Zamani-Hank Y, Nothaft A, Shaefer HL
… +1 more, Hanna M
Public Health Rep
· 2026 Jan · PMID 41545020
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Programs in the United States aimed at improving maternal and infant health vary in effectiveness in reaching eligible participants. Administrative burdens such as learning, psychological, and compliance costs increase b...Programs in the United States aimed at improving maternal and infant health vary in effectiveness in reaching eligible participants. Administrative burdens such as learning, psychological, and compliance costs increase barriers to initial and sustained enrollment in these programs. This case study explored the effectiveness of Rx Kids-the United States' first community-wide unconditional cash prescription program for mothers and infants launched in Flint, Michigan-in achieving exceptionally high program uptake. We compared total births among program participants with total births in Flint based on birth certificate records to estimate aggregate and prenatal uptake rates. We calculated an aggregate uptake rate in the range of 100% and a prenatal uptake rate of 93%. A limitation of our methodology was our inability to match program participants to birth certificate data. We discuss this and other limitations and offer recommendations for further refining estimates of program uptake using a data match process. The high uptake rate of Rx Kids underscores the importance of program design in reducing administrative burdens, with broad implications for improving maternal and infant health and public health at large.
Christy SM, Buhlmann M, Kang D
… +5 more, Reich RR, Rathwell JA, Kasting ML, Vadaparampil ST, Giuliano AR
Public Health Rep
· 2026 Jan · PMID 41529866
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OBJECTIVES: Hepatitis C virus (HCV) screening rates are low in the United States and may be lower among populations experiencing social vulnerability. Little is known about these potential disparities. The current study...OBJECTIVES: Hepatitis C virus (HCV) screening rates are low in the United States and may be lower among populations experiencing social vulnerability. Little is known about these potential disparities. The current study examined HCV screening prevalence across time, spatial distribution, and social vulnerability among adults in Florida. METHODS: We used data on clinical encounters from the OneFlorida+ data repository to examine the prevalence of HCV screening among adult patients in Florida (N = 1 380 811) from August 1, 2015, through July 31, 2021, by birth cohort (1924-1944, 1945-1965, 1966-1985, and 1986-1997) and risk group (average vs high risk of HCV infection based on behavioral and medical factors). Among patients with a recorded 9-digit zip code (n = 853 965), we conducted spatial analyses, and we used the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) to examine screening disparities. RESULTS: The 1945-1965 birth cohort had the highest likelihood of HCV screening (7.9% among average-risk patients and 24.2% among high-risk patients); those in the 1924-1944 birth cohort had the lowest likelihood (2.0% among average-risk patients and 8.6% among high-risk patients). High-risk patients in almost every geographic area were more likely than average-risk patients to be screened. Screening prevalence was highest in north and northeastern Florida. Among all patients, screening tended to be most likely among those with the highest socioeconomic status and with either the least or most social vulnerability. CONCLUSIONS: HCV screening rates were low in Florida across all study years and birth cohorts. Spatial and SVI analyses revealed geographic disparities by region and social vulnerability groups. Interventions are needed to support HCV elimination.
Public Health Rep
· 2026 · PMID 41527324
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Because breastfeeding behaviors are influenced by social norms, we examined public opinions toward societal supports for breastfeeding using data from the 2015 and 2024 SummerStyles surveys (N = 4127 and N = 4371, respec...Because breastfeeding behaviors are influenced by social norms, we examined public opinions toward societal supports for breastfeeding using data from the 2015 and 2024 SummerStyles surveys (N = 4127 and N = 4371, respectively, from the noninstitutionalized US population). In 2024, 81.9% of respondents agreed "there should be paid maternity leave for workers," 73.5% believed "women should have the right to breastfeed in public places," 66.9% agreed "women should be encouraged to breastfeed," and 65.9% agreed "a mother needs a lot of support to breastfeed her baby"-up 12, 11, 5, and 17 percentage points, respectively, from 2015. High and increased positive public opinions about supports for breastfeeding suggest heightened approval for breastfeeding-supportive programs and policies.
