Public Health Reports[JOURNAL]
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200 papers
Decreasing Noise Exposure Should Be a Public Health Priority.
Balk SJ, Neitzel R
Public Health Rep · 2026 · PMID 41165259 · Full text
Abstract loading — click title to view on PubMed.
A Place to Stay: Building a Centralized Public Map of Lodging Resources for Patients and Caregivers Traveling for Care.
Owens JA, Ezeji V, Williams V … +3 more , Okoye G, Lilly FRW, Ward RJ
Public Health Rep · 2026 · PMID 41165168 · Full text
Access to specialized health care often requires patients and caregivers to travel long distances, imposing logistical and financial burdens. Temporary lodging near hospitals is essential for health care access, yet info...
Access to specialized health care often requires patients and caregivers to travel long distances, imposing logistical and financial burdens. Temporary lodging near hospitals is essential for health care access, yet information is fragmented, forcing patients and caregivers to search across multiple websites to see all options available. We conducted a cross-sectional review (April 2023-May 2024) of publicly available data, cataloging US organizations that offer temporary lodging near health care facilities. We geocoded and integrated data into the Healthcare Housing Navigator, an interactive map built with ArcGIS Experience Builder. Our review identified 510 lodging organizations. The tool uses geographic information systems for interactive filtering and displays key details, such as organization name, location, cost, and eligibility criteria. By centralizing fragmented information on medical lodging, the Healthcare Housing Navigator addresses an overlooked health-related social need and equips patients, caregivers, and care teams with timely, accessible information.
Pharmacist Involvement in Hepatitis C Management and Time to Treatment Initiation in Medically Underserved Primary Care Settings.
Furdich K, Awad M, Maguire M … +8 more , Valentino AS, Staudt A, Nelson NG, Church J, Wagner B, Tutu P, Cohrs J, Paul S
Public Health Rep · 2025 Oct · PMID 41163449 · Full text
OBJECTIVES: Although the existing literature highlights the success of pharmacist-led hepatitis C virus (HCV) treatment, the impact of these models on time to treatment initiation has not been studied. This study compare...
OBJECTIVES: Although the existing literature highlights the success of pharmacist-led hepatitis C virus (HCV) treatment, the impact of these models on time to treatment initiation has not been studied. This study compared outcomes for HCV treatment using direct-acting antivirals (DAAs) in 2 groups: pharmacist-led programs in 5 federally qualified health centers in Ohio and an external cohort from an out-of-state academic medical center. We assessed the time to HCV treatment initiation, rates of DAA initiation, and sustained virologic response (SVR) rates. METHODS: We conducted a retrospective cohort analysis using electronic health records and pharmacy claims for patients with HCV referred to pharmacists from November 2021 through December 2023. We collected data on demographic characteristics, pre-entry characteristics, treatment initiation rates, time to initiation, and cure rates. The treatment initiation rate included all patients referred to a pharmacy. We defined time to initiation as the period from pharmacy referral to the date of medication pickup. We defined cure as achieving SVR 12 weeks posttreatment (SVR12) and analyzed SVR12 rates in an intent-to-treat and per-protocol manner. We compared time to initiation with an external cohort median of 300 days. RESULTS: Of 477 referred patients, 317 (66.5%) initiated DAAs. The mean (SD) time to treatment initiation was 63.7 (74.2) days, with a median of 37 days. Among the 212 patients completing SVR12 laboratory tests, 194 achieved cure, yielding a per-protocol SVR12 of 91.5% and an intent-to-treat SVR12 of 61.2%. Patients without (vs with) health insurance and with (vs without) a history of substance abuse had longer treatment delays. CONCLUSIONS: This study demonstrates the value of integrating pharmacists into HCV treatment teams to meet public health needs.
Evaluation of Surveillance for Suspected Human Exposure to Rabies, Washington State, 2018-2023.
Paris K, Hamlet A, Lipton B … +1 more , Oltean H
Public Health Rep · 2026 · PMID 41090527 · Full text
OBJECTIVES: We evaluated the data quality, acceptability, sensitivity, simplicity, and representativeness of the surveillance system for suspected human rabies exposure in Washington State to understand current surveilla...
