BACKGROUND: In August 2020, the Centers for Disease Control and Prevention (CDC) released guidance to prevent transmission of coronavirus disease 2019 (COVID-19) in K-12 education settings. Schools varied in the degree to which they were able to implement COVID-19 prevention strategies during the height of the pandemic. METHODS: An evaluation team conducted interviews with state education staff and focus groups with district and school staff over 2 years to explore contextual factors that influenced the implementation of CDC's recommended COVID-19 prevention strategies. RESULTS: Eight implementation drivers influenced COVID-19 response efforts in school settings, including COVID-19 guidance, political climate, communication challenges, state health and education agency support, partnerships, physical and financial resources, staffing, and student needs. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Evaluation results offer insights for future guidance and support for schools and educators as they continue efforts to prevent the spread of COVID-19 and other infectious diseases for safe in-person learning. CONCLUSIONS: The authors describe key drivers and conditions that influenced, facilitated, and/or impeded schools' implementation of COVID-19 prevention strategies. Federal, state, district, and school leadership can use the results to bolster future emergency preparedness and response efforts to protect student and school employee health.

Mpox emerged on the global scale in 2022 and predominately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma related to mpox is a potential harm for individuals experiencing multiple levels of marginalization who may already be discriminated against in family, health care, and other social domains. To understand perceived mpox stigma among cisgender GBMSM in the United States, we conducted a study within the American Men's Internet Survey with 824 cisgender GBMSM >= 15 years from August 5 to 15, 2022. Perceived mpox stigma was most prevalent among non-Hispanic Black individuals (13.9%) compared to non-Hispanic White individuals (6.0%) and particularly among men aged 25-29 (15.1%) compared to men aged 40+ (5.6%). In adjusted logistic regression models, mpox stigma was significantly associated with knowing someone who tested for mpox (adjusted odds ratio (aOR) = 4.3 95% confidence interval, CI [2.1, 9.0]), knowing someone who was vaccinated for mpox (aOR = 2.1; 95% CI [1.2, 3.7]), or having an unexplained rash in the 3 months prior to survey completion (aOR = 3.6; 95% CI [1.9, 7.0]). These initial findings suggested people who were more connected to mpox-affected social networks and also those who had symptoms consistent with mpox were more likely to experience stigma. Taken together, these data suggest the potential harmful impact of mpox-related stigma by affecting those who would most benefit from services. Moreover, these data suggest the importance of real-time stigma measurement and mitigation for both rapidly emergent and chronic infectious diseases to improve equity, reduce fear and misinformation, and optimize the impact of public health responses. (PsycInfo Database Record (c) 2025 APA, all rights reserved) Impact Statement Stigma can have far-reaching consequences. It can exacerbate health disparities, influence social networks, and discourage individuals from seeking preventative health care, including vaccination. This study's findings highlight that, even if not widespread, stigma can concentrate in marginalized groups and drastically affect individuals' lives. By acknowledging and addressing stigma, public health agencies and providers can foster inclusivity, limit fear, promote trust in health care systems, and improve the overall health and resilience of communities. (PsycInfo Database Record (c) 2025 APA, all rights reserved)

Climate change poses profound threats to human safety, health, and well-being. Public health agencies, especially state, territorial, local, and Tribal health departments, can play an essential role in climate change adaptation and mitigation. Public health climate action can protect health, promote health equity, and increase climate change resilience. The Centers for Disease Control and Prevention has updated its original climate and health framework for practitioners and expanded its utility by developing practical guidance. The revised framework, Building Resilience Against Climate Effects, supports health departments and their partners by providing an accessible approach that can be tailored to different contexts. The framework has been updated to center justice, equity, and belonging; integrate climate change mitigation or reduction of greenhouse gas emissions that cause climate change; and address agency capacity. The Building Resilience Against Climate Effects framework also emphasizes collaboration, especially cross-sectoral and community partnerships, communication, and evaluation. Framework elements, key tactics, and guiding principles are presented in a pragmatic, step-by-step implementation guide. The implementation guide can be used by state, territorial, local, and Tribal health departments to galvanize or expand their engagement with public health climate action, which grows more urgent each year. (Am J Public Health. Published online ahead of print May 22, 2025:e1-e12. https://doi.org/10.2105/AJPH.2025.308061).

BACKGROUND: School professionals, including classroom teachers, school administrators, psychologists, teachers' aides, and nurses, often interact with students with concussions. To ensure they have the knowledge to identify and manage concussions, the U.S. Centers of Disease Control and Prevention developed the HEADS UP to Schools online training. METHODS: The HEADS UP to Schools training includes a pre-test and post-test consisting of 16 knowledge questions in three areas (symptom recognition, school support and accommodation, and guidance and recommendations for school staff) and five self-efficacy questions. Pre- and post-test responses of 8750 individuals were compared and analyzed to evaluate the effectiveness of the training. RESULTS: Respondent scores significantly improved between pre- and post-test responses for all knowledge questions and self-efficacy questions. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Schools and school districts may consider offering this training to staff to help ensure that at least one person at each school is trained on concussion and to increase awareness of evidence-based practices. CONCLUSIONS: Knowledge and self-efficacy on concussion identification and management improved among school professionals who completed the HEADS UP to Schools training. Future research to assess whether concussion knowledge and self-efficacy are maintained long term may be beneficial.