Public Health Rep
· 2026 Jan · PMID 41527293
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OBJECTIVES: Infection mitigation practices and health care infrastructure challenges during the COVID-19 pandemic caused delays in medical care and chronic disease detection and management. These challenges also hindered...OBJECTIVES: Infection mitigation practices and health care infrastructure challenges during the COVID-19 pandemic caused delays in medical care and chronic disease detection and management. These challenges also hindered healthy lifestyle choices. We analyzed diabetes and cardiovascular disease (CVD) mortality independent of COVID-19 comorbidity to assess the effect of the COVID-19 pandemic on chronic disease mortality. METHODS: We obtained Illinois Vital Records System death records for calendar year 2019 (January 1 through December 1, 2019) and COVID-19 year 1 (March 16, 2020, through March 15, 2021). We included Illinois residents with causes of death recorded as diabetes or CVD and the absence of COVID-19 infection. We calculated age-adjusted mortality rates for diabetes and CVD as underlying causes of death. We examined data by age, sex, race and ethnicity, education, geography, and CVD subtypes. RESULTS: The infection-independent, all-cause mortality rate per 100 000 population in Illinois increased 3.6% from January 1, 2019, through March 15, 2021 (765.8 [95% CI, 761.2-770.3] vs 793.2 [95% CI, 788.6-797.8]). The overall diabetes mortality rate increased 19.9% (19.6 [95% CI, 18.9-20.3] vs 23.5 [95% CI, 22.7-24.3]). The overall CVD mortality rate change (3.9%; 239.2 [95% CI, 236.7-241.7] vs 248.5 [95% CI, 245.9-251.1]) was similar to the all-cause mortality rate change. Sex, minority race, ethnicity, those with high school diplomas or some college education, middle to older age, and urban residence influenced mortality rate increases among people with diabetes and CVD. CONCLUSION: The COVID-19 pandemic had an infection-independent effect on chronic disease mortality. This knowledge may help public health officials guide policy that protects chronic disease management during future public health emergencies.
Public Health Rep
· 2026 · PMID 41527283
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In this article, we share insights related to the coaching and mentoring of doctor of public health (DrPH) students based on our experience. We discuss the evolution of DrPH programs, which are distinct from research-foc...In this article, we share insights related to the coaching and mentoring of doctor of public health (DrPH) students based on our experience. We discuss the evolution of DrPH programs, which are distinct from research-focused PhD programs, along with challenges faced by faculty members and students. We apply the Community of Inquiry framework as a theoretical foundation and propose a novel service-first focus approach to support mid-career professional DrPH students. Our coaching and mentoring approach focuses on leadership development, collaboration, and 6 critical elements: compassion and empathy, prompting inquisitiveness, goals and milestones, meeting them where they are, partnership, and a coaching mindset. We use a case study approach focused on the University of South Florida College of Public Health's DrPH online program. Testimonials from DrPH alumni illustrate the value of the service-first focus approach. We also discuss the importance of cultivating faculty members who support these students through systems approaches, leadership development, partnership, and trust building. Areas for future research include evaluating the impact of this mentorship approach on student milestone attainment compared with outcomes among students who were mentored in more traditional ways, including those in PhD programs. Such an evaluation would provide valuable data to continue to shape this model. Enlisting other DrPH programs to strengthen the evaluation's rigor would benefit all doctoral programs seeking to accelerate and enhance student success.