OBJECTIVES: We evaluated the data quality, acceptability, sensitivity, simplicity, and representativeness of the surveillance system for suspected human rabies exposure in Washington State to understand current surveillance practices and areas for improvement. METHODS: We conducted a mixed-methods evaluation of the state's surveillance system for suspected rabies exposures. Specifically, we compared the number of suspected rabies exposures in the Washington Disease Reporting System (WDRS) with (1) the number of possible rabies exposures captured by syndromic surveillance (Rapid Health Information NetwOrk [RHINO]) and (2) the number of rabies postexposure prophylaxis administrations in the Washington Immunization Information System (WA IIS) from January 2018 through May 2023. We interviewed local health jurisdiction (LHJ) representatives about investigation and reporting of suspected rabies exposure. RESULTS: From January 2018 through May 2023, there were 1766 reports of suspected rabies exposure in WDRS, 5054 events in RHINO, and 2378 events in WA IIS; we found substantial differences among LHJs in the ratio of WDRS reports to events in RHINO and WA IIS. Interview data confirmed variability in reporting practices and data management. LHJ partners identified common barriers and weaknesses of the surveillance system, including staff turnover, system complexity, and a lack of resources for data modernization. CONCLUSIONS: Suspected rabies exposures may not be consistently captured by the existing surveillance system. Variation among data entry procedures and storage systems across LHJs could be attributed to resource availability, population size, and capacity for data modernization. These data will be used to develop recommendations for improvements in rabies exposure surveillance in Washington State.
Conflict, Enteric Disease Burden, Infrastructure, and Policy to Guide Targeted Deployment of Wastewater Surveillance in Low- and Middle-Income Countries.
Sheth P, Graves D, Nadakal S … +4 more , Street R, Chigwechokha P, Hodge B, Holm RH
Public Health Rep · 2026 · PMID 41090511 · Full text
OBJECTIVE: Enteric diseases are a leading cause of death in low- and middle-income countries (LMICs), and wastewater surveillance is a novel approach to understanding their spread in communities. This study identifies LM...
OBJECTIVE: Enteric diseases are a leading cause of death in low- and middle-income countries (LMICs), and wastewater surveillance is a novel approach to understanding their spread in communities. This study identifies LMICs that could benefit from the implementation of wastewater surveillance, offering field researchers, health organizations, and policymakers data-driven guidance for prioritization. MATERIALS AND METHODS: We used principal component analysis (PCA) across country-level self-reported policy capabilities, estimated enteric disease prevalence, the impact of conflicts, and the status of water and sanitation infrastructure for LMICs to model clusters of highly similar countries. Each PCA cluster grouped countries with greater similarity to one another than to other clusters, allowing for targeted surveillance interventions. RESULTS: We modeled 7 clusters. We based recommendations ranging from actively increasing internal investment to promoting wastewater surveillance or deferring current wastewater surveillance implementation on the balance of attributes found for each cluster. PRACTICE IMPLICATIONS: This country-clustering framework offers several policy and investment profiles without overwhelming complexity. Within this framework, the targeted deployment of wastewater surveillance may provide data to reduce enteric disease morbidity and mortality in LMICs.
Racial and Ethnic Disparities in COVID-19 Vaccination Intention and Uptake by July 2022 in Wisconsin.
Alishahi ML, Modji K, Seibert G … +2 more , Pray I, Westergaard R
Public Health Rep · 2025 Oct · PMID 41068049 · Full text
OBJECTIVES: Understanding COVID-19 vaccination behavior can guide public health efforts to increase vaccination acceptance and uptake. We examined COVID-19 vaccination intention among Wisconsin residents and assessed rac...
