The Relationships Between State Health Department Practitioners' Perceptions of Organizational Supports and Evidence-Based Decision-Making Skills.

OBJECTIVES: Evidence-based decision making (EBDM) allows public health practitioners to implement effective programs and policies fitting the preferences of their communities. To engage in EBDM, practitioners must have skills themselves, their agencies must engage in administrative evidence-based practices (A-EBPs), and leaders must encourage the use of EBDM. We conducted this longitudinal study to quantify perceptions of individual EBDM skills and A-EBPs, as well as the longitudinal associations between the 2. METHODS: An online survey completed among US state health department practitioners in 2016 and 2018 assessed perceptions of respondents' skills in EBDM and A-EBPs. We used χ2 tests, t tests, and linear regressions to quantify changes over time, differences by demographic characteristics, and longitudinal associations between individual skills and A-EBPs among respondents who completed both surveys (N = 336). RESULTS: Means of most individual EBDM skills and A-EBPs did not change significantly from 2016 to 2018. We found significant positive associations between changes in A-EBPs and changes in EBDM skill gaps: for example, a 1-point increase in the relationships and partnerships score was associated with a narrowing of the EBDM skill gap (ß estimate = 0.38; 95% CI, 0.15-0.61). At both time points, perceived skills and A-EBPs related to financial practices were low. CONCLUSIONS: Findings from this study can guide the development and dissemination of initiatives designed to simultaneously improve individual and organizational capacity for EBDM in public health settings. Future studies should focus on types of strategies most effective to build capacity in particular types of agencies and practitioners, to ultimately improve public health practice.

Evaluating Comprehensive State Tobacco Prevention and Control Programs Using an Outcome Indicator Framework.

The outcome indicator framework helps tobacco prevention and control programs (TCPs) plan and implement theory-driven evaluations of their efforts to reduce and prevent tobacco use. Tobacco use is the single-most preventable cause of morbidity and mortality in the United States. The implementation of public health best practices by comprehensive state TCPs has been shown to prevent the initiation of tobacco use, reduce tobacco use prevalence, and decrease tobacco-related health care expenditures. Achieving and sustaining program goals require TCPs to evaluate the effectiveness and impact of their programs. To guide evaluation efforts by TCPs, the Centers for Disease Control and Prevention's Office on Smoking and Health developed an outcome indicator framework that includes a high-level logic model and evidence-based outcome indicators for each tobacco prevention and control goal area. In this article, we describe how TCPs and other community organizations can use the outcome indicator framework in their evaluation efforts. We also discuss how the framework is used at the national level to unify tobacco prevention and control efforts across varying state contexts, identify promising practices, and expand the public health evidence base.

Self-reported Preparedness to Respond to Mass Fatality Incidents in 38 State Health Departments.

CONTEXT: Public health departments play an important role in the preparation and response to mass fatality incidents (MFIs). OBJECTIVE: To describe MFI response capabilities of US state health departments. DESIGN: The data are part of a multisector cross-sectional study aimed at 5 sectors that comprise the US mass fatality infrastructure. Data were collected over a 6-week period via a self-administered, anonymous Web-based survey. SETTING: In 2014, a link to the survey was distributed via e-mail to health departments in 50 states and the District of Columbia. PARTICIPANTS: State health department representatives responsible for their state's MFI plans. MEASURES: Preparedness was assessed using 3 newly developed metrics: organizational capabilities (n = 19 items); operational capabilities (n = 19 items); and resource-sharing capabilities (n = 13 items). RESULTS: Response rate was 75% (n = 38). Among 38 responses, 37 rated their workplace moderately or well prepared; 45% reported MFI training, but only 30% reported training on MFI with hazardous contaminants; 58% estimated high levels of staff willingness to respond, but that dropped to 40% if MFIs involved hazardous contaminants; and 84% reported a need for more training. On average, 76% of operational capabilities were present. Resource sharing was most prevalent with state Office of Emergency Management but less evident with faith-based organizations and agencies within the medical examiner sector. CONCLUSION: Overall response capability was adequate, with gaps found in capabilities where public health shares responsibility with other sectors. Collaborative training with other sectors is critical to ensure optimal response to future MFIs, but recent funding cuts in public health preparedness may adversely impact this critical preparedness element. In order for the sector to effectively meet its public health MFI responsibilities as delineated in the National Response Framework, resources to support training and other elements of preparedness must be maintained.

Data needs for policy research on state-level health insurance markets.

