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Responding to Disruptions in Access to Controlled Substance Medications: A Guide for State Health Departments and Their Partners Responding to Disruptions in Access to Controlled Substance Medications astho, association of state and territorial health officials, public health official, state health, territorial health, island areas, island jurisdictions, opioid prescriptions, access to opioid prescriptions, opioid rapid response program, opioid therapy, withdrawal symptom, rapid response, opioid crisis, opioid overdose, mental health, prescription monitoring, united states, discontinuation of opioid, opioid withdrawal, symptoms of withdrawal, opioid use disorder, type of drug, opioid medications, department of health, stop drinking, drinking alcohol, prescription drugs, opioid prescribing, drug withdrawal, opioid pain, physical dependence ASTHO | A guide on responding to disruptions in access to opioid prescription. Responding to Disruptions in Access to Controlled Substance Medications: A Guide for State Health Departments and Their Partners (2025) provides important updates to the 2022 edition and ASTHO’s 2020 document Responding to Pain Clinic Closures: A Guide for State Health Departments. This guidebook reflects the current state and federal landscape regarding disruptions, shares updated recommendations on strategies states might use to mitigate risks to patients affected by a disruption, and includes additional state examples. These updates are informed by the CDC’s Opioid Rapid Response Program (ORRP) and states’ coordinated responses to ORRP notifications since the program was formally established in late 2020, as well as tabletop preparedness exercises ASTHO has conducted with states. Get the Report (PDF) Content Updated - Report - Responding to Disruptions in Access to Controlled Substance Medications website yes

The Suicide, Overdose, Adverse Childhood Experiences Prevention Capacity Assessment Tool (SPACECAT) compiled a national report and accompanying infographic, that break down the biggest findings from the data, and highlight the biggest barriers facing health agencies today.

The OD2A Health Equity Needs Assessment is designed to assess the support, technical assistance, and training that state, local, and territorial health agencies need to move health equity forward within their OD2A programs.