OBJECTIVES: Understanding COVID-19 vaccination behavior can guide public health efforts to increase vaccination acceptance and uptake. We examined COVID-19 vaccination intention among Wisconsin residents and assessed racial and ethnic disparities in vaccine uptake. METHODS: We assessed vaccination intention during COVID-19 testing registration in February 2021 and used the Wisconsin Immunization Registry to ascertain COVID-19 vaccination uptake by July 2022. We described differences in intention to get vaccinated and assessed the association between racial and ethnic identity and vaccination. We analyzed vaccination likelihood by using Cox proportional hazards models and presented adjusted hazard ratios (AHRs) with 95% CIs. RESULTS: Of 12 196 people, 9843 (80.7%) intended to be vaccinated against COVID-19. A higher proportion of non-Hispanic Black people (21.1%) than people in all other racial and ethnic groups did not intend to get vaccinated. Adjusting for vaccination intention, age group, sex, and neighborhood Area Deprivation Index, Hispanic people were 41% (AHR = 0.59; 95% CI, 0.54-0.64) less likely than non-Hispanic White people to get vaccinated. Compared with non-Hispanic White people, non-Hispanic Black people were 24% (AHR = 0.76; 95% CI, 0.68-0.84) less likely to get vaccinated and Asian people were 18% (AHR = 0.82; 95% CI, 0.75-0.90) less likely to get vaccinated. CONCLUSIONS: Racial and ethnic disparities in vaccination uptake persisted despite controlling for intention. Efforts to focus public health resources on increasing COVID-19 vaccination among racial and ethnic minority groups are important.
Guidance for the Methodological Challenges of Polytobacco Use in Tobacco Regulatory Science.
Mermelstein R, Pentz MA, Hedeker D … +10 more , Audrain-McGovern J, Fleischer NL, Bray B, Giovenco DP, Mayne RG, Hirschtick JL, Mackinnon DP, Strong D, Price S, Stanton CA
Public Health Rep · 2026 · PMID 41020569 · Full text
Abstract loading — click title to view on PubMed.
Accuracy of Suicidal Behaviors in Administrative Data as Measured by -Based Codes, 2000-2024: A Rapid Review.
Hensley SW, Esie P, Ta M … +1 more , Matheson A
Public Health Rep · 2026 · PMID 40988305 · Full text
OBJECTIVES: Suicidal behaviors present public health challenges worldwide. Surveillance and research aimed at preventing suicidal behaviors often rely on administrative data. Existing systematic reviews examine the valid...
OBJECTIVES: Suicidal behaviors present public health challenges worldwide. Surveillance and research aimed at preventing suicidal behaviors often rely on administrative data. Existing systematic reviews examine the validity of methods for identifying suicidal outcomes in administrative datasets but do not include codes based on the (ICD-10), despite their widespread use for >2 decades. This rapid review evaluates methods for identifying suicidal behaviors using ICD-10 codes. METHODS: We searched PubMed and PsycINFO to identify relevant studies worldwide. Studies were included if they measured suicidal behaviors, used ICD-10 codes, validated the behaviors against a gold standard, and provided measures of accuracy (eg, specificity, sensitivity). We extracted data on study populations, data sources, ICD-10 codes used, gold-standard comparators, and accuracy measures from included studies. RESULTS: Of 2246 studies identified, 9 met our inclusion criteria. For methods identifying suicide attempts, sensitivity ranged from 19% to 45%, specificity from 47% to 99%, positive predictive value from 21% to 82%, and negative predictive value from 65% to 92%. For methods identifying self-harm, sensitivity ranged from 12% to 85%, specificity from 98% to 100%, positive predictive value from 64% to 100%, and negative predictive value from 86% to 87%. Only sensitivity was reported for suicide death (range, 78%-97%). CONCLUSIONS: Findings indicate that sensitivity and positive predictive value for identifying suicide attempts using ICD-10 codes are low. Studies and surveillance methods relying on these codes might substantially underestimate rates of suicidal behaviors. ICD-10 codes may provide higher accuracy for identifying self-harm and other nonfatal suicidal behaviors than codes from the .
Association Between Social Vulnerability and Infection-Induced SARS-CoV-2 Antibody Seroprevalence Among Children: United States, 2021-2022.
Kim Y, Iachan R, Biel M … +3 more , Jones JM, Bratcher A, Clarke KEN
Public Health Rep · 2025 Sep · PMID 40988300 · Full text
OBJECTIVES: Understanding the differential burden of pediatric SARS-CoV-2 infection by social factors is important to guide public health action. We evaluated the associations between county-level social vulnerability an...