Private and public health insurance provision in the United States operates against a backdrop of 50 different regulatory environments in addition to federal rules. Through creative use of available data, a large body of research has contributed to our understanding of public policy in state health insurance markets. This research plays an important role as recent trends suggest states are taking the lead in health care reform. However, several important questions have not been answered due to lack of data. This paper identifies some of these areas, and discusses how the Agency for Healthcare Research and Quality could push the research agenda in state health insurance policy further by augmenting the market-level data available to researchers. As states consider new forms of regulation and assistance for their insurance markets, there is increased need for better warehousing and maintenance of policy databases.

The best practices: use of the guidelines by ten state tobacco control programs.

BACKGROUND: The Best Practices for Comprehensive Tobacco Control Programs by the Centers of Disease Control and Prevention was the first national resource to define the nine required components of a comprehensive state tobacco control program. This evaluation examined how states used the guidelines in their program planning, and identifies strengths and weaknesses of the guidelines. METHODS: During 2002-2003, data were collected and analyzed from ten state tobacco control programs on familiarity, funding, and use of the guidelines. Data were collected via written surveys and qualitative interviews with key tobacco control partners in the states. The typical number of participants interviewed was 17, representing an average of 15 agencies per state. RESULTS: Lead agencies and advisory agencies were the most familiar with the guidelines, while other state agencies were less aware of the guidelines. Participants' prioritization of the nine components was closely related to the lead agencies' estimated category expenditures. Three states modified the guidelines to develop more-tailored frameworks. Major strengths of the guidelines included providing a basic program framework and state-specific funding recommendations. The guidelines did not address implementation strategies or tobacco-related disparities, and had not been updated with current evidence-based research. CONCLUSIONS: The guidelines are important recommendations for state tobacco control programs. To continue to be useful to states, the guidelines need to be updated to address implementation and tobacco disparities, and include additional evidence-based examples. Active dissemination of updated guidelines needs to be increased beyond typical consumers to other tobacco control partners such as coalitions and other state agencies.

Validating California teachers study self-reports of recent hospitalization: comparison with California hospital discharge data.

Determining an accurate method of obtaining complete morbidity data is a long-standing challenge for epidemiologists. The authors compared the accuracy and completeness of existing California hospital discharge data with self-reports of recent hospitalizations and surgeries from participants in the California Teachers Study. Self-reports were collected by questionnaire in 1997 from 91433 female teachers and administrators residing in California. Of the 13430 hospital discharge diagnoses identified for these women, cohort members reported 58%. Self-reporting was highest for neoplasms and musculoskeletal and connective tissue diseases and was most accurate for scheduled admissions, more recent admissions, longer lengths of stay, and less severe disorders. Hospitalizations for mental health and infectious disease were not as well reported. Among the 26383 self-reports-including outpatient surgeries, which are not captured by the hospital discharge database-confirmation was lower, as expected, especially for disorders of the nervous system and sense organs and skin and subcutaneous tissue. Confirmation was highest for childbirth admissions. The hospital discharge database was more specific, but the self-reports were more comprehensive, since many conditions are now treated in outpatient settings. The combination of self-reports and secondary medical records provides more accurate and complete morbidity data than does use of either source alone.

Treatment of latent tuberculosis infection in contacts of new tuberculosis cases in the United States.

BACKGROUND: Few data are available describing treatment completion rates among recently infected contacts of tuberculosis (TB) cases, a group at high risk for development of active TB. METHODS: Health department records were reviewed for all contacts of 360 culture-positive pulmonary TB cases reported from five health departments in the United States in 1996. RESULTS: Of 2,267 contacts who completed screening, 630 (28%) had newly documented positive skin tests (121 with skin test conversion). Treatment of latent TB infection was documented to have been recommended for 447 (71%). Among these, treatment was documented to be initiated for 398 (89%). Of these, 203 (51%) were documented to have completed a 6-month course of treatment, and 78 (20%) received directly observed treatment. Treatment was recommended more often for contacts < 15 years of age, skin test converters, close contacts, and contacts of smear-positive cases. Treatment completion rates were higher for skin test converters. CONCLUSIONS: In this study, fewer than one third of all persons with newly documented positive skin tests detected during contact investigations were proven to have completed treatment. Achieving high rates of completion of therapy for latent TB infection in recently infected contacts of active cases of pulmonary TB is essential to maximize public health prevention efforts aimed at eliminating TB.