BACKGROUND: Integrating Routine Immunization (RI) into COVID-19 vaccination implies that COVID-19 vaccination is the primary focus, with RI services added to the effort. During COVID-19 vaccination campaigns in Nigeria, healthcare workers also provided routine vaccines such as measles and polio to individuals who came for their COVID-19 shots. This paper aims to demonstrate that integrating RI into COVID-19 vaccination increases overall vaccine coverage but may introduce equity issues. METHODOLOGY: The data used in this study consist of COVID-19 immunization records (first, second, and booster doses) from 23 local government areas (LGAs) in Niger State, Nigeria. The project aimed to vaccinate the remaining 30% of the population who had not received any COVID-19 vaccine doses. Two LGAs were excluded due to security concerns. Routine immunizations (RIs) provided alongside COVID-19 vaccinations included the inactivated polio vaccine (IPV), oral polio vaccine (OPV), pentavalent polio vaccine (PENTA), and other vaccines based on specific needs, primarily targeting zero-dose children. The primary outcome was vaccine coverage, measured as the percentage of targeted individuals who received at least one dose of the COVID-19 vaccine. Secondary outcomes included the uptake of routine immunization during COVID-19 vaccination campaigns and a gender equity analysis to assess disparities in vaccination rates between males and females. RESULTS: A total of 436,598 individuals were vaccinated, with a daily average of 3,898. Among those vaccinated, 49.78% were male, while 50.22% were female, achieving a percentage coverage of 101%. Of the vaccinated individuals, 76% received a single dose, 5.1% received a second dose, and 18.3% received a booster dose. Among those who received a single dose, 49.9% were male and 50.1% were female. Among those who received the second dose, 47.4% were male and 52.6% were female. Among those who received the booster dose, 49.8% were male and 50.2% were female. No significant mean differences were found between males and females for those who received the first and booster doses. Similarly, there were no significant mean differences between the targeted and achieved vaccinations, despite variations in coverage across the 23 LGAs. Additionally, 60,373 routine immunizations were administered alongside COVID-19 vaccinations. A breakdown of the RI distribution showed that 17.6% of recipients received PENTA, 18.3% received OPV, 17.6% received IPV, and 46.5% received other vaccines. A significant mean difference was observed between males and females when RI was integrated into COVID-19 vaccinations, suggesting a gender disparity. CONCLUSION: Although integrating RI into COVID-19 vaccination efforts increased overall immunization coverage, the data suggest potential inequities, as a higher proportion of RI doses were administered to females. This finding highlights differences in vaccine access between males and females. Further research is needed to understand the impact of gender differences in RI integration and to promote equitable vaccination access for all.

BACKGROUND: Healthcare providers play a critical role in the return to school (RTS) process after a child sustains a mild traumatic brain injury (mTBI). The purpose of this study was to examine healthcare providers' perspectives on effective communication with school personnel and gaps within those practices, using a qualitative approach. METHODS: Twelve community-based healthcare providers in suburban Oregon and Ohio completed semi-structured interviews between February 2021 and July 2021 via Zoom. Data were analyzed using thematic analysis. RESULTS: Primary themes centered on how breakdowns in communication between healthcare and education systems occur easily without formalized systems, and how formalized systems of care are beneficial. CONCLUSIONS: Children with mTBI benefit when there is (1) a consistent communication system between school-based staff, caregivers, and healthcare providers and (2) a clear point person in the school system. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Schools should create intentional and formalized communication pathways with healthcare providers as an effective approach to meeting the needs of students and their families.

OBJECTIVE: The National Association of Chronic Disease Directors (NACDD) is a nonprofit organization that supports state and territorial chronic disease prevention and health promotion efforts through capacity building and technical assistance. Each year, NACDD surveys health department leaders who oversee chronic disease prevention and health promotion (hereafter, Chronic Disease Directors). We have previously used the annual survey results to inform strategic planning and resource allocation but have not historically published key findings in the peer-reviewed literature. In this paper, we report on NACDD's 2023 survey outcomes and place those findings into the broader public health policy context. DESIGN: State Chronic Disease Directors completed a survey about their organizational capacity and development needs. Responses were summarized in aggregate and by jurisdiction size. RESULTS: State chronic disease units have varied staffing and responsibilities, but most address diabetes, cardiovascular diseases, and cancer screening and prevention. Chronic Disease Directors generally reported strong or improving capacity in most practice areas but ranked workforce development lower. Staffing increased slightly during 2023 compared with the 2020 baseline (median of 1.3 and 1.1 employees per 100 000 jurisdiction population, respectively). However, Chronic Disease Directors expressed ongoing concerns about turnover, hiring, and training of inexperienced staff, as well as about funding limitations and uncertainty. Looking forward to 2024, many Chronic Disease Directors expressed intentions to focus on supporting their workforce with training and development opportunities and addressing health equity. CONCLUSIONS: During this period of pandemic recovery, turnover, hiring, and training-particularly of the many new public health staff-remain key areas of concern for many chronic disease units. Continued stabilization of public health funding and increased prioritization of organizational capacity development-particularly workforce development, chronic disease data systems, and tools for addressing health equity-could help ensure chronic disease units can better address current and emerging challenges in chronic disease prevention and health promotion.

