Identity Concealment May Discourage Health-Seeking Behaviors: Evidence From Sexual-Minority Men During the 2022 Global Mpox Outbreak.

People who conceal their stigmatized identities often experience worse physical health. One possibility for why is that concealment may render certain health-seeking behaviors more difficult. We tested this possibility during the 2022 global mpox outbreak, a public-health emergency that disproportionately affected sexual-minority men. We recruited adult sexual-minority men from Prolific at two time points near the outbreak's peak and attenuation (n = 864 and n = 685, respectively). We found that men who concealed their minority sexual orientations were less likely to (a) receive a vaccine to protect against mpox, (b) receive an mpox test, and (c) report having received an mpox vaccine. The relationship between concealment and vaccine receipt was serially mediated by reduced community connectedness and reduced knowledge of mpox resources. We call for thoughtful consideration of how to reach stigmatized groups with public-health resources, inclusive of those who conceal.

Developmental and adult stress: effects of steroids and neurosteroids.

In humans, exposure to early life adversity has profound implications for susceptibility to developing neuropsychiatric disorders later in life. Studies in rodents have shown that stress experienced during early postnatal life can have lasting effects on brain development. Glucocorticoids and sex steroids are produced in endocrine glands and the brain from cholesterol; these molecules bind to nuclear and membrane-associated steroid receptors. Unlike other steroids that can also be made in the brain, neurosteroids bind specifically to neurotransmitter receptors, not steroid receptors. The relationships among steroids, neurosteroids, and stress are multifaceted and not yet fully understood. However, studies demonstrating altered levels of progestogens, androgens, estrogens, glucocorticoids, and their neuroactive metabolites in both developmental and adult stress paradigms strongly suggest that these molecules may be important players in stress effects on brain circuits and behavior. In this review, we discuss the influence of developmental and adult stress on various components of the brain, including neurons, glia, and perineuronal nets, with a focus on sex steroids and neurosteroids. Gaining an enhanced understanding of how early adversity impacts the intricate systems of brain steroid and neurosteroid regulation could prove instrumental in identifying novel therapeutic targets for stress-related conditions.

Postnatal development of hippocampal CA2 structure and function during the emergence of social recognition of peers.

It is now well-established that the hippocampal CA2 region plays an important role in social recognition memory in adult mice. The CA2 is also important for the earliest social memories, including those that mice have for their mothers and littermates, which manifest themselves as a social preference for familiarity over novelty. The role of the CA2 in the development of social memory for recently encountered same-age conspecifics, that is, peers, has not been previously reported. Here, we used a direct social interaction test to characterize the emergence of novelty preference for peers during development and found that at the end of the second postnatal week, pups begin to significantly prefer novel over familiar peers. Using chemogenetic inhibition at this time, we showed that CA2 activity is necessary for the emergence of novelty preference and for the ability to distinguish never encountered from recently encountered peers. In adulthood, the CA2 region is known to integrate a large number of inputs from various sources, many of which participate in social recognition memory, but previous studies have not determined whether these afferents are present at adult levels by the end of the second postnatal week. To explore the development of CA2 inputs, we used immunolabeling and retrograde adenovirus circuit tracing and found that, by the end of the second postnatal week, the CA2 is innervated by many regions, including the dentate gyrus, supramammillary nucleus of the hypothalamus, the lateral entorhinal cortex, and the median raphe nucleus. Using retroviral labeling of postnatally generated granule cells in the dentate gyrus, we found that mossy fiber projections to the CA2 mature faster during development than those generated in adulthood. Together, our findings indicate that the CA2 is partially mature in afferent connectivity by the end of the second postnatal week, connections that likely facilitate the emergence of social recognition memory and preference for novel peers.

Atypical perineuronal nets in the CA2 region interfere with social memory in a mouse model of social dysfunction.

