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

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.

The 2019-2020 flu season had approximately 5 million fewer illnesses than the previous year. Thanks to COVID-19 mitigation efforts like social distancing and increased handwashing—coupled with a higher rate of flu vaccinations among the public this year—this all likely led to a milder end to the 2019-2020 flu season and start of the 2020-2021 flu season.

Several states and territories, as well as many local governments, are going beyond recommendations and requiring individuals to wear face coverings when they are in public settings and spaces (i.e. grocery stores, retail stores, restaurants, public and private transportation services, parks, etc.). Ongoing research and evidence suggests the relationship between mandatory face coverings and declines in daily COVID-19 growth rates is statistically significant.

This Health Policy Update is an overview of state legislative activity to increase financial stability for families during the COVID-19 pandemic which may help to prevent adverse childhood experiences.

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.

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

As schools work to stay open for in-person learning, it is essential to understand key recommendations related to COVID-19 prevention in K-12 schools. CDC recommends that health department staff work closely with K-12 schools to effectively prevent and respond to COVID-19 infections. Health department staff may look to school officials to understand the unique context of each school setting, while school officials may look to health department staff to better understand federal, state, and local guidance. This document compiles CDC guidance for COVID-19 prevention strategies in K-12 schools and should supplement state or territorial and local policies. Schools and health departments should layer the COVID-19 prevention strategies listed in this ASTHOBrief.

Evidence suggests that access to healthy, safe, and affordable housing is connected to preventing suicide and overdose, with state and federal programs supporting access to housing for people with low incomes, substance use disorders, and/or mental illness. This brief provides an overview of policies to increase housing opportunities for people experiencing homelessness, substance use disorder, and/or mental illness during the 2021 state legislative sessions.

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.

This ASTHOBrief contains three key recommendations for improving the 2013 CDC/CSTE Cancer Cluster Investigation Guidelines.

Linking Datasets to Address Racial Equity in Maternal and Child Health Outcomes astho, association of state and territorial health officials, data sources, people of color, centers for disease control, racial inequities, advance racial equity, maternal morbidity, maternal death, maternal health, child health, participate in prams, risk assessment monitoring system, disease control and prevention, maternal and child, morbidity and mortality, pregnancy risk assessment monitoring, pregnancy related death, racial justice, linked data, achieve health equity, advancing health equity, racial equity, maternal and child health, maternal mortality and morbidity, racial disparities, health equity, data linkages, vital records, pregnancy risk assessment monitoring system Stephany Strahle ASTHO | Strategies for promoting racial equity in maternal and infant health through data linkages. Racial disparities in maternal and child health outcomes impact populations across the United States. Having robust data to understand these disparities may inform more comprehensive initiatives and policies that address the impacts and root causes of inequities. Looking at administrative datasets, such as hospital discharges and vital records, allows health professionals to monitor inequities by racial and ethnic communities. Often not captured in these data, however, is the complex interaction of social determinants—such as access to social support, racial discrimination, insurance coverage throughout pregnancy and postpartum, and access to paid family and medical leave—and their impact on health outcomes. Public health surveillance systems monitor these outcomes and aim to answer questions on a broad range of contextual experiences. These systems can be combined with administrative data through data linkage, “a process that matches records representing the same person or entity derived from different data sources in order to generate new and more comprehensive datasets.” These linkages can help identify areas for patient-centered outcomes research and inform policy recommendation and programs that address maternal and child health disparities across racial and ethnic groups. State Approaches to Data Linkages Linking Vital Records with Income Data California In a recent working paper on maternal and infant health inequities in California, researchers linked administrative vital records with parental income data. This research found that “infant and maternal health in Black families at the top of the income distribution is markedly worse than that of White families at the bottom of the income distribution.” Linking vital records, a source that typically does not capture income information, with data sources that do, provided a novel and robust dataset illuminating the exacerbated disparities experienced by racial and ethnic minorities at all income levels. Using PRAMS to Monitor Health Outcomes The Pregnancy Risk Assessment Monitoring System (PRAMS) allows jurisdictions to monitor various maternal and infant health indicators before, during, and after pregnancy. As one of the few public health surveillance systems collecting data on race-related experiences and discrimination, it also provides a better understanding of disparities among racial and ethnic groups. As part of ASTHO’s Linking PRAMS and Clinical Outcomes Data Multi-Jurisdiction Learning Community, two state teams from Massachusetts and Georgia used data linkage of PRAMS to explore racial disparities in maternal and child health outcomes. Massachusetts The Division of Maternal and Child Health Research and Analysis at the Massachusetts Department of Public Health linked PRAMS data with the Pregnancy to Early Life Longitudinal Data System (PELL), a data system linking birth files to hospital discharge records that can be later used to link hospital-based service records, data on early intervention services, and other data documenting maternal and infant health experiences beyond birth. Previously, both PRAMS and PELL data informed Massachusetts’s 2022 report from the Special Commission on Racial Inequities in Maternal Health, which provided policy-related recommendations on doula workforce development and equitable implementation of paid family and medical leave within the state. Sarah Stone, PhD, MPH, the director of the Massachusetts Office of Data Translation, notes that linking PRAMS, which provides insights into the social determinants shaping people’s experiences during pregnancy, with the more administrative data included in PELL can further inform additional evidence-based initiatives to address inequities in maternal mortality and severe maternal morbidity. Georgia At the Maternal and Child Health Section of the Division of Epidemiology in the Georgia Department of Public Health, linkages between PRAMS and Georgia Vital Record data can provide insight into the observed differences in health outcomes among the state’s diverse population. Jenna Self, MPH, Georgia’s PRAMS project director and health surveys team lead, explains that “the linkages will help explore the association between maternal postpartum behaviors and negative infant health outcomes (e.g., mortality, hospitalization, emergency department visits) with the goal of understanding the health disparities” to inform future equity-focused initiatives. The development of a linked data environment will allow the Georgia Department of Public Health to ask and answer previously time and resource prohibitive questions. Recommendations Data linkage can be a powerful tool to create enhanced datasets that better inform state initiatives to improve racial equity in maternal and infant health outcomes. To use data linkages that identify areas needing equitable public health efforts, states should: Build and strengthen cross-collaborative relationships within and between various state agencies owning the datasets to facilitate data sharing. Consider the racial equity impacts of performing data linkages by exploring research questions that lead to more evidence-based decision-making. Understanding the linked data using a racial equity lens can better inform equitable policy recommendations and programmatic planning. Examine which data sources, when linked, could fill in gaps of understanding and provide a wealth of information to identify disparities and point to specific gaps in quality health care. Brief - Linking Datasets to Address Racial Equity in Maternal and Child Health Outcomes - Special Thanks website yes