OBJECTIVES: Understanding the differential burden of pediatric SARS-CoV-2 infection by social factors is important to guide public health action. We evaluated the associations between county-level social vulnerability and infection-induced SARS-CoV-2 antibody seroprevalence and how associations changed over time. METHODS: We analyzed pediatric national serosurvey data from 50 US states, the District of Columbia, and Puerto Rico from September 2021 through December 2022 (N = 216 273). Specifically, we estimated adjusted prevalence ratios (APRs) of SARS-CoV-2 antibody seropositivity across terciles of overall county Social Vulnerability Index (SVI) scores and vulnerability scores across the 4 SVI domains: socioeconomic status, household characteristics, racial and ethnic minority status, and housing and transportation. We conducted multilevel mixed-effects Poisson models with robust variance estimation of the association of seropositivity with scores for SVI and its domains over time, adjusting for age, sex, rural/urban status, US Census region, and county vaccination rates. RESULTS: In September 2021, children residing in the highest (APR = 1.4) and medium (APR = 1.2) tercile counties by SVI score were more likely to have serologic evidence of past SARS-CoV-2 infection than those residing in the lowest tercile counties. This association attenuated over time; domain-specific vulnerability scores for socioeconomic status and household characteristics displayed similar associations and temporal patterns. CONCLUSIONS: Our findings demonstrate the dynamic nature of pediatric health during a public health emergency. The results reinforce the importance of data systems that allow public health agencies to be responsive through tailored strategies to support children experiencing the greatest health effects, thereby advancing opportunities for all people to attain their highest level of health.
Vulvovaginal Candidiasis Among American Indian and Alaska Native People, Indian Health Service, 2016-2022.
Benedict K, Kennedy JL, Smith DJ … +2 more , Haberling DL, Chukwuma U
Public Health Rep · 2026 · PMID 40948478 · Full text
Vulvovaginal candidiasis (VVC) is an infection caused by the yeast that affects more than 50% of women in their lifetime. We aimed to describe VVC among American Indian/Alaska Native (AI/AN) girls and women who were rec...
Vulvovaginal candidiasis (VVC) is an infection caused by the yeast that affects more than 50% of women in their lifetime. We aimed to describe VVC among American Indian/Alaska Native (AI/AN) girls and women who were receiving care in the Indian Health Service (IHS) system during 2016-2022. We calculated the annual VVC prevalence per 1000 IHS user population and examined underlying medical conditions, previous diagnoses, and antifungal treatment. Among 6 million female patient-years, 70 766 patients had ≥1 VVC diagnosis code (2022 prevalence: 14.2 per 1000 IHS user population). Frequent previous or concurrent diagnoses included diabetes (24.8%), urinary tract infection (13.6%), screening for sexually transmitted infection (13.2%), and unspecified acute vaginitis or vulvitis (13.0%). Approximately one-third (33.1%) of patients received fluconazole, and 25.7% received prescription topical antifungal medication. VVC was a common condition among AI/AN patients who accessed care in the IHS health care system. VVC prevalence among AI/AN patients was similar to the prevalence among the broader US population. These data provide a baseline for future studies to evaluate diagnostic and treatment practices for VVC among AI/AN people.
Nonfatal Overdose Biosurveillance: A Cross-Sectional Pilot Study.
Bates MN, Murphy C, Jin Z … +2 more , Burmeister B, Barkholtz HM
Public Health Rep · 2025 · PMID 40937595 · Full text
OBJECTIVE: Nonfatal overdoses provide critical insights into the substance use crisis, offering opportunities for timely interventions and prevention. This study pilots a nonfatal overdose biosurveillance strategy to ana...
OBJECTIVE: Nonfatal overdoses provide critical insights into the substance use crisis, offering opportunities for timely interventions and prevention. This study pilots a nonfatal overdose biosurveillance strategy to analyze the demographic, clinical, and toxicological profiles of overdose patients, aiming to identify patterns and risk factors associated with these incidents. METHODS: We assessed residual urine specimens collected from emergency department patients experiencing a nonfatal overdose at 2 hospitals in Wisconsin from August 2022 through February 2024. We collected data on patient demographic characteristics, results of clinical toxicology screening, manner of overdose, risk factors for overdose, and discharge status. Statistical analyses identified associations and odds ratios (ORs) among patient characteristics, detected drugs, and discharge status. RESULTS: Of the 79 patients in the study, many had risk factors for overdose, including substance use disorder (48%), history of a mental health condition (43%), and polysubstance use (72%). Synthetic opioids had a strong positive association with a history of overdose (OR = 3.86). The presence of stimulants and antidepressants showed moderate sex-based associations, while race was linked to differing discharge status. Polysubstance use had a positive association with some drug combinations, such as narcotic analgesics and cocaine (OR = 4.00). CONCLUSIONS: This study highlights the prevalence of polysubstance use and identifies key demographic and clinical factors associated with nonfatal overdoses. These findings underscore the need for comprehensive, real-time biosurveillance to inform targeted public health interventions and improve patient outcomes. Enhanced understanding of these patterns can lead to more effective strategies for overdose prevention and management, addressing a critical gap in current public health approaches.