Social memory dysfunction is an especially devastating symptom of many neuropsychiatric disorders, which makes understanding the cellular and molecular processes that contribute to such abnormalities important. Evidence suggests that the hippocampus, particularly the CA2 region, plays an important role in social memory. We sought to identify potential mechanisms of social memory dysfunction in the hippocampus by investigating features of neurons, glia, and the extracellular matrix (ECM) of BTBR mice, an inbred mouse strain with deficient social memory. The CA2 is known to receive inputs from dentate gyrus adult-born granule cells (abGCs), neurons known to participate in social memory, so we examined this cell population and found fewer abGCs, as well as fewer axons from abGCs in the CA2 of BTBR mice compared to controls. We also found that BTBR mice had fewer pyramidal cell dendritic spines, in addition to fewer microglia and astrocytes, in the CA2 compared to controls. Along with diminished neuronal and glial elements, we found atypical perineuronal nets (PNNs), specialized ECM structures that regulate plasticity, in the CA2 of BTBR mice. By diminishing PNNs in the CA2 of BTBR mice to control levels, we observed a partial restoration of social memory. Our findings suggest that the CA2 region of BTBR mice exhibits multiple cellular and extracellular abnormalities and identify atypical PNNs as one mechanism producing social memory dysfunction, although the contribution of reduced abGC afferents, pyramidal cell dendritic spine, and glial cell numbers remains unexplored.

Interpersonal traits and the neural representations of cognitive control in the prefrontal cortex.

Adaptive interpersonal functioning relies on the effectiveness of behavioral and neural systems involved in cognitive control. Whether different subcomponents of cognitive control and their neural representations are associated with distinctive interpersonal dispositions has yet to be determined. The present study investigated the relationships between prefrontal cortex (PFC) activation associated with two subcomponents of cognitive control and individual differences in interpersonally relevant traits and facets within the Five-Factor Model of personality. Undergraduate participants (n = 237) provided self-ratings of interpersonal traits and underwent functional near-infrared spectroscopy to measure activation in regions-of-interest linked to subcomponents of cognitive control: the right lateral PFC and its involvement in response selection and inhibition/suppression (RS) during a go/no-go task, and the left lateral PFC associated with goal selection, updating, representation, and maintenance (GS) on a tower planning task. Multilevel models revealed that during both RS and GS, Neuroticism and Extraversion were associated with lower and higher levels of activation, respectively. Higher Agreeableness was related to lower activation during RS but also with greater activation during GS. More narrowly defined interpersonal facets subsumed within the broader trait domains were differentially associated with RS- and GS-related neural responses. Taken together, these findings highlight potential avenues of future research to better understand the ways in which the neural processes that subserve cognitive control may underlie interpersonal dispositions.

Adult-born granule cell mossy fibers preferentially target parvalbumin-positive interneurons surrounded by perineuronal nets.

Adult-born granule cells (abGCs) integrate into the hippocampus and form connections with dentate gyrus parvalbumin-positive (PV+) interneurons, a circuit important for modulating plasticity. Many of these interneurons are surrounded by perineuronal nets (PNNs), extracellular matrix structures known to participate in plasticity. We compared abGC projections to PV+ interneurons with negative-to-low intensity PNNs to those with high intensity PNNs using retroviral and 3R-Tau labeling in adult mice, and found that abGC mossy fibers and boutons are more frequently located near PV+ interneurons with high intensity PNNs. These results suggest that axons of new neurons preferentially stabilize near target cells with intense PNNs. Next, we asked whether the number of abGCs influences PNN formation around PV+ interneurons, and found that near complete ablation of abGCs produced a decrease in the intensity and number of PV+ neurons with PNNs, suggesting that new neuron innervation may enhance PNN formation. Experience-driven changes in adult neurogenesis did not produce consistent effects, perhaps due to widespread effects on plasticity. Our study identifies abGC projections to PV+ interneurons with PNNs, with more presumed abGC mossy fiber boutons found near the cell body of PV+ interneurons with strong PNNs.

Leadership Disparities in State Governmental Public Health Workforce: Examining the Influence of Gender.

