Should they stay or should they go? Leader duration and financial performance in local health departments.

CONTEXT: The delivery of programs by local health departments (LHDs) has shifted from "if we do not have the money we don't do it" to LHD directors should "identify and fund public health priorities." This shift has subsequently increased performance expectations of LHD leaders. In the for-profit sector the leaders' failure to perform has resulted in a shortening tenure trend. Tenure is a proxy for human capital accumulation. In LHDs, the nature of association, if any, between leader tenure and agency performance is unknown. RESEARCH OBJECTIVE: Examine association between financial performance of LHDs with short-, average-, and long-tenured LHD leaders. STUDY DESIGN: Variation in leader characteristics and percent change in expenditure were examined using a longitudinal cohort design and positive deviance methodology. Bivariate analysis of LHD financial performance and leader characteristics was conducted, and a logistic regression model was developed to test association between leader tenure and LHDs that experienced a positive percentage expenditure change. PARTICIPANTS: From a total of 2523 LHDs, 1453 were examined. The cross-sectional surveys of US public health agencies conducted by the National Association of County and City Health Officials in 2008 and 2010 contain the leader and LHD variables. RESULTS: Approximately 44% of LHDs experienced a positive percentage expenditure change. Leader tenure, age, gender, and education status were significantly associated with a positive percentage expenditure change using a chi-square test of independence. From the logistic regression analysis tenure, educational status, employment status, area population, governance, classification, and jurisdiction were statistically significant. Local health departments with leaders whose tenure was less than 2 years were less likely than those with average tenure to experience a positive percentage expenditure change. CONCLUSIONS: The odds ratios for tenure suggest that tenure is positively associated up to a threshold level and then declines. Implying that LHD financial performance is sensitive to leader tenure.

The Impact of Naloxone Coprescribing Mandates on Opioid-Involved Overdose Deaths.

INTRODUCTION: Since 2017, a total of 10 states have mandated naloxone coprescribing intended to prevent fatal opioid overdoses. This study aims to assess the association between naloxone coprescribing/offering mandates and opioid-involved overdose deaths on the basis of the opioid type. METHODS: Data on overdose deaths from 1999 to 2020 came from the National Center for Health Statistics CDC WONDER Online Database. This study examined deaths stratified by illicit/synthetic opioids and prescription/treatment opioids. Difference-in-difference negative binomial regression models estimated average marginal effects and 95% CIs. Covariates included opioid dispensing rate, Good Samaritan law, pharmacy-based naloxone access law, mandatory use of prescription drug monitoring program, and recreational cannabis dispensaries. Data collection and analysis were conducted in 2022. RESULTS: Ten states implemented naloxone coprescribing/offering mandates during the period. Coprescribing/offering mandates significantly reduced the number of prescription/treatment overdose deaths by 8.61 per state per quarter (95% CI= -15.13, -2.09), a 16% reduction from the counterfactual estimates. Coprescribing/offering mandates did not significantly impact illicit/synthetic overdose deaths (average marginal effect=0.32; 95% CI= -18.27, 18.91). CONCLUSIONS: Coprescribing/offering mandates prevent overdose deaths for its target population, individuals using prescription/treatment opioids. These mandates do not appear to impact populations using illicit/synthetic opioids; thus, expanded efforts are needed to reach these individuals.

Performance of the BD Veritor system SARS-CoV-2 antigen test among asymptomatic collegiate athletes: A diagnostic accuracy study.

BACKGROUND: COVID-19 testing strategies and determining the accuracy of tests is crucial for the prevention of disease in asymptomatic communities. OBJECTIVE: To determine the positive predictive value for the BD Veritor System for rapid detection of SARS-CoV-2 (BD Veritor System) among asymptomatic athletes and athletic staff in a University setting. Secondarily, a cost savings analysis was conducted to evaluate the benefits of a rapid antigen testing strategy over a universal PCR-based strategy. METHODS: Asymptomatic athletic personnel at Ferris State University tested using the BD Veritor System from November 4, 2020-February 15, 2021. Individuals whose antigen test was positive immediately had specimen collected for confirmatory PCR testing. These results were used to determine the positive predictive value (PPV) for the BD Veritor System. A cost-savings analysis was conducted from the University's perspective to determine the value of this rapid antigen testing strategy over a universal PCR-based strategy. RESULTS: A total of 3352 antigen tests were performed on 359 individuals during the study period. During this period, 21 positive antigen tests were obtained of which 5 individuals had a positive reflex PCR result. The calculated PPV of the BD Veritor System among asymptomatic individuals was 25%. According to the mandated athletics testing schedule, the University spent $67,475.76 on BD Veritor System tests and $1785 on confirmatory PCR tests. In contrast, if a solely PCR-based approach had been continued, the same testing strategy would have cost the University $284,920. By employing a 2-tiered testing strategy with the BD Veritor System with reflex PCR testing, the University realized a cost savings of $215,659.24 during the 3-month period. CONCLUSIONS: Despite sub-optimal PPV associated with the BD Veritor System among asymptomatic athletes, the University was able to effectively use an antigen-based testing program to comply with collegiate testing requirements and realize $215,659.24 cost savings per quarter over a PCR-based strategy.