An Assessment of Knowledge and Awareness of Human Trafficking Among Health Care Professionals and Students in Texas, 2020.
Nwokocha E, Huang YC, Machona B … +3 more , Hernandez J, Blank A, Lin LC
Public Health Rep · 2025 · PMID 40936494 · Full text
OBJECTIVES: Human trafficking results in negative health outcomes among survivors. However, a lack of awareness and understanding of human trafficking limits health care professionals' ability to provide appropriate care...
OBJECTIVES: Human trafficking results in negative health outcomes among survivors. However, a lack of awareness and understanding of human trafficking limits health care professionals' ability to provide appropriate care in primary and community care settings. We assessed the general understanding and awareness of human trafficking among students, staff, and faculty at The University of Texas at Austin. METHODS: We used self-report instruments in an online survey to collect data on demographic characteristics and responses to questions on human trafficking knowledge, awareness, and the needs of survivors. We summarized participants' knowledge, awareness of, training on, and exposure to institutional protocols related to human trafficking and examined subgroup differences. We also analyzed participants' perspectives on awareness, training, and protocols in responses to open-ended items. RESULTS: Most respondents were female (80 of 85; 94.1%) and associated with the School of Nursing (84 of 85; 98.8%). The average for correct responses to knowledge of human trafficking was 70%. Few respondents (n = 11; 13%) had received at least 1 hour of training in human trafficking in the last year. Most respondents (n = 57; 67.1%) were unsure about ways to request training on human trafficking and whether their institution had any structure for addressing it. Not knowing how to assist human trafficking victims without putting them in danger was reported as difficult. A lack of knowledge and training was reported as a barrier to identifying victims. CONCLUSIONS: Limited understanding and knowledge related to human trafficking and a lack of protocols for nursing professionals to address human trafficking are barriers to effective health care provision. Regular education for students and health care professionals would provide much-needed support for human trafficking survivors.
Cohort Tracking of Sickle Cell Trait-Positive Births Identified by Newborn Screening, California, 1991-2013: Public Health Surveillance for Sickle Cell Trait.
Paulukonis ST, Horiuchi S, Austin T … +1 more , Vichinsky EP
Public Health Rep · 2025 · PMID 40932173 · Full text
OBJECTIVES: Sickle cell trait (SCT) is the carrier status for sickle cell disease, and people with SCT have both hemoglobin A (HbA) and sickling hemoglobin (HbS). SCT is generally regarded as a benign condition, but clin...
OBJECTIVES: Sickle cell trait (SCT) is the carrier status for sickle cell disease, and people with SCT have both hemoglobin A (HbA) and sickling hemoglobin (HbS). SCT is generally regarded as a benign condition, but clinical complications can be substantial. No registry or surveillance system exists to track health outcomes for people with SCT; this study aimed to identify methodology for surveillance. METHODS: This longitudinal analysis included all live births with SCT identified by the California Department of Public Health Newborn Screening (NBS) Program from 1991 through 2013 and 3 matched controls per newborn, linked to death data in California for 1991-2013. RESULTS: There were 94 240 live births with SCT and 282 720 matched healthy controls; 693 (0.74%) deaths occurred in the SCT group, and 1910 (0.68%) deaths occurred among the matched controls. Those with SCT had an increased mortality hazard ratio (MHR) compared with matched controls (11% higher; = .02). When stratified, the MHR was higher among those aged 1 to 4 years (44% higher; < .001) and 5 to 14 years (48% higher; = .005) than among the matched controls. Examination of causes of death showed only a slightly higher-than-expected risk of death due to respiratory causes among people with SCT. CONCLUSIONS: These findings highlight the need for population-level research, including investigation into causes of death, to inform clinical management and counseling for SCT. Other states may replicate this methodology with population-based data sources. Further surveillance of the health of those with SCT is needed.