Reprioritizing Black Maternal Health How We Can Prioritize Black Maternal Health Lawrence Young Black women face significant rates of maternal morbidity and mortality — learn how public health can better support them in this blog post. I do not have to look far to understand the urgency of the Black maternal health crisis. I have watched friends, colleagues, and loved ones from every walk of life struggle through pregnancies that should have been safe and celebrated. Some are highly educated professionals. Others are young mothers still finding their way. Many had access to quality insurance and still faced complications, long hospital stays, and minimal follow-up care. Many have shared unfortunate experiences that run the gamut from feeling unheard or perhaps unnecessarily undergoing a procedure — the care in health care was not there for them. These are not isolated incidents. They are part of a larger, structural failure that demands our attention and our action. As public health professionals, we must ask ourselves: How can we better care for and about Black mothers? And what would it look like to center them in the systems that were created to protect women in one of the most vulnerable times of their lives? Understanding the Root of the Crisis Black women in the United States are three to four times more likely to die from pregnancy-related causes than their White counterparts. In many states, including Connecticut, this difference persists even when controlling for education and income. These outcomes are not the result of individual choices or biological differences — they are the result of systems designed with historical blind spots. Education and income, often seen as protective factors, do not shield Black women from these outcomes. Research shows that pregnancy-related mortality rates are higher among Black women with a college degree than among White women with the same level of education or with less than a high school diploma. The same is true for women with respect to the risk of dying within the first year postpartum. These disparities grow with age and extend beyond mortality to include severe maternal morbidity, such as preeclampsia — a pregnancy complication related to high blood pressure — which can have lasting health impacts if untreated including death. Additionally, American Indian, Alaska Native, Black, Native Hawaiian, Pacific Islander, Asian, and Hispanic women all experience higher rates of ICU admission during delivery compared to White women. ICU admission is considered a key marker for maternal complications and system-level failure. Public Health as Partner in Progress Public health has a responsibility to do more than document issues and concerns. We must be in the business of addressing them. In Connecticut, we are working across agencies and community organizations to move from acknowledgment to action. One of the most important leaders in this work is #Day43, an initiative launched by Waterbury Bridge to Success Community Partnership. The name refers to the period between 43 days and one year postpartum, during which approximately 20% of pregnancy-related deaths occur. #Day43 exists to raise awareness of Black maternal health and transform systems to support mothers. Their work spans research, advocacy, policy, technical assistance, and storytelling grounded in lived experience. Waterbury’s maternal health data reflects this crisis. According to the #Day43 Black Maternal Health Report, 18.6% of pregnant women in Waterbury received late or no prenatal care. Those in the city face higher rates of C-sections, limited access to postpartum care, and insufficient support for mental health and breastfeeding. The community described a significant lack of maternity care resources, particularly in the North End, where many Black and Hispanic families reside. Through initiatives like this, residents are not just seen as stakeholders. They are recognized as storytellers, system builders, and agents of change. Their leadership is shaping how we define, measure, and deliver maternal care in Connecticut. This vision aligns with broader maternal health equity efforts across the state. For example, The Connecticut Health Foundation is developing a Maternal Health Equity Blueprint in partnership with community leaders, researchers, and families. Waterbury voices are essential contributors to this process. Listening as a Path of Healing The experiences of Black mothers reflect a broader truth. Too often, our systems are not built to hear them. That lack of trust is both historical and current. It shows up in rushed appointments, dismissed symptoms, and inaccessible services. Community-based providers, such as doulas and midwives of color, are critical to bridging this gap. They do more than provide care — they restore dignity. Yet these providers are often underfunded and undervalued in mainstream health care systems. Public health must champion integrating these providers into existing systems and promoting long-term sustainability. To maximize maternal health outcomes, the next phase of this work must intentionally include structured cross-sector collaboration. It must focus on building systems that educate both providers and families on urgent maternal warning signs, provide consistent discharge education, and strengthen local surveillance and outreach infrastructure. These strategies are essential, scalable, and lifesaving. We cannot improve outcomes without acknowledging the deep cultural, emotional, and psychological work required to rebuild trust. We cannot heal what we do not hear. Re-Examining the “Public” in Public Health Re-examining the public in public health means placing the needs of our most vulnerable communities at the center. It means investing in care that is integrative and supportive with community co-designed solutions. It also means wholistically addressing other intersecting systems that influence maternal outcomes. We can start by: Expanding funding for community-based perinatal health workers, including doulas and midwives. Embedding relevant metrics into maternal health program design and evaluation. Creating statewide listening sessions and family advisory councils to ensure policies reflect lived realities. Partnering across sectors to improve access to safe housing, transportation, and mental health supports for new mothers. Supporting local initiatives like #Day43 that lead from within communities and reflect community-defined solutions. Educating families on health information and individual health rights through accessible, trusted channels. To truly care for and about Black mothers, we must act beyond awareness months and social media campaigns. We must improve current processes and design opportunities that will support them and keep them alive. Public health was created to serve the public. The most powerful way to honor that mission is to focus on the public, ensuring they are a priority and not an afterthought. article yes

This ASTHOBrief addresses the financial challenges facing pregnant people in rural areas.

For many individuals living with disabilities, inaccessible vaccination websites have been a significant barrier to receiving the COVID-19 vaccine. Recent studies have found that many vaccination websites do not reliably meet accessibility standards. This brief discusses how several disability rights laws apply to COVID-19 vaccine registration websites and offers considerations for state and territorial health agencies as they work to improve website accessibility for people living with disabilities.

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.

Community Action Plan Templates for Children’s Environmental Health Environmental Health Community Action Plan Templates Health agencies can use these community action plan templates to bolster their children’s environmental health programs. ASTHO, through support from EPA, developed a set of four Community Action Plan Templates for use by state and territorial health agencies. These templates are intended to be adapted and customized by jurisdictions according to their specific needs and goals for children’s environmental health. Jurisdictions can prioritize the most pressing actions based on the areas of highest importance, needs, strategic plans, and timelines. The templates focus on air quality, climate, environmental justice, and lead poisoning. They provide a roadmap for creating community change by specifying what will be done, who will do it, and how it will be done. Health agencies can utilize the templates when helping communities develop new (or refine existing) action plans. Learn more about the templates by exploring the primer, or dive right in with one of the four templates below. website yes

This ASTHOBrief highlights healthy aging frameworks by AARP and Trust for America's Health that include health promotion, injury prevention, and chronic disease management along with another domain that emphasizes facilitation of social engagement, as well as a final domain focused on optimizing physical, cognitive, and mental health statuses of an individual.