Decent work, a United Nations Sustainable Development Goal, is built on the ethical treatment of workers and ensures respect of their security, freedom, equity, and dignity. In the future, a wide range of technological forces may pose significant impediments to the availability and quality of decent work. This paper applies a prescriptive taxonomy to categorize evidence of the psychosocial impacts technology may bring to the future of work and elucidate the associated ethical concerns. Ethical objectives in support of a future defined by decent work are also offered. Central to this technoethical discourse are the principles of nonmaleficence, beneficence, autonomy, justice, and respect for persons. Expanded technoethical education, ethical technology assessments, ethical foresight analysis, and revised ethical standards are important ways to address technology-related ethical challenges on a larger scale. The findings in this paper may serve as a foundation for the systemic prevention and control of adverse effects and ethical concerns from the use of technology in the workplace of the future.

The introduction of the Sustainable Development Goals by the United Nations has set a global target for achieving Universal Health Coverage, requiring resilient health systems capable of addressing public health emergencies and ensuring health security. Public health surveillance, crucial for detecting and responding to infectious disease outbreaks, is key to building health system resilience. Due to the high levels of mobility and political instability in the Middle East and North Africa (MENA) region, unique challenges arise in cross-border health surveillance. This review aims to highlight the importance of cross-border public health surveillance in strengthening health systems across MENA to achieve equitable health outcomes.A mixed-methods approach was utilized, combining a systematic literature review with semi-structured in-depth interviews (IDIs) involving 28 stakeholders from seven MENA countries. The literature review adhered to PRISMA guidelines, while the IDIs provided qualitative insights into current surveillance practices and challenges. Findings from the literature review and IDIs were triangulated and analyzed using the WHO Health Systems Strengthening (HSS) Building Blocks Framework to identify key challenges and recommendations for improving cross-border surveillance.Results indicate that existing cross-border surveillance systems in MENA face challenges in data collection, analysis, and sharing, with disparities across countries based on income levels and political contexts. Key challenges include delayed and incomplete data sharing, insufficient funding across sectors, inadequate training, inconsistent data definitions, and limited integration of health data for mobile populations. Recommendations emphasize strengthened governance and leadership to facilitate regional cooperation and information sharing, sustainable financing for implementing a One Health approach, utilizing innovative information systems, workforce development to enhance data collection and analysis, and secure supply chains for medicines and vaccines and equitable service delivery for all mobile populations.In conclusion, the WHO HSS Building Block Framework provides a comprehensive approach to assessing and improving cross-border public health surveillance and enhancing health security and equity in MENA. Strengthening cross-border surveillance systems may help MENA countries meet IHR requirements, achieve greater health security, and advance health equity among all types of mobile populations. Despite limitations, the study offers critical insights for improving cross-border surveillance strategies in the region.

The COVID-19 pandemic magnified long-standing health disparities, showing that certain populations are at higher risk for effects of public health emergencies than others. The pandemic response also put demands on the nation's health departments and stretched their limited resources. In 2021, the Centers for Disease Control and Prevention launched the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities (hereinafter, COVID-19 Health Disparities Grant) to reduce COVID-19 health disparities and advance health equity. Health departments in all 50 states, 50 localities, 5 territories, and 3 freely associated states were recipients of approximately $2.25 billion. This study explored the extent to which investments from the COVID-19 Health Disparities Grant, through the allocation of funds across 5 strategies, correspond to reported changes in recipient health departments' capacity to address the COVID-19 public health emergency and future emergencies as measured in the Health Department and Jurisdiction Capacity Survey in 2023. The survey measured capacity along 4 domains: workforce and human resources, interorganizational relationships, data and informational resources, and governance and planning. In total, 70 of 75 recipients who responded to the survey reported that they began with low capacity in at least 1 capacity domain and advanced their capacity during grant implementation. This study demonstrated the reported value of investments in health departments to build capacity and infrastructure to address health disparities and advance health equity to respond to future public health emergencies.

BACKGROUND: Seasonal influenza illness and acute respiratory infections can impose a substantial economic burden in low- and middle-income countries (LMICs). We assessed the cost of influenza illness and acute respiratory infections across household income strata. METHODS: We conducted a secondary analysis of data from a prior systematic review of costs of influenza and other respiratory illnesses in LMICs and contacted authors to obtain data on cost of illness (COI) for laboratory-confirmed influenza-like illness and acute respiratory infection. We calculated the COI by household income strata and calculated the out-of-pocket (OOP) cost as a proportion of household income. RESULTS: We included 11 studies representing 11 LMICs. OOP expenses, as a proportion of annual household income, were highest among the lowest income quintile in 10 of 11 studies: in 4/4 studies among the general population, in 6/7 studies among children, 2/2 studies among older adults, and in the sole study for adults with chronic medical conditions. COI was generally higher for hospitalizations compared with outpatient illnesses; median OOP costs for hospitalizations exceeded 10% of annual household income among the general population and children in Kenya, as well as for older adults and adults with chronic medical conditions in China. CONCLUSIONS: The findings indicate that influenza and acute respiratory infections pose a considerable economic burden, particularly from hospitalizations, on the lowest income households in LMICs. Future evaluations could investigate specific drivers of COI in low-income household and identify interventions that may address these, including exploring household coping mechanisms. Cost-effectiveness analyses could incorporate health inequity analyses, in pursuit of health equity.