Evaluation of Kindergarten Through Grade 12 All-Cause Absenteeism Data as an Indicator and Predictor of Respiratory Disease, 2018-2022.
Oberholtzer ZW, Jeon S, Fineman L … +5 more , Hocevar Adkins SN, Kang GJ, Imberi-Olivares K, Barrios LC, Meltzer MI
Public Health Rep · 2025 Sep · PMID 40914872 · Full text
OBJECTIVES: Increases in absenteeism among schoolchildren may precede increases in incidence of community-level respiratory diseases. This study assessed the correlations and predictive values between all-cause absenteei...
OBJECTIVES: Increases in absenteeism among schoolchildren may precede increases in incidence of community-level respiratory diseases. This study assessed the correlations and predictive values between all-cause absenteeism among kindergarten through grade 12 students and community-level increases in influenza and COVID-19. METHODS: We used absenteeism data from 4 school districts (1 each in Arizona, California, Nevada, and Wisconsin) between fall 2018 (starting approximately late August) and spring 2022 (typically ending in May) to calculate correlations between school absenteeism and community-level cases of influenza, percentage of influenza-like illness, and COVID-19. We estimated the positive predictive value (PPV) of a ≥20% increase in school absences to predict a ≥20% increase in community respiratory disease 1 or 2 weeks later. RESULTS: We observed a median correlation of 0.4 between absenteeism and influenza cases across school years and districts, with a maximum of 0.8. COVID-19 cases had a median correlation of 0.1 with school absenteeism during the 2021-2022 school year. The median PPV for predicting increases 2 weeks ahead was 0.4 for influenza and was 0.3 for COVID-19. CONCLUSIONS: Correlations and PPVs between all-cause school absenteeism and respiratory disease were variable, often <0.5. School and public health officials may find absenteeism an inconsistent predictor of community-level respiratory diseases, limiting its utility for syndromic surveillance. Standardizing absence definitions and improving reporting timeliness may enhance its effectiveness.
Implementation of Mobile Medical Units for Veterans Experiencing Homelessness: A Mixed-Methods Study.
Yoon J, Wong EP, Weber JJ … +2 more , Blonigen DM, Tsai J
Public Health Rep · 2025 · PMID 40914871 · Full text
OBJECTIVES: Mobile medical units (MMUs) provide health care services in the community to reach populations with geographic, financial, and other barriers to care. The US Department of Veterans Affairs (VA) Homeless Patie...
OBJECTIVES: Mobile medical units (MMUs) provide health care services in the community to reach populations with geographic, financial, and other barriers to care. The US Department of Veterans Affairs (VA) Homeless Patient Aligned Care Team (HPACT) program deployed MMUs to 25 sites in fiscal year 2024 to increase access for veterans experiencing homelessness. We examined early implementation of MMUs in HPACT sites by describing implementation and operational issues, services provided, and characteristics of veterans who used MMUs. METHODS: To examine the implementation of MMUs on veterans experiencing homelessness, we conducted a mixed-methods study using an online survey and health care administrative data. Measures included MMU implementation time, staffing type, services, safety measures, maintenance costs, and characteristics of veterans using and not using MMUs. We examined differences between veterans who used MMUs and those who did not. RESULTS: Seventeen of 25 sites responded to the survey; MMU implementation occurred during a mean of 147 hours in 5 months. Most sites (15 of 17) visited housing sites and homeless shelters in community- and VA-supported programs to provide health screenings, education, and medication administration and prescribing. Operating costs varied widely for vehicle maintenance and gas and medical and telehealth equipment. Veterans who used MMUs (vs did not use MMUs) had more medical comorbidities (Elixhauser score of 3.4 vs 2.8), were more likely to have substance use disorder (49.9% vs 39.1%), and had higher baseline levels of health care use, especially emergency department visits (0.4 vs 0.3 visits per quarter). CONCLUSIONS: Evidence on the effects of MMUs on patient engagement with primary and mental health care and acute care use is needed to inform decisions to implement MMUs.