The Louisiana Department of Health has developed Power Outage Partners, a first-of-its-kind program to recruit owners of stand-by residential generators to recharge the batteries of neighbors’ life support equipment during power outages.

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

Learn how health agencies are prioritizing children’s health as they develop public health emergency preparedness planning in this blog.

Heart Disease and Stroke Prevention in the Pacific Territories heart disease, stroke prevention, american heart month, cardiovascular health, chronic disease, pacific territories, environmental infrastructure, disease epidemic, tobacco use, mental health, united states, physical activity, health problems, leading cause of death, health conditions, american heart, cardiovascular disease, chest pain, type of heart disease, coronary heart disease, heart health, flow to the heart, risk of heart disease, heart disease and stroke, prevent heart disease, astho, association of state and territorial health officials Marcus Plescia Heart disease and stroke prevention in the pacific territories. Each February, American Heart Month raises awareness for heart disease and cardiovascular health—a matter that warrants attention year-round. In ASTHO’s 2023 Environmental Scan, territorial health officials highlighted chronic disease prevention and treatment as top current public health program and service priorities, emphasizing heart disease and stroke as key focus areas. As such, I want to highlight heart disease as a public health issue in the U.S. territories, which have played an important role in ASTHO’s chronic disease prevention efforts. Several years ago, ASTHO CEO Mike Fraser pointed out Mark Durand’s work in the Pacific territories. Durand developed a list of prioritized chronic disease-related health policies and a matrix to map progress across six jurisdictions. This ultimately provided the basis for ASTHO’s Essential Policies for Chronic Disease Prevention and Control—which served as a foundation for ASTHO’s Heart Disease and Stroke Prevention (HDSP) Learning Collaborative—and led to the launch of ASTHO’s technical packages in all program areas. Heart Disease and Stroke Prevalence in the Pacific In the United States, heart disease is the first leading cause of death and stroke is the fifth. Disparities exist across several demographic lines, including race, ethnicity, and nationality. U.S.-Affiliated Pacific Islands (USAPIs) adults have the second-highest death rate from cardiovascular disease in the country. Additionally, in all USAPIs involved in ASTHO’s HDSP Learning Collaborative—Commonwealth of Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), Guam, and Republic of Palau—heart disease and stroke are in the top three leading causes of death, with cases soaring in recent years. The U.S. territories are home to small and diverse populations with rich history, cultural practices, and languages. Unfortunately, the long-lasting impacts of colonialism have weakened the social, cultural, and environmental infrastructure that has historically protected the health of USAPIs communities. In recent decades, health threats have shifted from infectious diseases to preventable chronic diseases; the Pacific Island Health Officers Association even declared a Regional State of Emergency in 2010 because of their non-communicable disease epidemic. Since this declaration, there has been increased interest in and efforts toward policy and health system interventions in USAPIs, which ASTHO has been proud to support through our learning collaborative. Heart Disease and Stroke Prevention Learning Collaborative: Key Accomplishments Since 2013, ASTHO has partnered with CDC to develop and sustain the HDSP Learning Collaborative, focused on improving rates of hypertension. In all, 36 participating states, territories, and freely associated states have implemented innovative strategies through systems, policy, and quality improvement processes. Historically, this learning collaborative—open to both states and islands—has focused on the design and implementation of hypertension control programs. In USAPIs, program efforts evolved to address and improve cardiovascular health more broadly. Although USAPIs workplans differ from each other, they all have advanced health equity by understanding community needs and adapting to health system capacity. Table-CMO Heart Disease Stroke Prevention in the Pacific Tools for Change/Spotlight-CMO Heart Disease Stroke Prevention in the Pacific website yes

Tobacco control has been a public health success in states across the nation, but there is still work to be done, especially surrounding the popularity of menthol and other types of flavored tobacco.