OBJECTIVE: To determine the extent to which gender disparities exist in either obtaining a leadership position or pay equity among those with leadership positions in state governmental public health agencies. DESIGN: Utilizing the 2014 Public Health Workforce Interests and Needs Survey, a nationally representative cross-sectional study of state governmental public health agency employees, the characteristics of the state governmental public health agency leadership were described. We estimated the odds of being a manager or an executive leader and the odds of leaders earning greater than $95 000 annually for women compared with men using polytomous multinomial regression and logistic regression models, respectively. SETTING AND PARTICIPANTS: The Public Health Workforce Interests and Needs Survey was conducted via electronic survey at 37 state health departments. This study utilized only those respondents who listed their current position as a supervisory position (n = 3237). MAIN OUTCOME MEASURES: Leadership position and high-earning leadership were the 2 main outcome measures explored. Leadership position was defined as a 3-level ordinal variable: supervisor, manager, or executive leader. High-earning leadership was defined as a member of leadership earning $95 000 or greater. RESULTS: Women accounted for 72.0% of the overall state governmental public health agency workforce and 67.1% of leadership positions. Women experienced lower odds (odds ratio = 0.55, 95% confidence interval: 0.39-0.78) of holding executive leadership positions than men and lower odds (odds ratio = 0.64, 95% confidence interval: 0.50-0.81) of earning an annual salary greater than $95 000. CONCLUSION: While women were represented in similar proportions in the general workforce as in leadership positions, gender disparities still existed within leadership positions. Increased effort is needed to ensure that opportunities exist for women in executive leadership positions and in pay equity. With public health's commitment to social justice and the benefits of diversity to an agency's policies and programs, it is important to ensure that women's voices are equally represented at all levels of leadership.

State Health Official Career Advancement and Sustainability Evaluation-Description of the Methods Used in the SHO-CASE Study.

State health officials (SHOs) lead state governmental public health agencies, playing an important role in their states. However, little comprehensive research has examined SHOs or characteristics of these leaders, limiting evidence about ways to improve SHO selection and subsequent performance. This brief describes the methods of the SHO-CASE study focused on current and former SHOs in state public health agencies. Methods used include qualitative components that informed the development of survey questions, survey administration, and survey response. A total of 147 SHOs responded to the SHO survey representing every state and Washington, District of Columbia. The SHO-CASE study survey database represents the most comprehensive database of its kind regarding a range of attributes of current and former SHOs. These data can be used to explore factors contributing to SHO success including valuable insights into effectively working with the states' elected officials.

The Protein Tyrosine Phosphatase Shp2 Regulates Oligodendrocyte Differentiation and Early Myelination and Contributes to Timely Remyelination.

Shp2 is a nonreceptor protein tyrosine phosphatase that has been shown to influence neurogenesis, oligodendrogenesis, and oligodendrocyte differentiation. Furthermore, Shp2 is a known regulator of the Akt/mammalian target of rapamycin and ERK signaling pathways in multiple cellular contexts, including oligodendrocytes. Its role during later postnatal CNS development or in response to demyelination injury has not been examined. Based on the current studies, we hypothesize that Shp2 is a negative regulator of CNS myelination. Using transgenic mouse technology, we show that Shp2 is involved in oligodendrocyte differentiation and early myelination, but is not necessary for myelin maintenance. We also show that Shp2 regulates the timely differentiation of oligodendrocytes following lysolecithin-induced demyelination, although apparently normal remyelination occurs at a delayed time point. These data suggest that Shp2 is a relevant therapeutic target in demyelinating diseases such as multiple sclerosis.SIGNIFICANCE STATEMENT In the present study, we show that the protein phosphatase Shp2 is an important mediator of oligodendrocyte differentiation and myelination, both during developmental myelination as well as during myelin regeneration. We provide important insight into the signaling mechanisms regulating myelination and propose that Shp2 acts as a transient brake to the developmental myelination process. Furthermore, we show that Shp2 regulates oligodendrocyte differentiation following demyelination and therefore has important therapeutic implications in diseases such as multiple sclerosis.