The Experiences of Patients With Rare Diseases in Pennsylvania: A Community-Based Study.
Sussman JH, Dagli MM, Wald SL … +6 more , Akhtar SS, Natan K, Xu JA, Li A, Dawson B, Welch WC
Public Health Rep · 2025 · PMID 40914869 · Full text
OBJECTIVE: Rare diseases collectively affect approximately 30 million people in the United States. Despite advances in genomic medicine, early diagnosis is challenging because of limited awareness of, accessibility to, a...
OBJECTIVE: Rare diseases collectively affect approximately 30 million people in the United States. Despite advances in genomic medicine, early diagnosis is challenging because of limited awareness of, accessibility to, and disparities in health care resources. We assessed the real-world experiences of patients with rare diseases in Pennsylvania and evaluated the effect of delayed diagnosis on psychosocial and financial burdens. METHODS: The Pennsylvania Rare Disease Advisory Council conducted a Rare Disease Needs Assessment Survey from September 2020 through January 2023. The survey, distributed through multiple channels, collected responses from patients, caregivers, and rare disease advocates in Pennsylvania. We analyzed quantitative and qualitative data on diagnosis, health care access, financial burden, and psychosocial support. RESULTS: A total of 1214 respondents participated, representing a diverse spectrum of rare diseases and demographic groups. More than half (57.8%) of respondents indicated diagnostic delays of ≥1 year, which were associated with additional misdiagnoses, increased annual spending, out-of-state travel, and reduced work and school hours; however, diagnostic delays were not associated with disease category. Many respondents (48.5%) reported >$5000 in annual spending related to care for their rare disease, and 24.9% were unable to access medications because of financial reasons. Diagnostic delays were associated with worse perspectives on the efficacy of care across multiple domains even after a correct diagnosis was achieved. Patients aged 0 to 20 years had a faster time to diagnosis than patients aged >20 years did. CONCLUSION: Patients with rare diseases in Pennsylvania face substantial barriers to diagnosis, specialized care, and financial support. Despite policy initiatives, gaps remain in genetic testing access, specialist availability, and psychosocial resources. Addressing these issues through improved diagnostics, expanded access to care, and targeted policy changes is essential to enhancing patient outcomes and quality of life.
Wastewater Monitoring: Improving Public Awareness and Understanding in the United States, May 2024.
Kreuter MW, Garg R, Marsh AK … +5 more , Olagoke A, Weng O, De La Vega V, Dunn C, Johnson KJ
Public Health Rep · 2026 · PMID 40914868 · Full text
OBJECTIVES: Although wastewater monitoring for virus detection has increased in communities worldwide, public awareness, understanding, questions, and concerns about wastewater monitoring are largely unknown. We assessed...
OBJECTIVES: Although wastewater monitoring for virus detection has increased in communities worldwide, public awareness, understanding, questions, and concerns about wastewater monitoring are largely unknown. We assessed awareness, knowledge, and support for wastewater monitoring for detection of viruses and bacteria among US residents and elicited questions and concerns from residents about its use. METHODS: We conducted a survey among a racially and ethnically diverse sample of residents in Colorado, Maryland, Missouri, Nebraska, and Texas to assess awareness, knowledge, and support of wastewater monitoring. We also asked an open-ended question to elicit further questions and concerns from survey participants about wastewater monitoring. Two independent reviewers coded the responses to the open-ended question. RESULTS: Among 516 survey participants (52% White, 31% Black, 27% Hispanic ethnicity), 289 (56%) were aware that local public health departments and federal health agencies tested sewer water yet 334 (65%) knew "little or nothing" about wastewater monitoring. After participants were exposed to a brief description of the wastewater monitoring process, 80% "supported" or "strongly supported" wastewater monitoring to detect viruses and bacteria. When we analyzed responses to the open-ended question on wastewater monitoring, 3 broad categories and 9 subcategories of questions and concerns about wastewater monitoring emerged: (1) how wastewater monitoring works (mechanics, accuracy, cost, safety), (2) what is done with the findings generated by wastewater monitoring (public accessibility, government trust, public health response), and (3) what protections were in place against misuse of findings (privacy, fairness). CONCLUSIONS: Proactive public education is needed to increase understanding, build support, and prevent disinformation about wastewater monitoring. Local systems are needed to share findings rapidly, clearly, and simply.