Arnold MJ, Leavens ELS, Sanderson Cox L
… +5 more, Brown A, Mayo MS, Baldwin NL, Nguyen TA, Nollen NL
Public Health Rep
· 2025 Dec · PMID 41388646
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OBJECTIVES: Menthol flavoring is a critical public health issue, but prior research has largely represented the voices of White adults who smoke menthol cigarettes, who represent a small subset of adults who smoke mentho...OBJECTIVES: Menthol flavoring is a critical public health issue, but prior research has largely represented the voices of White adults who smoke menthol cigarettes, who represent a small subset of adults who smoke menthol cigarettes in the United States. This study compared perceptions of a hypothetical menthol cigarette or flavored cigar (MC/FC) ban among Black and White adults who smoke menthol cigarettes. METHODS: Participants were a convenience sample of 2113 Black and 1087 White adults who smoke menthol cigarettes, collected through Amazon Mechanical Turk from July 2023 through January 2024. Participants reported opinions about an MC/FC ban, the likely public health outcomes, and a hypothetical impact of the ban on their smoking behavior. We used stepwise logistic regression to model factors associated with ban opposition or ambivalence. RESULTS: More than one-third of adults who smoke menthol cigarettes supported an MC/FC ban (37.2% Black vs 34.5% White; = .13), but Black (vs White) adults who smoke menthol cigarettes were more likely to endorse the public health benefits of a ban, as assessed via agreement with 5 statements of US Food and Drug Administration rationale (mean [SD] number of statements endorsed, 3.0 [1.7] vs 2.4 [1.8]; < .001). Smoking more cigarettes per day, believing that menthol cigarettes are more addictive or harder to quit than nonmenthol cigarettes, and intending to continue using nicotine under a ban increased the odds of opposition or ambivalence to the ban. CONCLUSIONS: Targeted outreach to those who consume predominantly menthol products and those who do not intend to quit nicotine could increase support of an MC/FC ban among adults who smoke menthol cigarettes.
MacDonald G, Martin Frazier C, Argotsinger B
… +4 more, Gill A, Corso LC, Martinez SA, Dauphin LA
Public Health Rep
· 2026 · PMID 41388642
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OBJECTIVES: The Centers for Disease Control and Prevention (CDC) supports health departments in meeting public health accreditation standards, but how cumulative investments in these activities are related to growth in a...OBJECTIVES: The Centers for Disease Control and Prevention (CDC) supports health departments in meeting public health accreditation standards, but how cumulative investments in these activities are related to growth in accreditation nationwide has not been documented. We analyzed CDC funding for accreditation activities for an 18-year period to determine cumulative investment relative to reach and coverage of the US population by accredited health departments. METHODS: We conducted a secondary analysis of Public Health Accreditation Board (PHAB) data to examine changes in the percentage of state health departments (SHDs) and local health departments (LHDs) that were accredited during 2005-2023. RESULTS: During 2005-2023, CDC distributed $248 million to 3 recipient types for accreditation activities, including health departments, PHAB, and other partner organizations. During this time, the number of accredited SHDs increased from 2 of 51 (4%) in 2013 to 41 of 51 (80%) in 2023, and the number of accredited LHDs increased from 20 of 2297 (1%) in 2013 to 395 of 2297 (17%) in 2023. In 2023, 83% of the US population was served by an accredited SHD and 43% by an accredited LHD. Among the 395 accredited LHDs nationwide, 322 (82%) were in states that provided funds to localities for accreditation activities from investments we analyzed. CONCLUSIONS: Sustained funding for multicomponent accreditation activities was followed by growth in accredited SHDs and LHDs. States that allocated CDC funding to support local accreditation had more accredited LHDs than states that did not allocate such funding. Further research is needed to understand how accreditation of health departments changes in relation to other funding sources and supports.
Walters J, Mosites E, Hall E
… +1 more, Snowden JM
Public Health Rep
· 2026 · PMID 41388630
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OBJECTIVE: Homelessness is a pervasive and pressing problem in the United States and is associated with health risks and premature mortality. However, accurately defining and classifying homeless status can be complex, a...OBJECTIVE: Homelessness is a pervasive and pressing problem in the United States and is associated with health risks and premature mortality. However, accurately defining and classifying homeless status can be complex, and assessment of homelessness status requires careful consideration of the data collection process. We assessed the validity of the ascertainment of homeless status on death certificates. METHODS: We quantitatively compared the classification of homeless status from 2023 Multnomah County, Oregon, medical examiner data (considered the gold-standard source, due to the in-depth investigation and extensive data available as a case narrative) with housing status from Oregon Health Authority 2023 vital record (death certificate) data alone. We also described people with an indication of homelessness in the 2023 medical examiner data but not in the 2023 vital record data and considered possible causes of this misclassification. RESULTS: A total of 171 of 394 (43%) decedents whom we classified as homeless via medical examiner data had an address listed in the final death certificate; all were significantly younger (aged 42 y) than the 223 people with concordant records (aged 46 y). CONCLUSIONS: We found that the presence of an address on a death certificate does not rule out homelessness at the time of death, especially among younger decedents. Other jurisdictions should assess the accuracy of their homeless classification data, as more research is necessary to quantify the presence of misclassification.
