Conducting Community Health Needs Assessments in the Local Public Health Department: A Comparison of Random Digit Dialing and the Community Assessment for Public Health Emergency Response.

CONTEXT: Community health needs assessments (CHNAs) are now required by the Affordable Care Act (ACA) for nonprofit hospitals and the Public Health Accreditation Board (PHAB) for local health departments that seek accreditation. Currently, various primary data collection methods exist that meet the ACA and PHAB requirements. OBJECTIVE: To compare 2 CHNA data collection methods implemented in the same geographical area from a local health department perspective. DESIGN AND SETTING: Two community surveys, one door-to-door and one telephone, in the 76706 zip code area of McLennan County, Texas. PARTICIPANTS: Adult survey respondents (Community Assessment for Public Health Emergency Response [CASPER]: N = 184; random digit dialing [RDD]: N = 133) of the 76706 zip code in McLennan County, Texas. MAIN OUTCOME MEASURES: Survey response rates, sociodemographic characteristics of survey respondents, and self-reported health behaviors from both community survey types. RESULTS: The CASPER survey had a contact rate of 36.0% and a cooperation rate of 60.5%, compared with a 10.1% response rate for the RDD survey. CASPER respondents were younger (26.6% aged 18-24 years), had lower education attainment (17.4% less than high school), and had a higher proportion of Hispanics (24.5%) than RDD respondents (4.6%, 10.5%, and 17.3%, respectively). CASPER respondents were less likely to report being overweight or obese (56.5%), to report days where no fruit or vegetables were consumed (7.1%), and to report days where no walking activity was conducted (9.8%) than RDD respondents (70.2%, 27.8%, and 21.8%, respectively). The CASPER survey cost less to conduct ($13 500) than the RDD survey ($100 000) and was logistically easier for the local health department to conduct using internally available resources. CONCLUSIONS: Local health departments use various data collection methods to conduct CHNAs for their populations and require varying levels of commitment and resources. RDD and CASPER can be used to meet ACA and PHAB requirements, collecting valuable health needs estimates and offer various strengths and weaknesses. PHAB and ACA requirements can be met using the CASPER or RDD survey to conduct CHNAs. However, local health departments may consider the CASPER survey a viable alternative to the RDD survey when time and resources are limited. The CASPER survey offers flexibility and efficiency and requires limited equipment and training.

A Case of Primary Amebic Meningoencephalitis Associated with Surfing at an Artificial Surf Venue: Environmental Investigation.

Naegleria fowleri is a thermophilic ameba found in freshwater that causes primary amebic meningoencephalitis (PAM) when it enters the nose and migrates to the brain. In September 2018, a 29-year-old man died of PAM after traveling to Texas. We conducted an epidemiologic and environmental investigation to identify the water exposure associated with this PAM case. The patient's most probable water exposure occurred while surfing in an artificial surf venue. The surf venue water was not filtered or recirculated; water disinfection and water quality testing were not documented. N. fowleri and thermophilic amebae were detected in recreational water and sediment samples throughout the facility. Codes and standards for treated recreational water venues open to the public could be developed to address these novel venues. Clinicians and public health officials should also consider novel recreational water venues as a potential exposure for this rare amebic infection.