Exploring Neighborhood Opportunity as a Factor in Pediatric Asthma Visits to the Emergency Department.
Khodakarami N, Akinlotan M, Ferdinand AO
Public Health Rep · 2025 · PMID 40886322 · Full text
OBJECTIVES: Despite growing interest in environmental and social determinants of health, few studies have explored how residential mobility influences respiratory health outcomes. We examined the relationship between lev...
OBJECTIVES: Despite growing interest in environmental and social determinants of health, few studies have explored how residential mobility influences respiratory health outcomes. We examined the relationship between levels of opportunity across education, health and environment, social and economic, and all domains in a child's neighborhood and the likelihood of emergency department (ED) visits for asthma and showed how moving from one neighborhood to another would affect the odds of visiting the ED for asthma. METHODS: In this cross-sectional study, we analyzed asthma-related ED visits among children aged 2 to 17 years in 9 US states (Arizona, Florida, Kentucky, Maryland, New Jersey, North Carolina, Oregon, Rhode Island, and Wisconsin) during 2016-2019. We used a multivariable logistic regression model to examine the relationship between the Child Opportunity Index (COI) and ED visits for asthma. We used a piecewise linear logit model to estimate the neighborhood's opportunity effect. RESULTS: Children living in neighborhoods with very low COI had a high probability of visiting the ED for asthma (adjusted odd ratio = 1.14; < .001). In addition, moving from a low to a very low COI neighborhood significantly increased the probability of asthma-related ED visits among children aged 5 to 9 years (0.8 percentage points), Black children (0.4 percentage points), boys (0.7 percentage points), and those living in large metropolitan areas (0.6 percentage points). CONCLUSIONS: Our findings suggest that improvement in neighborhood opportunity may translate to better asthma-related health outcomes among children. Future research should continue to investigate the effects of neighborhood opportunity on other childhood conditions.
A Message From the Editor.
Dembek ZF
Public Health Rep · 2025 · PMID 40874576 · Full text
Abstract loading — click title to view on PubMed.
Centering Lived Experience in Human Trafficking Recovery: A Needs Assessment of Service Gaps and Survivor Involvement in Kern County, California.
Hogan KA, Woo-Cater S, Sharp D … +3 more , Roe-Sepowitz D, Gibbs H, Lindén P
Public Health Rep · 2025 · PMID 40874439 · Full text
OBJECTIVES: Human trafficking is a persistent and complex issue in Kern County, California, where data on how social service systems are responding to the needs of survivors are limited. We aimed to identify the service...
OBJECTIVES: Human trafficking is a persistent and complex issue in Kern County, California, where data on how social service systems are responding to the needs of survivors are limited. We aimed to identify the service needs and gaps in efforts for human trafficking response among social service providers in Kern County and to explore the role of engaging people with lived experiences in service delivery. METHODS: We conducted a cross-sectional survey from April 26 through May 31, 2021, among 57 social service agencies in Kern County involved in assisting juvenile and adult survivors of sex trafficking and/or labor trafficking. In the survey, we included 77 questions addressing agency demographic characteristics, services provided, training needs, and the involvement of people with lived experiences of trafficking in service delivery. We analyzed quantitative and qualitative data. RESULTS: Of the 57 contacted agencies, 27 (47.4%) completed the survey. Among the 27 responding agencies, 22 (81.5%) provided services to individuals who have experienced sex trafficking and 13 (48.1%) provided services to individuals who have experienced labor trafficking. Only 7 agencies (31.8%) had specialized positions for sex trafficking recovery services. Barriers to service delivery among agencies included funding shortages and limited training in trauma-informed care. Moreover, most agencies did not engage people with lived experiences of trafficking in decision-making roles. CONCLUSIONS: Enhanced funding, targeted training, and increased engagement of people with lived experiences of trafficking among social service providers in Kern County are needed to improve the support system for trafficking victims and create a more effective, collaborative response to human trafficking in the region.
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