Microglia Play an Active Role in Obesity-Associated Cognitive Decline.

Obesity affects >600 million people worldwide, a staggering number that appears to be on the rise. One of the lesser known consequences of obesity is its deleterious effects on cognition, which have been well documented across many cognitive domains and age groups. To investigate the cellular mechanisms that underlie obesity-associated cognitive decline, we used diet-induced obesity in male mice and found memory impairments along with reductions in dendritic spines, sites of excitatory synapses, increases in the activation of microglia, the brain's resident immune cells, and increases in synaptic profiles within microglia, in the hippocampus, a brain region linked to cognition. We found that partial knockdown of the receptor for fractalkine, a chemokine that can serve as a "find me" cue for microglia, prevented microglial activation and cognitive decline induced by obesity. Furthermore, we found that pharmacological inhibition of microglial activation in obese mice was associated with prevention of both dendritic spine loss and cognitive degradation. Finally, we observed that pharmacological blockade of microglial phagocytosis lessened obesity-associated cognitive decline. These findings suggest that microglia play an active role in obesity-associated cognitive decline by phagocytosis of synapses that are important for optimal function.SIGNIFICANCE STATEMENT Obesity in humans correlates with reduced cognitive function. To investigate the cellular mechanisms underlying this, we used diet-induced obesity in mice and found impaired performance on cognitive tests of hippocampal function. These deficits were accompanied by reduced numbers of dendritic spines, increased microglial activation, and increased synaptic profiles within microglia. Inhibition of microglial activation by transgenic and pharmacological methods prevented cognitive decline and dendritic spine loss in obese mice. Moreover, pharmacological inhibition of the phagocytic activity of microglia was also sufficient to prevent cognitive degradation. This work suggests that microglia may be responsible for obesity-associated cognitive decline and dendritic spine loss.

The effects of living in an outdoor enclosure on hippocampal plasticity and anxiety-like behavior in response to nematode infection.

The hippocampus of rodents undergoes structural remodeling throughout adulthood, including the addition of new neurons. Adult neurogenesis is sensitive to environmental enrichment and stress. Microglia, the brain's resident immune cells, are involved in adult neurogenesis by engulfing dying new neurons. While previous studies using laboratory environmental enrichment have investigated alterations in brain structure and function, they do not provide an adequate reflection of living in the wild, in which stress and environmental instability are common. Here, we compared mice living in standard laboratory settings to mice living in outdoor enclosures to assess the complex interactions among environment, gut infection, and hippocampal plasticity. We infected mice with parasitic worms and studied their effects on adult neurogenesis, microglia, and functions associated with the hippocampus, including cognition and anxiety regulation. We found an increase in immature neuron numbers of mice living in outdoor enclosures regardless of infection. While outdoor living prevented increases in microglial reactivity induced by infection in both the dorsal and ventral hippocampus, outdoor mice with infection had fewer microglia and microglial processes in the ventral hippocampus. We observed no differences in cognitive performance on the hippocampus-dependent object location task between infected and uninfected mice living in either setting. However, we found that infection caused an increase in anxiety-like behavior in the open field test but only in outdoor mice. These findings suggest that living conditions, as well as gut infection, interact to produce complex effects on brain structure and function.

Differential Expression of Mucins in Murine Olfactory Versus Respiratory Epithelium.