This blog describes FSM’s efforts to improve access to care in some of the most remote and underserved areas of the Pacific.

Forming Partnerships to Increase Rural Immunization Rates ASTHO, Association of State and Territorial Health Officials, national immunization awareness month, farmworker communities, vaccine equity project, increase rural immunization, immunization rates, healthcare access, community action agencies, barriers to vaccine uptake, community partnerships, underlying medical conditions, back-to-school vaccinations, national community action partnership, vaccination strategies, vaccination importance, farmworker communities, challenges to healthcare access, vaccination rates, national center for farmworker health, rural immunization, preventable disease Shalini Nair, Heather Tomlinson ASTHO | Learn how public health partners with community organizations to bring vaccines to rural communities that otherwise would have difficulty accessing care in this blog. Rural communities face many challenges in accessing health care, like limited provider availability, gaps in insurance coverage, transportation issues, language barriers, and limited internet access. Additionally, rural populations are more likely to have underlying medical conditions, less likely to have insurance, and live farther from medical facilities. During the COVID-19 pandemic, overall routine vaccination coverage remained stable; however, there was a notable 4–5% drop in vaccination rates among young children living below the federal poverty level and in rural areas. In response, CDC developed the Let’s Rise initiative and a back-to-school campaign to provide actionable strategies and resources for getting Americans back on schedule with their routine vaccines. This month is National Immunization Awareness Month, highlighting the importance of vaccination for people of all ages. Boosting vaccine access and confidence is crucial to limit the spread of vaccine-preventable diseases. Barriers to Vaccine Uptake While they only account for 14% of Americans, rural communities represent nearly two-thirds of primary health care shortage areas. Due to the lack of providers, rural Americans often live over 10 miles from their closest health care facility and do not always have access to reliable transportation. Additionally, rural communities also have a larger proportion of people who are uninsured and underinsured. Studies have shown that primary care visits and strong provider recommendations can greatly enhance utilization of preventative health measures, such as vaccination, while limited access to these aspects can reduce health outcomes. The COVID-19 pandemic exacerbated this disparity as many rural hospitals closed and the country faced national workforce shortages. Rural communities were significantly impacted, with 76% of rural adults knowing someone who had COVID-19 and 38% contracting COVID-19 themselves. Despite this impact, the majority of those polled reported this did not change their intent to get vaccinated. Furthermore, the gap in COVID-19 vaccination coverage between urban and rural areas more than doubled between April 2021 and January 2022, despite rural communities having disproportionately higher COVID-19 disease incidence and mortality. The digital divide also limits access to accurate information on the safety and efficacy of vaccines. States and community groups have taken various actions to address these barriers. Successful Strategies to Address Low Vaccination Rates in Rural Communities With support from CDC, ASTHO is working with the National Community Action Partnership and five community action agencies (CAAs) on the Partnering for Vaccine Equity project. A recent blog showcases some of the work the CAAs have implemented to improve vaccine acceptance and uptake and to customize evidence-based strategies to their own communities and neighborhoods. Two project partners, Pickens County Community Action and Enrichment Services Program, are working to build trust and increase vaccine uptake in rural Alabama by leveraging existing networks and taking a whole-health approach to outreach efforts. In Russell County, Enrichment Services deployed a highly successful paper- and social media-based messaging campaign centered around messages that emphasized three points: Vaccines are Safe, Vaccines Save Lives, and Vaccines Save Money. By reaching out to local churches, Enrichment Services was able to greatly expand the reach of their health promotion messages. In addition, to increase the number of available access points for vaccination, Enrichment Services co-located outreach at schools and engaged local EMT representatives from the National Association of Emergency Medical Technicians for their first-hand knowledge of the community. Sample graphics from Enrichment Services' vaccine equity messaging campaign. In Pickens County, Pickens Community Action relied on existing partnerships with over 30 community organizations to kickstart their vaccine equity efforts. To address access-related barriers, Pickens sponsored rides to and from their vaccine clinics and partnered with local physicians to provide personalized counseling to individuals receiving vaccinations. Notably, they established both a faith-based and a disability services advisory committee to further assist their outreach efforts. Some of their existing partners in the community include the local National Association for the Advancement of Colored People (NAACP), the Black Belt Community Foundation, Whatley Health System, Hill Hospital of Sumter County, The University of Alabama, and elected officials. Left: A food table being set up for Pickens’ Community Health Fair at the Tom Bevill Lock and Dam in Pickensville, AL. Right: A mobile outreach van from partner the University of Alabama rolls in to assist at Pickens’ Community Health Fair. For both agencies, offering services that address the social determinants of health greatly increased engagement. Both sites found success in offering incentives—such as food or gas gift cards and free food giveaways—but their greatest success has been from co-locating vaccine events with service offerings that address essential needs such as housing, utility assistance, or education. This model has proven highly successful not only for COVID-19 vaccines, but also as a sustainable strategy for general vaccine outreach. Increasing Vaccination Rates in Farmworker Communities Numerous successful strategies have been implemented in rural communities largely comprised of immigrants—with a special focus on migrant farmworkers, who labored throughout the pandemic due to the critical nature of their work. In addition to facing barriers related to transportation, health insurance, and language access, many farmworkers are not able to visit a clinic or pharmacy due to their long working hours. The National Center for Farmworker Health, in collaboration with CDC and over 40 different organizations, worked to diffuse funding, trainings, and tools for building capacity to act during the public health emergency. This network generated over 1.3 million COVID-19 related educational interactions with farmworkers and supported the distribution of over 108,000 COVID-19 vaccine doses during 2020 and 2021. The network also documented effective practices undertaken by community-based organizations and agricultural employers to distribute vaccines, dispel myths, and build vaccine confidence. Photos courtesy of the Guatemalan-Maya Center (left) and National Center for Farmworker Health (right). State Considerations for Implementation Collaboration with trusted community groups can amplify state efforts to vaccinate communities, particularly in those with low vaccination rates. Working with CAAs and organizations that understand their communities and utilize innovative outreach strategies can help states expand the reach of their messaging. Communications should be tailored to include multilingual messaging and images that resonate with targeted communities. The National Governors Association developed a guide that provides valuable strategies for states to increase vaccine uptake in their rural communities. To help address the digital divide in their communities, several states have made investments in their digital infrastructure. Partnering with local pharmacies, federally qualified health centers, and emergency medical services to offer alternative vaccination sites in communities has been integral in improving awareness and access. Holding mobile vaccine clinics with after-hours availability or offering transportation to and from vaccine clinics can help address transportation issues and make vaccines accessible in communities with limited health care facilities. Addressing immunizationinequities in rural communities requires understanding the community and implementing innovative strategies tailored to these populations. Partnering with community-based organizations can help states reach critical audiences and ensure that vaccine efforts are addressing relevant barriers. article yes