Vaccination Perceptions of College Students: With and without Vaccination Waiver.

INTRODUCTION: The resurgence of vaccine preventable diseases occurs more often among intentionally unvaccinated individuals, placing at direct risk young adults not caught up on vaccinations. The objectives of this study were to characterize the sociodemographic characteristics of young adults with and without vaccination waivers and identify their perceived benefits, barriers, and influencers of vaccination. METHODS: Young adults (n = 964) from a Midwestern rural university responded to a survey (fall 2015-spring 2016) designed to identify their perception toward vaccination. Instrument consistency was measured using the Cronbach α-scores. The Chi-square test was used to test any sociodemographic differences and Mann-Whitney U-tests results for differences between exempt and non-exempt students. Analysis occurred in spring 2017. RESULTS: A little over one-third of young adults with a vaccination waiver were not up to date on their vaccinations, and think that vaccinations can cause autism. The biggest identifiable benefit was effective control against disease. The surveyed young adults ranked the out of pocket cost associated with vaccination as the most important barrier and safe and easy to use vaccines as the most important influencer of vaccination. CONCLUSION: Young adults who have had a vaccination waiver appear to not be up to date on their vaccinations. Vaccine administration programs, such as university campus clinics, would benefit from addressing perceptions unique to young adults with and without a vaccine waiver. This would subsequently better provide young adults a second shot for getting appropriately caught up on vaccinations.

Leadership for Public Health 3.0: A Preliminary Assessment of Competencies for Local Health Department Leaders.

BACKGROUND: The foundational public health services model V1.0, developed in response to the Institute of Medicine report For the Public's Health: Investing in a Healthier Future identified important capabilities for leading local health departments (LHDs). The recommended capabilities include the organizational competencies of leadership and governance, which are described as consensus building among internal and external stakeholders. Leadership through consensus building is the main characteristic of Democratic Leadership. This style of leadership works best within the context of a competent team. Not much is known about the competency structure of LHD leadership teams. The objectives of this study characterize the competency structure of leadership teams in LHDs and identify the relevance of existing competencies for the practice of leadership in public health. MATERIALS AND METHODS: The study used a cross-sectional study design. Utilizing the workforce taxonomy six management and leadership occupation titles were used as job categories. The competencies were selected from the leadership and management domain of public health competencies for the Tier -3, leadership level. Study participants were asked to rank on a Likert scale of 1-10 the relevance of each competency to their current job category, with a rank of 1 being least important and a rank of 10 being most important. The instrument was administered in person. DATA: Data were collected in 2016 from 50 public health professionals serving in leadership and management positions in a convenience sample of three LHDS. RESULTS: The competency of most relevance to the highest executive function category was that of "interaction with interrelated systems." For sub-agency level officers the competency of most relevance was "advocating for the role of public health." The competency of most relevance to Program Directors/Managers or Administrators was "ensuring continuous quality improvement." The variation between competencies by job category suggests there are distinct underlying relationships between the competencies by job category.

Openness to Change: Experiential and Demographic Components of Change in Local Health Department Leaders.

BACKGROUND: During the 2008-2010 economic recession, Kentucky local health department (LHD) leaders utilized innovative strategies to maintain their programs. A characteristic of innovative strategy is leader openness to change. Leader demographical research in for-profit organizations has yielded valuable insight into leader openness to change. For LHD leaders, the nature of the association between leader demographic and organizational characteristics on leader openness to change is unknown. The objectives of this study are to identify variation in openness to change by leaders' demographic and organizational characteristics and to characterize the underlying relationships. MATERIALS AND METHODS: The study utilized Spearman rank correlations test to determine relationships between leader openness to change (ACQ) and leader and LHD characteristics. To identify differences in the distribution of ACQ scores, Wilcoxon-Mann-Whitney and Kruskal-Wallis non-parametric tests were used, and to adjust for potential confounding, linear regression analysis was performed. DATA: Local health department leaders in the Commonwealth of Kentucky were the unit of analysis. Expenditure and revenue data were available from the state health department. National census data were utilized for county level population estimates. A cross-sectional survey was performed of KY LHD leaders' observable attributes relating to age, gender, race, educational background, leadership experience, and openness to change. RESULTS: Leaders had relatively high openness to change scores. Spearman correlations between leader ACQ and departmental 2012-2013 revenue and expenditures were statistically significant, as were the differences observed in ACQ by gender and the educational level of the leader. Differences in ACQ score by education level and agency revenue were significant even after adjusting for potential confounders. The analyses imply that there are underlying relationships between leader and LHD characteristics based on leader openness to change.