Disparities are evident in viral hepatitis morbidity, mortality, and outcomes. Disparities are considered an outcome of social determinants of health (SDoH), as systemic differences in the conditions in which people are born, grow, live, work, and age can lead to differences in health outcomes and access to health care services among population groups.1,2 Disparities in viral hepatitis incidence and mortality are described in surveillance reports 3 and the literature4,5; however, an examination of the influence of SDoH on disparities in viral hepatitis incidence, mortality, and outcomes is missing from the literature. This gap in the literature could be a direct result of limitations in viral hepatitis surveillance data in capturing relevant measures. However, examining data on social, economic, physical, and political environments of people affected by viral hepatitis is important for understanding the incidence and outcomes of the disease, developing interventions, and assessing progress toward achieving health equity. 1 This commentary discusses existing disparities in viral hepatitis, explores how SDoH may contribute to these disparities, and highlights opportunities to examine the influence of SDoH on viral hepatitis outcomes.

Thirty-four per cent of deaths among Americans aged 1-46 are due to injury, and many of these deaths could be prevented if all hospitals performed as well as the highest-performing hospitals. The Institute of Medicine and the National Academies of Science, Engineering and Medicine have called for learning health systems, with emphasis on clinical practice guidelines (CPGs) as a means of limiting preventable deaths. Reduction in mortality has been demonstrated when evidence-based trauma CPGs are adhered to; however, guidelines are variably updated, redundant, absent, inaccessible, or perceived as irrelevant. Ultimately, these barriers result in poor guideline implementation and preventable patient deaths. This multidisciplinary group of injury providers, clinical guidance developers and end users, public health and health policy experts and implementation scientists propose key areas for consideration in the definition of an ideal future state for clinical guidance development and dissemination. Suggestions include (1): professional societies collaborate rather than compete for guideline development.(2) Design primary clinical research for implementation, and where relevant, with guideline development in mind.(3) Select clinical topics for guideline development through systematic prioritization, with an emphasis on patient-centered outcomes.(4) Develop guideline authorship groups with a focus on transparency, equity of opportunity and diversity of representation.(5) Establish a plan for regular review and updating and provide the date the guideline was last updated for transparency.(6) Integrate options for adapting the guideline to local resources and needs at the time of development.(7) Make guidelines available on a platform that allows for open feedback and utilization tracking.(8) Improve discoverability of guidelines.(9) Optimize user-experience with a focus on inclusion of bedside-ready, mobile-friendly infographics, tables or algorithms when feasible.(10) Use open access and open licenses.(11) Disseminate clinical guidance via comprehensive and equitable communication channels. Guidelines are key to improve patient outcomes. The proposed focus to ensure trauma guidelines are equitably and effectively developed and disseminated globally.

BACKGROUND: Traumatic brain injury (TBI) is a common injury in children. Though research on youth TBI has largely focused on high school students, this study describes selected school outcomes after TBI in the past 12 months among children aged 5-17 years. METHODS: Data from parent-proxy respondents from the pilot administration of the National Concussion Surveillance System (a random-digit-dial telephone survey with over 10,000 adult respondents) were examined. Descriptive statistics of demographic and injury characteristics of children who sustained a TBI were calculated. The association between TBI signs/symptoms and selected school outcomes were determined by multinomial logistic regressions. RESULTS: Among the 3557 children sampled via parent-proxy-reporting, 9.9% sustained a TBI in the past year. Changes in sleep or being more tired than usual, trouble concentrating, sensitivity to light or noise, and difficulty learning or remembering new things were associated with a greater risk of worse school outcomes following a TBI. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: To promote a positive return to learn (RTL) experience among children following TBI, school districts may prioritize accommodations (e.g., breaks in learning, extra time for assignments) and implement existing ascending levels of academic support where warranted. CONCLUSION: These findings may inform stakeholders seeking to enhance RTL and provide needed support or services for school-aged children who sustain a TBI.

OBJECTIVE: To determine whether differences exist in antibiotic prescribing for respiratory infections in pediatric urgent cares (PUCs) by patient race/ethnicity, insurance, and language. DESIGN: Multi-center cohort study. SETTING: Nine organizations (92 locations) from 22 states and Washington, DC. PARTICIPANTS: Patients ages 6 months-18 years evaluated April 2022-April 2023, with acute viral respiratory infections, otitis media with effusion (OME), acute otitis media (AOM), pharyngitis, community-acquired pneumonia (CAP), and sinusitis. METHODS: We compared the use of first-line (FL) therapy as defined by published guidelines. We used race/ethnicity, insurance, and language as exposures. Multivariable logistic regression models estimated the odds of FL therapy by group. RESULTS: We evaluated 396,340 ARI encounters. Among all encounters, 351,930 (88.8%) received FL therapy (98% for viral respiratory infections, 85.4% for AOM, 96.0% for streptococcal pharyngitis, 83.6% for sinusitis). OME and CAP had the lowest rates of FL therapy (49.9% and 60.7%, respectively). Adjusted odds of receiving FL therapy were higher in Black Non-Hispanic (NH) (adjusted odds ratio [aOR] 1.53 [1.47, 1.59]), Asian NH (aOR 1.46 [1.40, 1.53], and Hispanic children (aOR 1.37 [1.33, 1.41]), compared to White NH. Additionally, odds of receiving FL therapy were higher in children with Medicaid/Medicare (aOR 1.21 [1.18-1.24]) and self-pay (aOR 1.18 [1.1-1.27]) compared to those with commercial insurance. CONCLUSIONS: This multicenter collaborative showed lower rates of FL therapy for children of the White NH race and those with commercial insurance compared to other groups. Exploring these differences through a health equity lens is important for developing mitigating strategies.