Mucins are a key component of the surface mucus overlying airway epithelium. Given the different functions of the olfactory and respiratory epithelia, we hypothesized that mucins would be differentially expressed between these 2 areas. Secondarily, we evaluated for potential changes in mucin expression with radiation exposure, given the clinical observations of nasal dryness, altered mucus rheology, and smell loss in radiated patients. Immunofluorescence staining was performed to evaluate expression of mucins 1, 2, 5AC, and 5B in nasal respiratory and olfactory epithelia of control mice and 1 week after exposure to 8 Gy of radiation. Mucins 1, 5AC, and 5B exhibited differential expression patterns between olfactory and respiratory epithelium (RE) while mucin 2 showed no difference. In the olfactory epithelium (OE), mucin 1 was located in a lattice-like pattern around gaps corresponding to dendritic knobs of olfactory sensory neurons, whereas in RE it was intermittently expressed by surface goblet cells. Mucin 5AC was expressed by subepithelial glands in both epithelial types but to a higher degree in the OE. Mucin 5B was expressed by submucosal glands in OE and by surface epithelial cells in RE. At 1-week after exposure to single-dose 8 Gy of radiation, no qualitative effects were seen on mucin expression. Our findings demonstrate that murine OE and RE express mucins differently, and characteristic patterns of mucins 1, 5AC, and 5B can be used to define the underlying epithelium. Radiation (8 Gy) does not appear to affect mucin expression at 1 week. LEVEL OF EVIDENCE: N/A (Basic Science Research).IACUC-approved study [Protocol 200065].

The State of the US Governmental Public Health Workforce, 2014-2017.

Public health workforce development efforts during the past 50 years have evolved from a focus on enumerating workers to comprehensive strategies that address workforce size and composition, training, recruitment and retention, effectiveness, and expected competencies in public health practice. We provide new perspectives on the public health workforce, using data from the Public Health Workforce Interests and Needs Survey, the largest nationally representative survey of the governmental public health workforce in the United States. Five major thematic areas are explored: workforce diversity in a changing demographic environment; challenges of an aging workforce, including impending retirements and the need for succession planning; workers' salaries and challenges of recruiting new staff; the growth of undergraduate public health education and what this means for the future public health workforce; and workers' awareness and perceptions of national trends in the field. We discussed implications for policy and practice.

The Extended Contact Hypothesis: A Meta-Analysis on 20 Years of Research.

According to the extended contact hypothesis, knowing that in-group members have cross-group friends improves attitudes toward this out-group. This meta-analysis covers the 20 years of research that currently exists on the extended contact hypothesis, and consists of 248 effect sizes from 115 studies. The aggregate relationship between extended contact and intergroup attitudes was r = .25, 95% confidence interval (CI) = [.22, .27], which reduced to r = .17, 95% CI = [.14, .19] after removing direct friendship's contribution; these results suggest that extended contact's hypothesized relationship to intergroup attitudes is small-to-medium and exists independently of direct friendship. This relationship was larger when extended contact was perceived versus actual, highlighting the importance of perception in extended contact. Current results on extended contact mostly resembled their direct friendship counterparts, suggesting similarity between these contact types. These unique insights about extended contact and its relationship with direct friendship should enrich and spur growth within this literature.

MCH Workforce Capacity: Maximizing Opportunities Afforded by a Changing Public Health System.

Objectives A skilled workforce is essential to advancing maternal and child health (MCH) in a rapidly changing public health system. Little is known about the MCH workforce's existing capacity to maximize opportunities afforded by ongoing change. We assessed MCH workforce capacity in three areas: Systems Integration, Evidence-Based Decision-Making, and Change Management/Adaptive Leadership. We then examined associations between workforce capacity and modifiable workforce development strategies/resources. Methods Data are from the Public Health Workforce Interests and Needs Survey (PH WINS). The present study was limited to employees working in MCH programs (weighted N = 3062). Workforce capacity was operationalized as self-reported awareness of public health trends and proficiency to perform related skills in the three areas. Survey-weighted generalized estimating equations were used to fit logistic regression models accounting for employee clustering within states. Results While awareness of public health trends was low, the majority of employees (> 70% in each area) reported proficiency to perform skills related to these trends. Capacity was lowest in Systems Integration. Employee engagement in academic partnerships and higher state contributions to MCH program budgets were the strategies/resources most consistently associated with higher capacity. Workplace support was the strongest correlate of capacity in Change Management/Adaptive Leadership. Conclusions for Practice Although employees lacked familiarity with specific public health trends, they were proficient in skills needed to engage in related work. Still, areas for improvement remain. Results provide a baseline against which future training efforts can be evaluated. Academic partnerships and MCH program funding may be useful to prioritize in the context of health transformation.

