nation’s Maternal Mortality Rates ARLINGTON, VA—State and territorial health officials are assessing maternal care programs within their states to address the rise in maternal deaths across the nation. According to a new Centers for Disease Control and Prevention (CDC) Vital Signs report, each year more than 700 women in the United States die during pregnancy, delivery, or up to a year postpartum, with three out of every five of these deaths being preventable. The Association of State and Territorial Health Officials (ASTHO) and its members are committed to protecting the health of mothers through multidisciplinary efforts to address preventable deaths, such as closing gaps in access to quality preconception and prenatal care, care for chronic conditions, missed diagnoses, and maternal education. “Across the country, state and territorial health officials are continually analyzing women’s health data, programs, and outcomes to address and prevent maternal mortality and morbidity,” says Michael Fraser, CEO of ASTHO. “As with all public health issues, officials take this trend very seriously, and we know that tackling this issue involves addressing the unique social, economic, and healthcare challenges that impact women’s health on multiple levels in every state.” The causes of maternal mortality and morbidity vary widely, depending on many local factors and stage of pregnancy or post-pregnancy. For example, weakened heart muscles (cardiomyopathy) are the leading cause of death between one week and one year postpartum. Postpartum care, however, often focuses on the infant—not the mother. Providing and covering high-quality care for mothers the first year following birth would ensure prompt follow-up care and communication about issues like severe bleeding, high blood pressure, and infection. “The majority of deaths from pregnancy-related complications are absolutely preventable,” says Nicole Alexander-Scott, MD, MPH, director of the Rhode Island Department of Health and president of ASTHO. “We also know that significant racial and ethnic disparities exist in the rates of fatalities from pregnancy-related complications. Health systems, healthcare providers, and public health professionals need to continue taking measures to improve access to and coordination and delivery of quality care for all women, regardless of their ZIP code. We also need to engage patients and communities in this work so that everyone knows that their voice matters, and that they are being heard.” Many states are assessing maternal and perinatal levels of care and the standardized capabilities of individual hospitals to ensure pregnant women deliver at facilities equipped for a range of medical outcomes. Some of these efforts include: Indiana passed a perinatal levels of care law (SB 360) last year so the state health department could establish a program to certify perinatal levels of care designations for licensed hospitals and birthing centers. The Indiana State Department of Health also works alongside the Indiana Hospital Association, the Indiana Rural Health Association, and the Indiana Family and Social Services Administration’s Office of Medicaid Policy and Planning to investigate opportunities to keep rural hospitals and obstetric units open, as 35 of Indiana’s 92 counties either have no hospital or have a hospital without obstetric services. The Texas Department of State Health Services (DSHS) established a multidisciplinary Maternal Mortality and Morbidity Task Force to review cases of pregnancy-related deaths and severe maternal morbidity, identify trends and disparities, examine best practices, and make recommendations to reduce the incidence of pregnancy-related deaths and severe maternal morbidity. Additionally, Texas DSHS is leading the statewide TexasAIM initiative to help hospitals and clinics in Texas carry out maternal safety projects. The North Carolina Maternal Mortality Review Committee identified significant racial disparities in maternal deaths, causing the state to place a greater emphasis on addressing the non-medical issues responsible for exacerbating these disparities. These efforts led to a reduction in disparities in pregnancy-related deaths over a 10-year period. North Carolina continues to work to confront the remaining increased risk of pregnancy-related deaths among black women. ASTHO Press Release Boilerplate website yes

Recent legislation at both the state and federal levels has significantly affected the ability of health care providers to serve patients virtually and across state lines.

The ASTHO State Health Policy team provides brief updates on 5 of the ten state health policy issues to watch in 2022: public health authority, immunization, data privacy and modernization, public health workforce, and health equity.

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.

This blog post discusses mitigating risks of AI use in government agencies, emphasizing privacy, transparency, and ethical concerns.