Abimbola TO, Van Handel M, Marks SM
… +8 more, Beeler Asay GR, Sandul A, Gift TL, Durham MD, Pampati S, Salomon JA, Martin EG, Mermin J
Public Health Rep
· 2026 · PMID 41342878
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In 2014, the Centers for Disease Control and Prevention (CDC) expanded capacity to conduct infectious disease and economic modeling through the National Center for HIV, Viral Hepatitis, STD, and TB Prevention Epidemiolog...In 2014, the Centers for Disease Control and Prevention (CDC) expanded capacity to conduct infectious disease and economic modeling through the National Center for HIV, Viral Hepatitis, STD, and TB Prevention Epidemiologic and Economic Modeling Agreement (NEEMA). NEEMA brought together CDC scientists, academic partners, and public health practitioners at state and local levels to use epidemiologic and economic modeling to support the understanding of the efficiency, outcomes, cost-effectiveness, return on investment, and impact of programs and policies related to the center's disease foci, priority populations, and settings. In collaboration with state and local health departments, NEEMA activities included the development of tools to aid forecasting and decision-making. This article summarizes the scientific contributions and lessons learned from the NEEMA collaboration. During 2014-2024, NEEMA produced 136 peer-reviewed studies and 8 decision support tools. These studies have been cited 2697 times in peer-reviewed literature and referenced more than 70 times in policy documents. NEEMA has expanded the knowledge base on effective and cost-effective high-impact interventions for HIV, viral hepatitis, STD, and tuberculosis programs and continues to be responsive to changing needs for evidence to inform decision-making and policy.
Bennett JC, Goldoft MJ, Lewis JW
… +8 more, Noonan E, Olson GS, Simmons JD, Lahiri R, Flynn A, Lieberman JA, Lindquist S, Holshue ML
Public Health Rep
· 2026 · PMID 41319142
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OBJECTIVES: Since 2000, leprosy has not been notifiable in Washington State, and statewide leprosy data have not been reported. We sought to increase our understanding of leprosy epidemiology in Washington State since 20...OBJECTIVES: Since 2000, leprosy has not been notifiable in Washington State, and statewide leprosy data have not been reported. We sought to increase our understanding of leprosy epidemiology in Washington State since 2001. METHODS: We reviewed data from the National Hansen's Disease Program to identify clinically diagnosed leprosy cases from 2001 through 2023 among Washington State residents. We analyzed cases over time, by county of residence, disease type, and global birth region. We used Poisson regression to estimate rates by birth region and incidence rate ratios to compare rates among US-born residents and those from other global birth regions. RESULTS: We identified 131 cases of leprosy in Washington State from 2001 through 2023. Most cases were among non-US-born people (95%), males (72%), and adults aged 18 to 64 years (87%); one-third were among Micronesian or Marshallese people. As compared with US-born people (0.2 per 1 000 000 population), the leprosy rate was 1064 times (95% CI, 466-3069) higher among people born in Oceania (215 per 1 000 000 population). Incidence rate ratios for other birth regions ranged from 301 (95% CI, 43-1396) for South America to 28 (95% CI, 11-82) for Asia. CONCLUSIONS: Focused public health interventions, including increased physician awareness of leprosy and its stigma for populations at high risk, may reduce the incidence of leprosy among Washington State residents born in Oceania, who had a disproportionately high disease rate.