Collective hormonal profiles predict group performance.

Prior research has shown that an individual's hormonal profile can influence the individual's social standing within a group. We introduce a different construct-a collective hormonal profile-which describes a group's hormonal make-up. We test whether a group's collective hormonal profile is related to its performance. Analysis of 370 individuals randomly assigned to work in 74 groups of three to six individuals revealed that group-level concentrations of testosterone and cortisol interact to predict a group's standing across groups. Groups with a collective hormonal profile characterized by high testosterone and low cortisol exhibited the highest performance. These collective hormonal level results remained reliable when controlling for personality traits and group-level variability in hormones. These findings support the hypothesis that groups with a biological propensity toward status pursuit (high testosterone) coupled with reduced stress-axis activity (low cortisol) engage in profit-maximizing decision-making. The current work extends the dual-hormone hypothesis to the collective level and provides a neurobiological perspective on the factors that determine who rises to the top across, not just within, social hierarchies.

Changes in the State Governmental Public Health Workforce: Demographics and Perceptions, 2014-2017.

CONTEXT: Workforce is a critical cog in the governmental public health enterprise in the United States. Until 2014, workforce research was largely conducted at the organizational level. However, the fieldings of the Public Health Workforce Interests and Needs Survey allow for nationally representative comparisons with individual respondents. OBJECTIVE: Using data from agencies that participated in 2014 and 2017, we conducted multi-cross-sectional comparisons of the Public Health Workforce Interests and Needs Survey data. DESIGN: The Public Health Workforce Interests and Needs Survey participants at the State Health Agency Central Offices were surveyed using a Web-based platform. Balanced repeated replication weights were used to account for differential designs between 2014 and 2017. SETTING: Thirty-three state health agency central offices that participated in both 2014 and 2017. PARTICIPANTS: Permanently employed governmental public health staff. MAIN OUTCOME MEASURES: We examined changes in perceptions of the workplace environment, job and pay satisfaction, intent to leave, awareness of emerging concepts in public health, and demographic/worker characteristics. Pearson and Rao-Scott-adjusted χ analyses were used to compare changes between 2014 and 2017. RESULTS: The percentage of staff who are people of color increased from 29% (95% confidence interval, 28%-30%) to 37% (95% confidence interval, 36%-38%) from 2014 to 2017 across 33 states. Approximately 26% of staff were younger than 40 years in 2014 compared with 29% in 2017 (P < .001). Job satisfaction increased in 17 states overall (P < .05, n = 5) and decreased in 16 states (P < .05, n = 5) but did not change in aggregate. Overall, the percentage of staff considering leaving the organization in the next year or retiring within 5 years is up from 44% to 48% (P < .001). CONCLUSIONS: Global measures of satisfaction are relatively high and consistent between 2014 and 2017. Demographics are shifting toward a marginally younger workforce as many retire, and a significant portion of staff indicates that they are considering leaving their organization or planning to retire.

Top Training Needs of the Governmental Public Health Workforce.

CONTEXT: Workforce development in governmental public health has historically focused on discipline-specific skills. However, as the field of public health has evolved, crosscutting skills have become critical. The 2017 fielding of the Public Health Workforce Interests and Needs Survey (PH WINS) provides a national benchmark for gaps in crosscutting skills in state and local health departments. OBJECTIVE: The purpose of this article is to identify top areas of training needs in the governmental public health workforce using data from PH WINS 2017. DESIGN: PH WINS participants in state and local health departments were surveyed in fall 2017 using a Web-based platform. Balanced repeated replication weights were used to account for complex sample design. SETTING: Forty-seven state health agencies, 26 large city health departments, and a nationally representative sample of mid-to-large local health departments. PARTICIPANTS: Permanently employed governmental public health staff. MAIN OUTCOME MEASURES: Training needs were determined by combining self-reported skill importance and proficiency. Skills reported to be of high importance, and low levels of proficiency were coded as training needs. Focus area gaps were defined as having a training need in at least one skill in the focus area. RESULTS: The largest area of training need, regardless of supervisory status, was in budgeting and financial management (55%; 95% confidence interval [CI], 53-56), with a large gap also identified in systems and strategic thinking (49%; 95% CI, 47-50). There was some variation by supervisory status, with training needs for nonsupervisors in change management and in developing a vision for a healthy community for management. CONCLUSIONS: The PH WINS training needs assessment provides the first nationally representative data on training needs for the state and local health department workforce. Across state and local health departments, there are common critical training needs essential for the current and future practice of public health.