The adage “what gets measured, gets done” has had staying power for a reason. When we can accurately describe conditions, quantify impact, and elucidate connections, we have a better chance at taking collective (and effective) action to tackle even the most challenging problems facing our communities. The National Survey of Children’s Health is a powerful tool to provide this critical information to researchers, policymakers, and state-level decision makers.

Responsible for planting, growing, harvesting, processing, and preparing the food we eat, agricultural workers are essential workers during the COVID-19 response to keep the U.S. food supply chain operating efficiently. But farmworkers are particularly vulnerable to COVID-19 due to lack of physical distancing, lack of access to health insurance and sick leave, and poor access to clean water for handwashing throughout the work day.

The movement to address racism through policy change in the U.S. is receiving significant political support at every level of government. Government institutions are acknowledging the systemic oppression of people of color that persists in the United States and elevating racism as an urgent public health emergency comparable to other public health crises.

Economic security and well-being, job stability, access to safe and affordable housing, access to healthy and nutritious foods, and access to resources to manage mental and physical health—all of these things impact individual, family, and community health. The COVID-19 pandemic has fundamentally impacted each of these social determinants of health for many Americans. Furthermore, some communities and industries have faced harder economic impacts than others, including households with low incomes, non-white households, and households with children. Human services and public health leaders can collaborate to make sure we are rebuilding systems and programs in a way that creates healthier, more resilient families and communities.