INTRODUCTION: Food and nutrition security is crucial for health, but many U.S. households experience food insecurity. This systematic review conducted in support of the Community Preventive Services Task Force (CPSTF) examines the effectiveness of Fruit and Vegetable Incentive (FVI) programs in reducing food insecurity, increasing fruit and vegetable (FV) consumption, and improving health outcomes among households with lower incomes. METHODS: Community Guide systematic review methods were applied. Studies were identified through a literature search (inception of each database to February 2023). U.S. studies were included if they evaluated programs offering participants financial incentives to purchase FV; were designed for or implemented among populations with lower incomes; reported health-related outcomes; and were published in English as peer-reviewed articles or government reports. RESULTS: This review included 30 studies. Thirteen of 14 datapoints from 12 studies indicated FVI programs reduced household food insecurity. Twenty-one of 29 datapoints from 23 studies showed increased FV consumption. Programs providing incentives to participants at risk for or with diet-related health conditions improved blood glucose levels by a median of 0.64 percentage points. DISCUSSION: Based on the review findings, CPSTF recommends FVI programs for populations with lower incomes to reduce household food insecurity, increase household FV consumption, and improve blood glucose levels in participants at risk for or with diet-related health conditions. Although the review did not find direct evidence of reducing health disparities, the CPSTF expects that these programs will improve health equity across the US by improving the affordability and accessibility of healthier foods for households with lower incomes.

Objective: The National Association of Chronic Disease Directors (NACDD) is a nonprofit organization that supports state and territorial chronic disease prevention and health promotion efforts through capacity building and technical assistance. Each year, NACDD surveys health department leaders who oversee chronic disease prevention and health promotion (hereafter, Chronic Disease Directors). We have previously used the annual survey results to inform strategic planning and resource allocation but have not historically published key findings in the peer-reviewed literature. In this paper, we report on NACDD’s 2023 survey outcomes and place those findings into the broader public health policy context. Design: State Chronic Disease Directors completed a survey about their organizational capacity and development needs. Responses were summarized in aggregate and by jurisdiction size. Results: State chronic disease units have varied staffing and responsibilities, but most address diabetes, cardiovascular diseases, and cancer screening and prevention. Chronic Disease Directors generally reported strong or improving capacity in most practice areas but ranked workforce development lower. Staffing increased slightly during 2023 compared with the 2020 baseline (median of 1.3 and 1.1 employees per 100 000 jurisdiction population, respectively). However, Chronic Disease Directors expressed ongoing concerns about turnover, hiring, and training of inexperienced staff, as well as about funding limitations and uncertainty. Looking forward to 2024, many Chronic Disease Directors expressed intentions to focus on supporting their workforce with training and development opportunities and addressing health equity. Conclusions: During this period of pandemic recovery, turnover, hiring, and training—particularly of the many new public health staff—remain key areas of concern for many chronic disease units. Continued stabilization of public health funding and increased prioritization of organizational capacity development—particularly workforce development, chronic disease data systems, and tools for addressing health equity—could help ensure chronic disease units can better address current and emerging challenges in chronic disease prevention and health promotion. © 2024 Lippincott Williams and Wilkins. All rights reserved.

Ground beef is a common source of US Salmonella illnesses and outbreaks. However, the demographic and socioeconomic factors that are related to risk in ground beef-associated outbreaks of Salmonella infections are poorly understood. We describe the individual-level demographic characteristics and county-level indicators of social vulnerability for people infected with Salmonella linked to outbreaks associated with ground beef in the United States during 2012-2018. Non-Hispanic (NH) White and NH American Indian/Alaska Native persons, and people living in non-metropolitan areas, were overrepresented among people in salmonellosis outbreaks linked to ground beef. Case patients disproportionately resided in counties with high social vulnerability, suggesting that one or more community social risk factors may contribute to or be associated with some food safety risks. Collecting and analyzing socioeconomic and demographic characteristics of people in outbreaks can help identify disparities in foodborne disease, which can be further characterized and inform equity-focused interventions.