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

Policymakers all over the country have used legislation about farmers markets and sugar-sweetened beverages to help curb many of the negative impacts of food environments.

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.

Tennessee Partners with Dialysis Facilities to Strengthen Infection Prevention Tennessee and Dialysis Facilities Strengthen Infection Prevention Alex Kurutz, Joshua Key, Connie Harig Learn how Tennessee partners with dialysis facilities to address training needs and, in turn, strengthen infection prevention. More than 800,000 people in the United States are living with end-stage kidney disease, and over half receive life-sustaining treatment through dialysis. Unfortunately, healthcare-associated infections (HAIs) remain a leading cause of hospitalization and death for this population. Patients undergoing dialysis, especially hemodialysis, are at increased risk for infections due to frequent vascular access, compromised immune systems, and regular exposure to clinical settings. To support patient safety and reduce the risk of dialysis-related infections, it is critical to ensure that facility staff have access to training on evidence-based protocols such as proper hand hygiene and vascular access care. In Tennessee, the Department of Health works closely with dialysis facilities to identify and address the training needs of their staff and improve infection control practices that advance the safety of patients on dialysis. To gain further insights into this successful partnership, ASTHO spoke with two Tennessee Department of Health personnel — Dialysis Nurse Consultant Joshua Key and Epidemiologist Alex Kurutz — as well as Connie Harig, Nurse Educator from Dialysis Clinic, Inc. in Knoxville, who shared their experiences implementing and participating in this program, shedding light on the process, benefits, and lessons learned from this collaboration. Identifying Training Needs To effectively support training facility staff, the Tennessee Department of Health began by looking at what data could tell them about their state’s needs. In addition to reviewing reports from the National Healthcare Safety Network (NHSN), the Department of Health conducted a learning needs assessment in fall 2022 to identify educational and training needs expressed by dialysis providers. All dialysis facilities in Network 8, which encompasses Tennessee, Mississippi, and Alabama, received the assessment, and results revealed that dialysis technicians and nurses desired additional training related to infection prevention practices. In response, Tennessee initiated the Hemodialysis Infection Prevention Educational Program — a day-long, interactive simulation training, inspired by a similar effort in Massachusetts. Joshua Key 1 - Tennessee Partners with Dialysis Facilities to Strengthen Infection Prevention Developing and Implementing the Simulation Training The department hired four part-time educators — two dialysis nurses, one certified hemodialysis technician, and one biomedical technician — to develop the training materials based on CDC guidance. They also developed pre- and post-tests as well as a training evaluation to assess any increase in knowledge and intent to apply the content moving forward. Lastly, they worked with the Georgia Nurses Association to offer continuing education credits for participating providers. A typical simulation training has the capacity for about 40 participants and involves an eight-hour day, beginning with brief presentations on each topic and moving into applied practice in the second half of the day during which participants rotate through stations to apply the skills they learned. Participants also hear from a patient advocate to learn more about the real-life impact of dialysis-related infections, an experience many trainees have described as powerful and important. Despite facing initial challenges connecting with a patient advocate, Tennessee Department of Health emphasized its importance, ultimately leaning on partners such as the National Kidney Foundation and the National Forum of ESRD Networks to identify an available advocate. article yes