Alrubaie N, Gidal B, Armour E
… +4 more, Hoornbeek J, Lanese B, VanGeest J, Hill CE
Public Health Rep
· 2026 · PMID 41287421
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OBJECTIVE: Teenage pregnancy rates are high in the United States. Teenagers with epilepsy are at a particular health risk due to challenging transitions of care and unique considerations for contraception as well as at i...OBJECTIVE: Teenage pregnancy rates are high in the United States. Teenagers with epilepsy are at a particular health risk due to challenging transitions of care and unique considerations for contraception as well as at increased risk for fetal and maternal complications in pregnancy. The objective of this study was to explore the live birth rate among teenaged girls with epilepsy in Michigan. METHODS: In this retrospective open-cohort epidemiological study, we estimated the live birth rate and identified predictors for births among Medicaid-insured teenaged girls (aged 15-19 y) with epilepsy in Michigan, using administrative data from the Michigan Children's Special Health Care Services Program from 2016-2022. RESULTS: Among teenaged girls with epilepsy in Michigan, the birth rate was 1.6 per 100 population. Significant factors associated with giving birth (vs not) included use of fewer antiseizure medications, lack of contraceptive use, and low annual household income. CONCLUSION: Given the risk factors identified (eg, no use of contraceptives, low income), teenaged girls with epilepsy may need greater access to care, resources, and/or support than teenaged girls without epilepsy. Our data suggest that targeted interventions to facilitate access to contraceptives could be beneficial. Improving data tracking and diagnosis coding practices will be important for the future study of the birth rate among teenaged girls with epilepsy.
Balio CP, Leslie HM, Pelton B
… +2 more, Dockery NA, Meit M
Public Health Rep
· 2026 · PMID 41287417
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OBJECTIVES: Public health nurses (PHNs) are one of the largest public health occupation groups, bringing important expertise to the activities of public health; however, their roles and distribution differ across the cou...OBJECTIVES: Public health nurses (PHNs) are one of the largest public health occupation groups, bringing important expertise to the activities of public health; however, their roles and distribution differ across the country. The objective of this study was to estimate the relative need for, supply of, and priority areas for PHNs at the county level. METHODS: We used a cross-sectional design with national data sources available at the county level to measure the local need for, supply of, and priority areas for PHNs. We estimated need through a newly developed index based on 4 domains: demographic characteristics, economic characteristics, health care context, and health outcomes within the county. We estimated supply by using registered nurse staffing data from local health departments. We identified priority tiers of PHN deserts as counties with relatively high need and low supply. We conducted the study in 2024-2025. RESULTS: The need for and supply of PHNs varied across the country, with little correlation (+0.26). For example, average need was highest in the southeastern United States (mean need score, 68.3 of 100; median need score, 76.0 of 100) and lowest in the upper northeastern United States (mean need score, 19.8 of 100; median need score, 13.5 of 100). CONCLUSIONS: The combination of local-level PHN need and supply can be used to identify potential gaps in PHN availability and can inform investment, recruitment, training, or allocation of other resources to address the PHN workforce needs of local health departments.
Vazquez Deida AA, Kim C, Gouin KA
… +4 more, Zhang K, Mikosz CA, Neuhauser MM, Kabbani S
Public Health Rep
· 2026 · PMID 41287412
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Characterizing high-volume co-prescribing of antibiotics and opioids can inform interventions that improve prescribing practices. Using 2021 Medicare Part D data, we conducted a cross-sectional analysis to assess concord...Characterizing high-volume co-prescribing of antibiotics and opioids can inform interventions that improve prescribing practices. Using 2021 Medicare Part D data, we conducted a cross-sectional analysis to assess concordance between high-volume prescribing of antibiotics and opioids and characterize associations between prescriber-level factors and high-volume co-prescribing of antibiotics and opioids. High-volume antibiotic prescribers accounted for 12.5 million (36.0%) antibiotic prescriptions, and high-volume opioid prescribers accounted for 22.3 million (51.9%) opioid prescriptions. We found fair concordance between being a high-volume prescriber of antibiotics and a high-volume prescriber of opioids (κ = 0.30). Prescribers in the South (adjusted odds ratio [AOR] = 3.67; 95% CI, 3.46-3.90) and in rural areas (AOR = 2.32; 95% CI, 2.12-2.54) were more likely to be high-volume co-prescribers of antibiotics and opioids than prescribers in the West and in urban areas, respectively. Public health and professional organizations can partner to provide support to optimize antibiotic and opioid prescribing practices and improve patient safety.