Public Health Workforce Self-Identified Training Needs by Jurisdiction and Job Type.

CONTEXT: Ensuring adequate and appropriate training of the workforce is a crucial priority for governmental public health. This is particularly important, given the diverse backgrounds of the public health workforce; the vast majority (approximately 83%) do not have formal training in public health, and those that do have formal training in public health have limited training in management and other essential organizational skills. OBJECTIVE: The purpose of this article is to identify training needs among public health workers in specific job types and settings. DESIGN AND PARTICIPANTS: This cross section study used 2014 data from the Public Health Workforce Interests and Needs Survey. Qualitative analyses were used to code open-ended responses to questions about training needs. Needs are stratified across job types and jurisdiction. RESULTS: Eight main themes or skill areas were identified with the largest proportion indicating a need for management/leadership skills (28.2%). The second most frequent need was communication skills (21.3%). Across the 9 job types examined, general management skills were either the first or second training need for 7 job types. Among individuals who already have leadership/management positions, budgeting was the most common training need. CONCLUSIONS: Findings from this study can inform targeted strategies to address training needs for specific types of employees. Such strategies can influence the efficiency and effectiveness of public health efforts and employee satisfaction. As new public health frameworks-like Public Health 3.0 and the Chief Health Strategist-are advanced nationally, it is necessary to ensure that the workforce has the skills and abilities to implement these frameworks.

Opportunities to Improve Employee Satisfaction Within State and Local Public Health Agencies.

CONTEXT: Public health agencies will likely struggle to staff at necessary levels, given ongoing workforce shortages, the potential for mass retirement, and expanding responsibility. Although the majority of public health workers are satisfied with their jobs overall, it is critical to understand the degree to which they are satisfied and identify factors that contribute to any dissatisfaction that occurs. OBJECTIVE: This study identified opportunities for public health agencies to improve work environments and, in turn, improve employee satisfaction and retention. DESIGN: Using data from the 2014 Public Health Workforce Interest and Needs Survey, we analyze responses to the survey question, "If you wish, you may provide comments below about your level of job satisfaction." The 2966 responses (2389 from state and 542 from local public health agencies) that indicated a negative disposition were examined to understand employee dissatisfaction. SETTING: The survey was administered to a representative sample of state health departments and convenience samples of local health departments. PARTICIPANTS: Responses from employees of state and local health departments are considered. MAIN OUTCOME MEASURES: The most frequently occurring themes overall were identified. In addition, responses describing weaknesses in organizational support (specifically training, communication, workload, and innovation) were summarized. RESULTS: The most frequently occurring themes were as follows: (1) salary, specifically in relation to the merit system, performance evaluation, and workload; (2) job security with emphasis on funding, organizational transformation, and politics/government; and (3) career development related to the merit system, performance evaluation, and management. Respondents also reported opportunities in the areas of training, communication, workload, and innovation to improve satisfaction levels. CONCLUSIONS: These findings serve as a call to action for leaders in health departments as well as national public health leaders to remedy the concerns raised in their responses. Some of the solutions are within the realm of public health agency leadership, but some may fall within the realm of governors and public health leaders at the federal level. It is important to share these findings so that appropriate decision makers can address public health workforce retention and recruitment issues in the interest of retaining valuable employees.