INTRODUCTION: The relationship between social determinants of health (SDOH) and health-related social needs (HRSN) and some chronic diseases at the population level is not well known. We sought to determine relationships between SDOH/HRSN and major chronic diseases among US adults by using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). METHODS: We used data from the new Social Determinants and Health Equity (SD/HE) module, conducted in 39 states, the District of Columbia, and 2 territories as part of the 2022 BRFSS. These data yielded a sample of 324,631 adult participants (aged ≥18 y). We examined 12 indicators of SDOH/HRSN and 9 chronic diseases. We calculated weighted prevalence estimates for each SDOH/HRSN measure for each chronic disease and associations between each SDOH/HRSN and each chronic disease. RESULTS: Two-thirds of participants (66.3%) had 1 or more chronic diseases, and 59.4% reported 1 or more adverse SDOH/HRSN. Prevalence estimates for individual SDOH/HRSN measures were generally higher among participants with chronic diseases (except cancer). The more chronic diseases reported, the more likely participants were to have SDOH/HRSN (P < .05 for linear trend). The leading SDOH/HRSN measures associated with each chronic disease varied; however, the most common were mental stress, receiving food stamps or participating in the Supplemental Nutrition Assistance Program, cost as a barrier for needed medical care, and life dissatisfaction. CONCLUSION: From a treatment and prevention perspective, health care providers should consider the influence of SDOH/HRSN on people with or at risk for chronic diseases. Additionally, human service and public health systems in communities with high rates of chronic disease should consider these findings as they plan to mitigate adverse SDOH.

Background: The Measles-Rubella Microarray Patch (MR-MAP) is an important technology that is expected to reduce coverage and equity gaps for measles-containing vaccines (MCVs), reach zero-dose children, and contribute to elimination of measles and rubella. MR-MAPs are anticipated to be easier to deploy programmatically and could be delivered by lesser-trained health workers, thereby increasing immunization coverage. The most advanced MR-MAP has reached clinical proof-of-concept through a Phase I/II trial in the target population of infants and young children. The World Health Organization (WHO) and partners have developed the Phase III clinical trial framework for MR-MAPs presented in this article. Objectives and Methods: The purpose of such framework is to inform the considerations, design and approach for the pivotal clinical trial design, while considering the anticipated data requirements to inform regulatory approval, WHO prequalification, and policy decision. Results: The proposed Phase III trial would compare the immunogenicity and safety of an MR-MAP with MR vaccine delivered subcutaneously in 9- to 10-month-old infants. An analysis of non-inferiority (NI) of immunogenicity would occur six weeks after the first dose. Should regulatory agencies or policy makers require, a proportion of infants could receive a second dose of either the same or alternate MR vaccine presentation six months after the first dose, with those children returning six weeks after the second dose for a descriptive assessment of immunogenicity, and then followed up six months after the second dose for evaluation of safety and immunogenicity. It is anticipated that this proposed pivotal Phase III trial framework would generate the required clinical data for regulatory licensure and WHO prequalification (PQ) of MR-MAPs. However, the trial design would need to be reviewed and confirmed by a national regulatory authority (NRA) that will assess the product for regulatory licensure and the WHO PQ team. Additional research will likely be required to generate data on concomitant vaccine delivery, the safety and immunogenicity of MR-MAPs in other age groups such as children 1-5 years and infants younger than 9 months of age, and the impact of MR-MAPs on coverage and equity. Such studies could be conducted during or after clinical MR-MAP development.

CONTEXT: Multisector community partnerships play a pivotal role in public health strategy for understanding and addressing social determinants of health (SDOH) and promoting health equity. The work of these partnerships is well aligned with building community resilience. PROGRAM: The Year 2 Improving Social Determinants of Health-Getting Further Faster (GFF) retrospective evaluation was designed to gather practice-based evidence that can inform future community-driven partnerships to improve chronic disease outcomes and advance health equity by addressing social determinants of health (SDOH). IMPLEMENTATION: This paper sought to determine how the efforts of multisector community partnerships could also support community resilience. Guided by CDC's Framework for Program Evaluation in Public Health and health equity principles, the GFF evaluation engaged 14 Multisector Community Partnerships to better understand how their SDOH interventions contribute to community changes that improve chronic diseases and advance health equity. Data collection included qualitative discussions along with additional quantitative analyses of SDOH outcomes, costs, and prevention impacts. This paper focuses on insights gathered from qualitative discussions (2 virtual 60-minute discussions with members of each of the 14 Partnerships) around community resilience. EVALUATION: Results from qualitative discussions demonstrate how Partnerships' SDOH efforts created parallel opportunities for nurturing community resilience. For example, Partnerships engaged community members in the design and implementation of SDOH interventions in ways that nurtured a sense of belonging and empowerment to shape their community. To further build community resilience, Partnerships mentioned the importance of sustained and flexible funding, help building stronger partnerships, and a shared goal to build resilience and engage community members. DISCUSSION: Findings indicate that community partnerships working to address SDOH can drive reciprocal improvements in community resilience-contributions that are critical for advancing health equity. Partnerships suggested that health departments may have opportunities to enhance community resilience through their role as funder, facilitator, and convener.