Learn how public health agencies are improving their financial management strategies and systems.

Learn how health agencies can improve access to critical medications by preparing for drug shortages and working with a diverse set of partners.

PHIG Success Story: In Massachusetts, Building Public Health Infrastructure Starts with a Strong Workforce Elise Moore Massachusetts open houses, supported by CDC's Public Health Infrastructure Grant (PHIG), connect the community with public health careers. Open houses are an opportunity for health departments to engage the community, foster trust and transparency, and build pathways for people seeking a career in public health. In late 2023, the Massachusetts Department of Health (DPH) held two virtual open houses—supported by the Public Health Infrastructure Grant (PHIG)—for students and alums of Massachusetts colleges and universities. More than 400 participants connected with state and local public health officials in various panels and networking events. DPH’s Workforce Director Arnaldo Machado shared his insights, lessons learned, and testimonials from staff about the experience with ASTHO. What strategies did DPH employ to engage participants? ARNALDO MACHADO: The "Who's in the room?" activities helped engage the participants and highlight our focus on racial and health equity. We were very clear about the reason for that exercise: ensuring we are reaching the communities we serve. The one-hour themed breakout rooms (15 minutes of staff presentations and 45 minutes of Q&A) were the highlight of both events. They fostered an interactive experience for participants. Lombardo-MA Building PH Infrastructure Starts with Strong Workforce - Block 1 What challenges did you encounter during the open houses and how did you meet them? MACHADO: A significant challenge was overcoming the immediate results mindset, which can sometimes be in conflict with the efforts needed for pathway events such as open houses. Unless that mindset changes, we will forever be working on short-term initiatives. A lot of times, people want to see immediate changes to hiring numbers. However, just as community engagement efforts do not result in enhanced public health outcomes overnight, pathway events yield results over time. After each event, more than 200 prospective candidates for the public health workforce are better informed about career paths, the human side of the department, and how to get more help. We aim to dismantle the large institutional view many people may have of us as an organization in the distance. Hopefully, we took one step further, through transparency, in building a relationship of trust with those present. So, we don't only measure the event's success based on immediate hires. Rather success is in the reach of our events, which will bear fruit for years to come. Beluk-MA Building PH Infrastructure Starts with Strong Workforce - Block 2 What insights have you gained from the post-event evaluation survey? MACHADO: My biggest measures were the levels of participation and overall satisfaction with the event. The participation rate of attendees versus registrants was around 50%, which is the average for DPH during recruitment events. We filled those registrations relatively quickly with minimal promotion to social networks and leveraging our academic health department partnerships. We also saw the satisfaction ratings grow between the first and second events. Participants appreciated the transparency in the hiring process presentations and felt more prepared to apply for DPH jobs. They also loved the opportunity to connect with people who worked in the department. Participants also asked for the opportunity to participate in more than one breakout session—and even though that opportunity was available at the second event, it came at the cost of losing content since all breakout sessions were concurrent. We resourced some of the session, so people won't have to experience repetitive content in the future. Turner-MA Building PH Infrastructure Starts with Strong Workforce - Block 3 Looking ahead, how do you anticipate leveraging PHIG funding to promote public health careers and engage with students and alumni from Massachusetts colleges and universities? MACHADO: With a shift to skills-based hiring in Massachusetts, I am thinking much beyond formal academic institutions for future outreach. We will continue to invest in academic pathways, and our academic health department manager is committed to that. Still, we are also forging partnerships with local career centers and veteran service programs and planning to reach young adults in the K-12 system. Additionally, we are using PHIG funding to implement significant career promotion efforts on our website through workforce highlights and clarification on many roles in the department. For year two of the grant, we have identified employees in nine domains determined by need—measured in long-time-to-hire metrics tracked for PHIG—and by strategic alignment. Contact Department-Blog - In Massachusetts, Building Public Health Infrastructure Starts with a Strong Workforce OE22-2203 PHIG website yes