CONTEXT: Adverse childhood experiences (ACEs), substance use disorders (SUDs), and overdose are interconnected issues impacting individuals and communities at multiple levels of the social ecology and across generations. Few studies describe approaches that intentionally and simultaneously address these issues. PROGRAM: This paper examines activities of 15 sites across the country that were designed to simultaneously prevent ACEs, SUD, and overdose. This paper describes the work at the intersection as well as gaps and opportunities. Describing ways to implement intersectional programming may assist other organizations in taking similar steps in their communities. IMPLEMENTATION: From December 2020 through July 15, 2023, funded sites received technical assistance from the National Association of County and City Health Officials and the Centers for Disease Control and Prevention for 18 months to support the implementation, adaptation, and/or expansion of evidence-based programs to address ACEs, SUD, and overdose. EVALUATION: Activities were coded to identify intersectional interventions that addressed ACEs, SUD, and overdose. Most of the ACEs prevention strategies and overdose prevention priority areas/guiding principles from which communities could choose were represented. Most activities were implemented with caregivers and families and addressed ACEs through interventions to lessen harm or to promote social norms. Primary prevention and coordination of resources were the most used overdose prevention priority area/guiding principle. DISCUSSION: It is possible to address the intersection of ACEs, SUD, and overdose on a local level. Opportunities to further address the intersection include incorporating more secondary and tertiary prevention strategies, expanding economic supports, and increasing the work focused on equity.

OBJECTIVE: State public health departments use federal funding to examine and address social determinants of health (SDOH) within their communities to improve health and advance health equity. Yet, most federal funding is categorical (ie, funding used for a specific program or narrow purpose), which can create barriers to addressing social and structural drivers of inequity. The Preventive Health and Health Services Block Grant (PHHS Block Grant) is a flexible funding mechanism that provides health departments the latitude to identify and fund initiatives that address local public health needs. It is unclear, however, to what extent health departments use this flexible resource to incorporate SDOH into their programs. DESIGN: Cross-sectional, descriptive analysis of state health department PHHS Block Grant program administrative data. SETTING: This study examined PHHS Block Grant budgets and workplans for the federal Fiscal Year 2021 to assess whether state health departments aligned their grant-funded program with the national objectives associated with the Healthy People 2030 SDOH Framework. PARTICIPANTS: Forty-seven states and the District of Columbia were included in this study. MAIN OUTCOME MEASURES: Percent of states that used PHHS Block Grant funds to address SDOH; proportion of funding allocated to address SDOH; percentage of programs that addressed SDOH. RESULTS: Three-fourths (75%) of states allocated funds to 97 programs aligning with at least 1 Healthy People 2030 SDOH-related objective. Fifty of the programs were fully or primarily funded by the PHHS Block Grant. Results also show that as the states' PHHS Block Grant funding level increased so did the percent of states that allocated funding toward SDOH programs. CONCLUSION: This study shows that state health departments are using the PHHS Block Grant to address SDOH, and that the grant plays an important funding role for these programs. States are incorporating the grant into their funding strategies to address SDOH.

OBJECTIVE: Identify commercial tobacco cessation interventions for American Indian and Alaska Native (AI/AN) communities, focusing on strategies used to advance health equity, including strategies to address social determinants of health (SDOH), community engagement, and cultural tailoring. DATA SOURCE: We searched Medline, Embase, PsycINFO, Cochrane Library, CINAHL, Scopus, ProQuest Central, Academic Search Complete, JSTOR, and Indigenous/Tribal health-related journals and databases. STUDY INCLUSION AND EXCLUSION CRITERIA: We included peer-reviewed studies on commercial tobacco cessation for AI/AN persons published January 1998-April 2023 that reported quit rates/attempts. We excluded studies that only used pharmaceutical interventions. DATA EXTRACTION: Two reviewers independently assessed each study against our inclusion/exclusion criteria. A reviewer extracted data, and another checked for completeness. DATA SYNTHESIS: Synthesis focused on reported intervention effectiveness and strategies used for addressing SDOH, community engagement, and cultural tailoring. We used a synthesis matrix which allowed for comparison across studies. RESULTS: We screened 1116 articles and included 12 for synthesis. Of the 12, five engaged community health workers; four included SDOH elements; and six were reported effective. Of these six, five included early-stage community engagement and four were culturally tailored. CONCLUSIONS: There are few commercial tobacco cessation interventions for AI/AN populations. Building capacity, including tribal capacity, to develop and test multi-level, culturally grounded cessation interventions that address relevant SDOH may advance commercial tobacco cessation efforts in these populations.

Case management of malaria in Africa has evolved markedly over the past twenty years and updated cost estimates are needed to guide malaria control policies. We estimated the cost of malaria illness to households and the public health service and assessed the equity of these costs in Uganda. From December 2021 to May 2022, we conducted a costing exercise in eight government-run health centres covering seven sub-regions, collecting health service costs from patient observations, records review, and a time-and-motion study. From November 2021 to January 2022, we gathered data on households' cost of illness from randomly selected households for 614 residents with suspected malaria. Societal costs of illness were estimated and combined with secondary data sources to estimate the total economic burden of malaria in Uganda. We used regression analyses and concentration curves to assess the equity of household costs across age, geographic location, and socio-economic status. The mean societal economic cost of treating suspected malaria was $15.12 (95%CI: 12.83-17.14) per outpatient and $27.21 (95%CI: 20.43-33.99) per inpatient case. Households incurred 81% of outpatient and 72% of inpatient costs. Households bore nearly equal costs of illness, regardless of socio-economic status. A case of malaria cost households in the lowest quintile 26% of per capita monthly consumption, while a malaria case only cost households in the highest quintile 8%. We estimated the societal cost of malaria treatment in Uganda was $577 million (range: $302 million-1.09 billion) in 2021. The cost of malaria remains high in Uganda. Households bear the major burden of these costs. Poorer and richer households incur the same costs per case; this distribution is equal, but not equitable. These results can be applied to parameterize future economic evaluations of malaria control interventions and to evaluate the impact of malaria on Ugandan society, informing resource allocations in malaria prevention.

Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age that influence health outcomes, and structural and systemic drivers of health (SSD) are the social, cultural, political, and economic contexts that create and shape SDOH. With the integration of constructs from previous examples, we propose an SSD model that broadens the contextual effect of these driving forces or factors rooted in the Centers for Disease Control and Prevention's SDOH framework. Our SSD model (1) presents systems and structures as multidimensional, (2) considers 10 dimensions as discrete and intersectional, and (3) acknowledges health-related effects over time at different life stages and across generations. We also present an application of this SSD model to the housing domain and describe how SSD affect SDOH through multiple mechanisms that may lead to unequal resources, opportunities, and consequences contributing to a disproportionate burden of disease, illness, and death in the US population. Our enhanced SDOH framework offers an innovative and promising model for multidimensional, collaborative public health approaches toward achieving health equity and eliminating health disparities.

Cardiovascular disease (CVD) is the leading cause of illness and death in the US and is substantially affected by social determinants of health, such as social, economic, and environmental factors. CVD disproportionately affects groups that have been economically and socially marginalized, yet health care and public health professionals often lack tools for collecting and using data to understand and address CVD inequities among their populations of focus. The Health Equity Indicators for Cardiovascular Disease Toolkit (HEI for CVD Toolkit) seeks to address this gap by providing metrics, measurement guidance, and resources to support users collecting, measuring, and analyzing data relevant to their CVD work. The toolkit includes a conceptual framework (a visual model for understanding health inequities in CVD); a comprehensive list of health equity indicators (metrics of inequities that influence CVD prevention, care, and management); guidance in definitions, measures, and data sources; lessons learned and examples of HEI implementation; and other resources to support health equity measurement. To develop this toolkit, we performed literature scans to identify primary topics and themes relevant to addressing inequities in CVD, engaged with subject matter experts in health equity and CVD, and conducted pilot studies to understand the feasibility of gathering and analyzing data on the social determinants of health in various settings. This comprehensive development process resulted in a toolkit that can help users understand the drivers of inequities in their communities or patient populations, assess progress, evaluate intervention outcomes, and guide actions to address CVD disparities.

While the health of all depends on the food chain, few studies have focused systematically on the health of food chain workers themselves (production, manufacturing, wholesale, retail, and commercial and institutional services). In this study we used 2018 and 2019 data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine health-related metrics of food chain workers, combined and by industry sector, compared to non-food chain workers, among 32 U.S. states. Logistic regression indicated U.S. food chain workers had higher prevalences of barriers to health care access, smoking, no physical exercise, and poor self-reported health than all other workers. Patterns were similar among food chain workers in all industry sectors except wholesale. Additionally, commercial food services workers had higher prevalence of poor mental health, while institutional food services workers had higher prevalences of obesity, diabetes, and hypertension than all other workers. We discuss implications of these results for interventions, with specific attention to improving employment conditions. Food chain worker health is critical for food system sustainability and population health equity.

BACKGROUND: Integrating and advancing health equity are a core tenant of the Centers for Disease Control and Prevention's mission. Comprehensive frameworks that clearly conceptualise equity are needed to prioritise and inform the advancement of health equity within public health. METHODS: To help meet this need, the investigative team developed The Continuum of Health Equity Practice & Science (The Continuum). The Continuum was developed in two phases: (1) an initial survey distributed to internal CDC Division of Injury Prevention investigators, and (2) a review of public health frameworks and the current health equity evidence base. RESULTS: The Continuum is a framework that includes seven key components of health equity and ultimately aims to guide public health practice and research towards the advancement of health equity. To illustrate its usefulness, we provide an example using adolescent suicide for each component of The Continuum and demonstrate how this may inform efforts to advance health equity. CONCLUSION: With a specific focus on conceptualising health equity and addressing systemic inequities, The Continuum may be used to inform efforts to advance equity in injury prevention and beyond.

Multisector community partnerships (MCPs) are a key element of the public health approach to addressing social determinants of health (SDOH). The Improving SDOH-Getting Further Faster (GFF) retrospective evaluation of MCP-driven SDOH interventions was designed to generate practice-based evidence that can help guide partnerships' efforts to improve chronic disease outcomes and advance health equity by addressing SDOH. This article shares Year 2 GFF findings related to sustainability strategies for partnerships focused on SDOH and their interventions. GFF partnerships' reported sustainability strategies, including establishing shared goals and increasing partners' capacity for SDOH work through training, align well with the rich coalition building evidence base. Findings also indicate some evolution of sustainability strategies, such as adopting team-based, decentralized leadership models to help guard against partner or staff turnover. Organizations looking to form, fund, or provide technical assistance to MCPs that address SDOH can use the practice-based insights shared in this research brief to plan ahead for sustainability.